患病率和血清转氨酶水平与慢性乙肝病毒感染者的人口为基

StephenW

Research Article
Prevalence and causes of elevated serum aminotransferase levels in a population-based cohort of persons with chronic hepatitis B virus infection

    Philip R. Spradling1, , ,
    Lisa Bulkow2,
    Eyasu H. Teshale1,
    Susan Negus3,
    Chriss Homan3,
    Brenna Simons3,
    Brian J. McMahon2, 3

    1 Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
    2 Arctic Investigations Program, Division of Preparedness and Emerging Infectious Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Anchorage, AK, United States
    3 Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AK, United States

    Received 20 November 2013, Revised 14 May 2014, Accepted 30 May 2014, Available online 6 June 2014


Background & Aims

Information delineating the possible causes for elevated serum aminotransferase activity among persons with chronic hepatitis B virus (HBV) infection is limited.
Methods

We analysed data collected from a population-based cohort of persons with chronic HBV infection followed from 2001 to 2010 to determine the frequency and causes of elevated aminotransferase activity. Any elevation concurrent with an HBV DNA level ⩾2000 IU/ml was attributed to immune active hepatitis B. Participant medical charts were reviewed by expert clinical staff to determine the presence of additional or alternative attributable causes. For each participant, a serum aminotransferase elevation could be attributed to more than one cause.
Results

Among 1090 persons with chronic HBV infection, the mean follow-up was 7.7 years and the median age in 2001 was 39 (range 19–96) years; 634 (58.2%) had ⩾1 elevated aminotransferase level during follow-up and 438 (69.1%) of persons with ⩾1 elevation had at least one cause assigned for the elevation. The most common causes of aminotransferase elevations were immune active hepatitis B (48.4%), alcohol consumption (30.8%), and non-alcoholic fatty liver disease (NAFLD) (24.7%). Among participants with HBV DNA levels persistently less than 2000 IU/ml, the most common causes were NAFLD or alcohol consumption.
Conclusions

In this population-based cohort of persons with chronic HBV infection, the prevalence of elevated aminotransferase activity was high and attributable to immune active chronic hepatitis B in approximately half of the cases; however, NAFLD or alcohol consumption were also common causes for enzyme elevations. These findings underscore the importance of monitoring HBV DNA levels, in addition to aminotransferase activity, among persons with chronic HBV infection so that appropriate interventions, including antiviral therapy, are utilised.
Abbreviations

    HBV, hepatitis B virus;
    DNA, deoxyribonucleic acid;
    NAFLD, non-alcoholic fatty liver disease;
    ALT, alanine aminotransferase;
    AST, aspartate aminotransferase;
    HCV, hepatitis C virus;
    HDV, hepatitis D virus;
    NHANES, National Health and Nutrition Examination Survey;
    ANTHC, Alaska Native Tribal Health Consortium;
    HBsAg, hepatitis B surface antigen;
    HBeAg, hepatitis B “e” antigen;
    Anti-HBe, antibody to hepatitis B “e” antigen;
    IgG, immunoglobulin G;
    BMI, body mass index;
    HIV, human immunodeficiency virus;
    RNA, ribonucleic acid;
    HAI, hepatic activity index

Keywords

    Hepatitis B;
    Aminotransferase levels;
    Immune active disease;
    Non-alcoholic fatty liver disease

StephenW

研究论文
患病率和血清转氨酶水平与慢性乙肝病毒感染者的人口为基础的队列原因

    菲利普河Spradling1，，，
    丽莎Bulkow2，
    Eyasu H. Teshale1，
    苏珊Negus3，
    Chriss Homan3，
    Brenna Simons3，
    布莱恩·J·McMahon2，3

    1部病毒性肝炎，国家中心的艾滋病毒/艾滋病，病毒性肝炎，性病和结核病预防，疾病控制中心和预防中心（CDC），亚特兰大，乔治亚州，美国
    2北极调查计划，准备和新发传染性疾病国家中心新发现及动物传染病，美国疾病控制和预防中心（CDC），锚固，阿拉斯加，美国科
    3肝脏疾病和肝炎项目，阿拉斯加原住民部落健康协会，安克雷奇，阿拉斯加，美国

    收到二○一三年十一月二十○日，修订2014年5月14日，2014年接受5月30日，可在线2014年6月6日


背景与目的

信息划定可能的原因血清转氨酶活性与慢性B型肝炎病毒的人当中（HBV）感染是有限的。
方法

我们分析了从后面二○○一年至2010年确定的频率和转氨酶活性的原因慢性HBV感染者的人口为基础的队列研究收集的数据。任何高度并行与HBV DNA载量⩾2000IU/ ml的是由于免疫活性B型肝炎参与者病历是由专业的医务人员审阅，以确定额外或替代归属原因的存在。每名参加者，血清转氨酶升高可能是由于多个原因。
结果

其中1090人患有慢性HBV感染者，平均随访7.7年，年龄中位数在2001年为39（范围19-96岁）;期间至少有一个原因分配的高度与⩾1抬高人的随访，438（69.1％），634例（58.2％）有⩾1转氨酶水平。转氨酶升高的最常见原因是免疫活性B型肝炎（48.4％），饮酒（30.8％），以及非酒精性脂肪肝病（NAFLD）（24.7％）。其中的参与者有HBV DNA水平持续高于2000 IU/ ml的少，最常见的原因是脂肪肝和酒精消费。
结论

在这个人口为基础的慢性HBV感染者队列，转氨酶活性的患病率很高，归因于免疫活动性慢性乙型肝炎约一半的病例;但是，脂肪肝，酒精消耗也是常见的原因酶升高。这些研究结果强调监测HBV DNA水平，除了转氨酶活性，慢性HBV感染者中，以便进行适当的干预措施，包括抗病毒药物治疗，被利用的重要性。
缩略语

    乙肝病毒，乙型肝炎病毒;
    DNA，脱氧核糖核酸;
    脂肪肝，非酒精性脂肪性肝病;
    ALT，丙氨酸氨基转移酶;
    AST，天冬氨酸转氨酶;
    丙型肝炎病毒，丙型肝炎病毒;
    HDV，丁型肝炎病毒;
    NHANES，全国健康和营养调查;
    ANTHC，阿拉斯加原住民部落健康协会;
    乙肝表面抗原，乙肝表面抗原;
    大三阳，乙肝的“e”抗原;
    抗HBe，抗乙肝“e”的抗原;
    IgG抗体，免疫球蛋白G;
    身体质量指数，体重指数;
    艾滋病毒，人类免疫缺陷病毒;
    核糖核酸，核糖核酸;
    海，肝活动指数

关键词

    乙型肝炎;
    转氨酶水平;
    免疫活动性病变;
    非酒精性脂肪肝疾病