A Large Population Histology Study Showing the Lack of Association between ALT E

StephenW

PLoS One. 2012;7(2):e32622. Epub  2012 Feb 28.
A Large Population Histology Study Showing the Lack of Association between ALT Elevation and Significant Fibrosis in Chronic Hepatitis B.Seto WK, Lai CL, Ip PP, Fung J, Wong DK, Yuen JC, Hung IF, Yuen MF.
SourceDepartment of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.

AbstractOBJECTIVE: We determined the association between various clinical parameters and significant liver injury in both hepatitis B e antigen (HBeAg)-positive and HBeAg-negative patients.
METHODS: From 1994 to 2008, liver biopsy was performed on 319 treatment-naïve CHB patients. Histologic assessment was based on the Knodell histologic activity index for necroinflammation and the Ishak fibrosis staging for fibrosis.
RESULTS: 211 HBeAg-positive and 108 HBeAg-negative patients were recruited, with a median age of 31 and 46 years respectively. 9 out of 40 (22.5%) HBeAg-positive patients with normal ALT had significant histologic abnormalities (necroinflammation grading ≥7 or fibrosis score ≥3). There was a significant difference in fibrosis scores among HBeAg-positive patients with an ALT level within the Prati criteria (30 U/L for men, 19 U/L for women) and patients with a normal ALT but exceeding the Prati criteria (p = 0.024). Age, aspartate aminotransferase and platelet count were independent predictors of significant fibrosis in HBeAg-positive patients with an elevated ALT by multivariate analysis (p = 0.007, 0.047 and 0.045 respectively). HBV DNA and platelet count were predictors of significant fibrosis in HBeAg-negative disease (p = 0.020 and 0.015 respectively). An elevated ALT was not predictive of significant fibrosis for HBeAg-positive (p = 0.345) and -negative (p = 0.544) disease. There was no significant difference in fibrosis staging among ALT 1-2×upper limit of normal (ULN) and >×2 ULN for both HBeAg-positive (p = 0.098) and -negative (p = 0.838) disease.
CONCLUSION: An elevated ALT does not accurately predict significant liver injury. Decisions on commencing antiviral therapy should not be heavily based on a particular ALT threshold.

StephenW

公共科学图书馆之一。 2012年7（2）：e32622。出处2012年02月28日。
一个人口众多的组织学研究显示协会之间缺乏ALT升高，并显着肝纤维化，慢性乙型肝炎
濑户星期，赖发光，IP PP，凤黄的DK，J，元朗金城，洪IF，元朗MF。
源

，香港玛丽医院，香港大学医学系。
抽象
目的：

我们确定了各种临床参数和显着的肝损伤在B型肝炎e抗原（HBeAg阳性）阳性和HBeAg阴性患者之间的关系。
方法：

从1994年到2008年，319治疗初治慢性乙肝患者进行肝活检。组织学评估是根据Knodell组织学活动指数为坏死性炎症和Ishak纤维化肝纤维化分期。
结果：

招募211 HBeAg阳性和108例HBeAg阴性患者，年龄中位数为31个和46岁。 9 ALT正常的HBeAg阳性患者40例（22.5％）有显着性（坏死性炎症分级≥7或纤维化评分≥3）病理异常。内的普拉蒂标准（30 U / L，男性，19 U / L，为妇女），与ALT正常的患者ALT水平与HBeAg阳性患者纤维化评分之间有一个显着性差异，但超过普拉蒂标准（P = 0.024）。年龄，谷草转氨酶和血小板计数均在HBeAg阳性患者显着纤维化的独立预测因素多元分析ALT升高（P = 0.007，0.047和0.045分别）。 HBV DNA和HBeAg阴性的疾病（P = 0.020和0.015分别）血小板计数显着纤维化的预测。 ALT升高，HBeAg阳性（P = 0.345）和阴性（P = 0.544），疾病的预测显着纤维化。有纤维化分期无显着差异ALT键1-2×正常值上限（ULN）>×2 ULN的HBeAg阳性（P = 0.098）和阴性（P = 0.838），疾病。
结论：

一个ALT升高不准确的预测显着的肝损伤。开始抗病毒治疗的决定，不应大量基于一个特定的ALT门槛。