病毒载量预测拥有长期血清转氨酶正常HbeAg阴性患者

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【文摘翻译】病毒载量是一个长期预测拥有长期血清转氨酶正常HbeAg阴性患者的因素
Viral level is an indicator of long-term outcome of
hepatitis B virus e antigen-negative carriers with persistently normal serum alanine aminotransferase levels.
Nakazawa T, Shibuya A, Takeuchi A, Shibata Y, Hidaka H,
Okuwaki Y, Takada
J, Tanaka Y, Watanabe M, Minamino T, Sakurai K, Koizumi W.
Source
Department of Gastroenterology, Kitasato University East
Hospital,
Sagamihara Nakazawa Medical Clinic, Sagamihara Department
of Clinical
Laboratory, Kitasato University East Hospital, Sagamihara,
Japan.
Abstract
Summary. The association between viral level and the long-term outcomes of hepatitis B virus (HBV) carriers who test negative for hepatitis B virus e antigen (HBeAg) but have persistently normal serum alanine aminotransferase levels (PNALT) remains unclear. We examined hepatocarcinogenesis, hepatitis reactivation, predictive factors and the time course of HBV DNA levels during follow-up in 104 HBeAg-negative Japanese carriers with PNALT. During a mean follow-up period of 6.4 ± 3.4 years, 5 patients (4.8%) had hepatocarcinogenesis and 14 (13.5%) had hepatitis reactivation. At 5 and 10 years, the cumulative rates of hepatocarcinogenesis were 2.4% and 9.9%, while those of hepatitis activation were 13.7% and 15.5%, respectively. An HBV DNA level of ≥5 log10 copies/mL was the sole predictor of hepatocarcinogenesis with a univariate analysis. An HBV DNA level of ≥5 log10 copies/mL and an alanine aminotransferase (ALT) level of >20 to ≤40 IU/L were independent predictors of hepatitis reactivation in a Cox model. Because there was no association between hepatocarcinogenesis and ALT activity, the HBV DNA level was considered an essential predictor. In addition, the baseline HBV DNA level was related to the future level and was not subject to wide fluctuations. Our results showed that an HBV DNA level of ≥5 log10 copies/mL predicts subsequent hepatocarcinogenesis and hepatitis reactivation in HBeAg-negative carriers with PNALT. As the baseline HBV DNA level reflects the future level, appropriate clinical management according to the viral level is expected to decrease future risk.
病毒的载量和长期的乙型肝炎病毒e抗原（HBeAg）阴性的乙型肝炎病毒（HBV）携带者有长期的正常的血清转氨酶水平之间的关系还不清楚。我们研究随访了104例HBeAg阴性转氨酶长期正常的日本患者，来观察肝癌，肝炎再次激活，预测因子和HBV DNA的日常水平。在平均随访6.4 ± 3.4年后，其中5例（4.8％）发生肝癌，14（13.5％）例有肝炎重新激活。在第5年和10年，肝癌的累积率分别为2.4％和9.9％，而肝炎激活率分别为13.7％和15.5％。 ≥5 log10拷贝/毫升HBV DNA的水平是肝癌发生的一个单因素分析的唯一指标。在Cox模型中，HBV DNA≥5 log10拷贝/毫升和丙氨酸转氨酶（ALT）> 20≤40 IU / L是肝炎活化的独立预测因素。因为肝癌和ALT活性之间没有关联，HBV DNA水平被认为是必不可少的预测因素。此外，基线HBV DNA水平关系到未来的水平，而且没有受到大的波动。我们的研究结果表明，对长期转氨酶正常的 HBeAg阴性乙肝携带者 ≥5 log10拷贝/ mL的HBV DNA水平可以预测后期的肝癌发生和乙肝重新激活。由于基线的HBV DNA水平反映了未来的水平，适当的根据病毒水平临床管理有望降低未来的风险。





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Thanks for sharing.
J ViralHepat. 2011 Jul;18(7):e191-9. doi: 10.1111/j.1365-2893.2010.01427.x. Epub 2011 Jan 11
.
应该算新的文章。不过，重视HBVDNA 观点不是已经被广泛接受了吗？新发现在那里。

关于ALT与肝癌不相关的观点，我不是很理解。ALT不正常表明有肝损害，肝脏长期受损，难道没有影响吗？


对于HBVDNA低水平（~3log10)但ALT不正常的肝炎患者，学界是否有讨论？