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本帖最后由 StephenW 于 2011-4-7 11:45 编辑
<http://onlinelibrary.wiley.com/doi/10.1111/j.1478-3231.2011.02491.x/abstract>
Evaluation of normal or minimally elevated alanine transaminase, age and DNA
level in predicting liver histological changes in chronic hepatitis B
Shahinul Alam, Nooruddin Ahmad, Golam Mustafa, Ananta Shrestha, AKM Khorshed
Alam, Mobin Khan
Article first published online: 6 MAR 2011
DOI: 10.1111/j.1478-3231.2011.02491.x
© 2011 John Wiley & Sons A/S
Issue
Liver International
Early View (Articles online in advance of print)
Abstract
Background: Serum alanine transaminase (ALT), hepatitis B virus (HBV) DNA level
and age are used in the evaluation of chronic hepatitis B (CHB).
Aim: We designed this study to evaluate liver histology with ALT and its
relation with age and HBV DNA.
Methods: During the period of October 2006 to July 2009, 499 CHB patients were
included in this study with detectable HBV DNA at PCR. Of these, 181 had normal
ALT, 200 had ALT [>(1 × ULN) <(2 ULN)] and 118 had ALT≥2 ULN and were
labelled as Group 1, 2 and 3 respectively.
Results: A strong positive correlation was found between ALT and histological
activity index (HAI) and fibrosis. However, 29 (52.7%) and five (9.1%) in Group
1 with positive HBeAg status had HAI ≥4 and fibrosis ≥2 respectively. Among
those with HBeAg-negative status, 66 (23.1%) had HAI >4 and 31 (10.8%) had
fibrosis ≥2. In Group 2, 14 (15.7%) had moderate-to-severe HAI and 19 (21.2%)
had fibrosis ≥2 when HBeAg was positive, in those with HBeAg negative 34
(30.6%) had moderate-to-severe HAI and 38 (34.2%) had fibrosis ≥2. An ALT
value of ≥58.5 U/l had higher sensitivity than that of 80 U/l in predicting
significant histological changes. Further, HAI and fibrosis were significantly
greater in the age of >30 years.
Conclusions: We recommend liver biopsy in HBeAg-negative CHB over 30 years of
age regardless of ALT level and starting treatment at ALT 1.5 × ULN instead of
2 × ULN. |
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