Roxanne Nelson, BSN, RN
April 23, 2018
Metabolic Syndrome Associated With Higher ALT Levels in Chronic Hepatitis B
About 1 in 4 people with chronic hepatitis B (HBV) infection who reside in North America have metabolic syndrome, which was also independently associated with higher alanine aminotransferase (ALT) levels over time, according to a new study published in Diabetes Care.
Metabolic syndrome is a risk factor for chronic liver disease progression, and aside from being directly associated with nonalcoholic fatty liver disease, metabolic syndrome could influence outcomes in other chronic liver diseases.
In this study, the prevalence of metabolic syndrome and its association with ALT levels and fibrosis was examined in a large cohort of 777 North American individuals with chronic HBV infection. Median follow-up was 3.7 years, and within this group, 171 individuals (22%) had metabolic syndrome.
There was a significantly lower prevalence of hepatitis B e antigen in patients with metabolic syndrome (14.2% vs 30.3%; P =.0002) and lower HBV DNA levels (median log10 value 3.23 vs 3.96; P <.0001) vs patients without. The investigators note that this observation was probably due to the older age and longer duration of HBV infection in patients with metabolic syndrome.
Adjusted multivariable analysis of serial ALT values showed that ALT was significantly higher in people with metabolic syndrome at baseline (mean 12%; P =.02) and even higher in people with persistent metabolic syndrome (mean 19%; P =.003). Liver biopsy results (n=77) showed that higher grades of steatosis and higher scores for perisinusoidal fibrosis in patients with metabolic syndrome and they were more likely have definite steatohepatitis (30% vs 2%).
“While absolute increases in ALT values were modest, they may be of clinical consequence in persons with ALT values at or near the threshold for consideration of antiviral therapy,” conclude the investigators.
Reference
Khalili M, Shuhart MC, Lombardero M, et al; Hepatitis B Research Network (HBRN). Relationship between metabolic syndrome, alanine aminotransferase levels, and liver disease severity in a multiethnic North American cohort with chronic hepatitis B [published online March 29, 2018]. Diabetes Care. doi:10.2337/dc18-0040
代谢综合征患者中乙型肝炎e抗原的患病率显着降低（14.2％比30.3％; P = 0.0002），HBV DNA水平降低（中位log10值3.23比3.96; P <0.0001）。研究人员指出，这种观察可能是由于代谢综合征患者年龄较大和HBV感染持续时间较长。
调整后的连续ALT值的多变量分析显示，代谢综合征患者基线ALT水平显着高于平均12％; P = .02），持续代谢综合征患者的平均ALT水平更高（平均19％; P = .003）。肝活组织检查结果（n = 77）显示，代谢综合征患者的脂肪变性等级较高，并且核周窦纤维化评分较高，他们更可能有明确的脂肪性肝炎（30％vs 2％）。