ALT持续正常的HBeAg阴性患者肝组织学显著病变的发生率不高

StephenW

ALT持续正常的HBeAg阴性患者肝组织学显著病变的发生率不高            

-----Prevalence of Significant Liver Disease Is Low in HBeAg (-) Chronic HBV Infection with Persistently Normal ALT

            

来源： 作者：国际肝病 发布时间：2012-6-12 14:28:56   阅读：12

                         　　ALT持续正常的HBeAg阴性患者肝内是否存在显著病变？这类患者是否需要进行肝活检或接受治疗？
                                               
                                                                                                             　　ALT持续正常的HBeAg阴性患者肝内是否存在显著病变？这类患者是否需要进行肝活检或接受治疗？
　　希腊雅典大学医学院Papatheodoridis等系统性回顾了当前所能收集到的ALT持续正常的HBeAg阴性患者的组织学数据，发现HBV DNA<20 000 IU/mL的HBeAg阴性患者如果ALT水平满足严格定义的“持续正常”——如6~12个月内3次不定期检测ALT正常，或12个月内定期3次检测ALT正常，则其肝内很少发生显著的组织学病变。
　　在满足入选标准的335例患者中，仅在10%的患者中观察到轻微及以上级别的坏死性炎症（通常为轻度），在8%的患者中观察到轻度及以上级别的肝纤维化；在HBV DNA<20 000 IU/mL的患者中，显著性肝脏病变的发生率更低，分别只有3%和5%。这类患者可被认为是非活动携带者，既不需要肝活检，也不需要立刻治疗，但应持续随访。

　　J Hepatol. 2012 Mar，在线发表.

StephenW

Follow-up and indications for liver biopsy in HBeAg-negative chronic hepatitis B virus infection with persistently normal ALT: A systematic review

• George V. Papatheodoridis
  ,
• Spilios Manolakopoulos
  ,
• Yun-Fan Liaw
  ,
• Anna Lok
  

Received 22 July 2011; received in revised form 24 November 2011; accepted 30 November 2011.  published online 26 March 2012.
Corrected Proof

Background & AimsThe adequacy of monitoring HBeAg-negative patients based on ALT activity is controversial and current guidelines favor liver biopsy in HBeAg-negative cases with normal ALT and HBV DNA>2000IU/ml. We systematically reviewed all the available histological data on HBeAg-negative patients with persistently normal ALT (PNALT) to determine the prevalence of significant liver disease and its associating factors.
MethodsLiterature search to identify studies with adult HBeAg-negative patients who had PNALT as defined by the authors, a minimum follow-up of 1 year and histological data. Traditional cut-off values of normal ALT were used in all studies. The definitions of PNALT were considered as acceptable or good if there were 3 ALT determinations at unspecified intervals during 6–12months or predefined intervals during 12-month periods, respectively.
ResultsSix studies including 335 patients met our inclusion criteria. Of these, four studies with 246 patients had good or acceptable definitions of PNALT. In the latter four studies, more than minimal (usually mild) necro-inflammatory activity was observed in 10% and more than mild fibrosis in 8% of all patients (moderate fibrosis: 7%, severe fibrosis: 1%, cirrhosis: 0%), and in 3% and 5% of patients with HBV DNA ⩽20,000IU/ml, respectively.
ConclusionsHistologically significant liver disease is rare in HBeAg-negative patients with PNALT based on stringent criteria and serum HBV DNA ⩽20,000IU/ml. Such cases can be considered as true inactive HBV carriers, who require neither liver biopsy nor immediate therapy but continued follow-up.

咬牙硬挺

肝功正常e抗原正常还不够必须病毒量不可测才比较安全。很多硬化都是肝功正常的小三阳患者

恰饭了某

咬牙硬挺 发表于 2012-6-13 07:39
肝功正常e抗原正常还不够必须病毒量不可测才比较安全。很多硬化都是肝功正常的小三阳患者 ...

是啊 ，为此前几天我刚去做了肝活检

chongxinfei

那这样的情况呢？肝功只有胆红素高出几个，而且经常存在，病毒阴，E抗原目前阳，硬化的概率怎么样，目前在抗病毒了。

StephenW

回复 咬牙硬挺 的帖子


这项研究应用于HBeAg阴性 - 肝功正常和HBVDNA<20000 IU /毫升.

"很多硬化都是肝功正常的小三阳患" - 我认为这是因为小三阳患者年龄较大, 慢性肝炎有很长一段时间.

咬牙硬挺

有时候小三阳肝炎表现为肝功在正常值的上限附近，很多人忽视了，久而久之就硬了

chongxinfei

回复 chongxinfei 的帖子

我是抗了之后转阴的

MP4

chongxinfei 发表于 2012-6-14 09:47
回复 chongxinfei 的帖子

我是抗了之后转阴的

要继续抗

王震宇

就这破水平，也别说，也就只能达到这水平了