Serial HBV DNA levels in patients with persistently normal transaminase over 10

StephenW

<http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2893.2011.01450.x/abstract>

Serial HBV DNA levels in patients with persistently normal transaminase over 10
years following spontaneous HBeAg seroconversion

Y.-C. Chen1, S.-F. Huang2, C.-M. Chu1, Y.-F. Liaw1

Article first published online: 14 MAR 2011

DOI: 10.1111/j.1365-2893.2011.01450.x
© 2011 Blackwell Publishing Ltd
Issue

Journal of Viral Hepatitis
Early View (Articles online in advance of print)

Summary.  Earlier studies addressing the hepatitis B virus (HBV) DNA cut-off
level for inactive chronic HBV infection largely involved patients with normal
alanine aminotransferase (ALT) for only 1–2 years and based on a single time
HBV DNA assay. This study was conducted to address this issue using serial HBV
DNA assays in patients with persistently normal ALT (PNALT) over 10 years
following spontaneous hepatitis B e antigen (HBeAg) seroconversion. Serial serum
specimens (mean 9 samples per patient) of 62 patients with PNALT and no disease
progression over 10 years (median 18.1 years) after spontaneous HBeAg
seroconversion were assayed for HBV DNA. Excluding assays within 1 year after
HBeAg seroconversion, 21% and 82.3% of the patients with PNALT had HBV DNA
levels persistently lower than 4 log10 and 5 log10 copies/mL, respectively, and
only 8% had a level ≥5 log10 copies/mL in at least two assays. Of the 27
patients with PNALT defined by ALT <30 U/L for male and <19 U/L for female, only
33% had serum HBV DNA level persistently <4 log10 copies/mL. There was no
significant difference in the serial HBV DNA changes among patients with
different gender, HBV genotype or age at HBeAg seroconversion. Liver biopsy in
nine patients invariably showed minimal necroinflammation and one showed Ishak
fibrosis score 4. These results suggest that 5 log10 copies/mL (20 000 IU/mL) is
a more appropriate cut-off HBV DNA level for inactive chronic HBV infection in
the setting of PNALT.

StephenW

串行HBV DNA水平与患者转氨酶持续正常超过10
年以下自发性HBeAg血清转换

Y.-C. Chen1，S.-F.的黄，C.-M. Chu1，Y.-F. Liaw1

文章首先在网上公布：二〇一一年三月十四日

分类号：10.1111/j.1365-2893.2011.01450.x
©2011布莱克韦尔出版有限公司
发行

作者：病毒性肝炎
厄尔利维尤（第预先在网上打印）

综述。此前研究解决乙型肝炎病毒（HBV）的DNA切断
慢性乙肝病毒感染的活跃程度在很大程度上参与了正常患者
谷丙转氨酶（ALT）只有1-2年，基于一个单一的时间
乙肝病毒DNA检测。这项研究是解决这一问题采用串行乙肝病毒
与患者DNA检测ALT持续正常（PNALT）10年以上
下面自发B型肝炎e抗原（HBeAg）血清转换。串行血清
标本（平均每位患者9个样品）与PNALT没有疾病62例
10年后进展自发性HbeAg（中位数18.1岁）
分别测定血清乙肝病毒的DNA。不包括化验后一年内
HBeAg血清转换，21％和82.3％的患者与PNALT有乙型肝炎病毒DNA
水平持续低于4 log10和5 log10拷贝/毫升，分别与
只有8％的水平≥5 log10拷贝/至少在两个实验毫升。在27
定义为男性和“<19单位/ L的ALT键“30单位/ L的女性，PNALT患者中，只有
33％的血清乙肝病毒DNA水平持续<4 log10拷贝/毫升。没有
显着差异，在患者血清HBV DNA序列的变化
不同性别，年龄，乙肝病毒的基因型或HBeAg血清转换。肝活检
九位病人都表明，一个最小的坏死性炎症表现伊沙克
纤维化评分4。这些结果表明，5 log10拷贝/毫升（20000国际单位/毫升）是
更合适的截止乙肝病毒DNA水平对慢性乙肝病毒感染无效
对PNALT设置。

lin12345

kennyu

回复 StephenW 的帖子

这个文章怎么理解？我还是不太明白文章的意思？为啥女性的PNALT会和男性不一致呢？

StephenW

kennyu 发表于 2011-3-18 13:03
回复 StephenW 的帖子

这个文章怎么理解？我还是不太明白文章的意思？为啥女性的PNALT会和男性不一致呢？

谢谢你，记住我不是专家.

正常ALT是大量人的ALT 的平均( normal ALT is determined by taking the average of the ALTs of a large number of people).
因此，中国人正常的ALT 可不同美国人正常的ALT (therefore in theory, the average Chinese average ALT can be different to the average of American ALTs).
因此，在医学文献，他们喜欢用正常值上限(UNL), 不使用数量(therefore, in medical literature, they like to use the term UNL upper limit, and not an absolute number).
在过去，正常值上限(UNL)为40，但最近，他们才意识到应该采取无肝脏疾病的人的平均, 因此，现在是(男)30 (In the past, UNL is 40, but recently, they realise they should take the average of people with no liver disease therefore it is now 30 for men).
男性和女性的平均水平是不同的 (males and females have different average ALTs).
男UNL是30，女UNL是19.

整体而言，B型肝炎女比男良性 (on the whole, Hepatitis B is more benign for females than males)

StephenW

回复 kennyu 的帖子

这个文章怎么理解？

a) "自发B型肝炎e抗原（HBeAg）血清转换" - 没有任何医疗,HBeAg +ve  --> HBeAg -ve,

和b)10年来, ALT持续正常 (PNALT),
和c)超过10年没有疾病进展,

这些患者, 他们的HBVDNA <=5 log10拷贝/毫升（20000国际单位/毫升).

因此, HBVDNA <=5log10拷贝/毫升,对这些患者 , 可能指示不活跃乙肝.

(my interpretation我的理解)

kennyu

回复 StephenW 的帖子

这个理解我认同，谢谢