THU-234
High body-mass index is associated with increased risk of alanine
aminotransferase elevation and hepatocellular carcinoma in
chronic hepatitis B patients with sustained viral control
Jian Sun1, Weiyin Lin2, Kaifeng Wang2, Rong Fan2, Xieer Liang2,
Jie Peng2, Yabing Guo2, Jinjun Chen2, Zhihong Liu2, Xiaoyun Hu2,
Jinlin Hou3. 1State Key Laboratory of Organ Failure Research, Guangdong
Provincial Key Laboratory of Viral Hepatitis Research, Department of
Infectious Diseases, Nanfang Hospital, Southern Medical University,
Guangzhou, China; 2Nanfang Hospital, Southern Medical University,
Department of Infectious Diseases, Guangzhou, China; 3Department of
Infectious Diseases, Nanfang Hospital, Southern Medical University,
Guangzhou, China
Email: [email protected]
Background and aims: Alanine aminotransferase (ALT) is a marker of
liver damage that results from a range of etiologies. This study
investigated whether high body-mass index (BMI) contributes to the
risk of ALT elevation and hepatocellular carcinoma (HCC) in chronic
hepatitis B (CHB) patients who achieved sustained viral control with
antiviral treatment.
Method: Thiswas a real-life, prospective cohort study which enrolled
CHB patients receiving nucleos (t)ide analogues (NAs) treatment with
sustained HBV DNA suppression (defined as HBV DNA undetectable
on two consecutive visits 6 months apart). At study enrollment,
logistic regression model was used to evaluate the association
between high BMI (defined as BMI ≥ 25 kg/m2) and the risk of ALT
elevation (defined as ALT > 35 U/L in males and >25 U/L in females).
Cox regression model was used to investigate the association
between high BMI and the risk of HCC during follow-up. The
impact of high BMI plus ALT elevation on the risk of HCC was also
evaluated.
Results: A total of 2, 085 patients with sustained HBV DNA
suppression were identified. At baseline, 494 (23.7%) patients had
high BMI, the median ALT level was 23 U/L and ALT elevation was
observed in 409 (19.6%) of patients. During a median follow-up of
2.27 years, 2011 patients finished at least two assessments of ALT, 578
(28.7%) patients had transient elevation of ALT (defined as ≥1
elevated ALT but some normal) and 139 (6.9%) patients had persistent
elevation of ALT, 28 patients developed HCC with 3 years cumulative
incidence of 1.85%. High BMI at baseline was associated with an
increased risk of transient and persistent elevation of ALT (p < 0.001).
The patients with high BMI at baseline had an increased risk of HCC,
after adjustment by ALT, cirrhosis, age and sex [adjusted hazard ratio
(aHR) and 95% CI: 2.40 (1.14-5.07), p = 0.021]. Compared to patients
with BMI < 25 kg/m2 and normal ALT at baseline, patients with BMI
≥25 kg/m2 and ALTelevationwere at the highest risk of HCC [aHR and
95% CI: 5.25 (1.87-14.73), p < 0.001].
Conclusion: High BMI is significantly associated with an increased
risk of AST elevation and HCC in CHB patients receiving NAs treatment
with sustained viral control. 作者: StephenW 时间: 2019-4-7 12:37