重大纤维化是在中国持续ALT正常的慢性乙型肝炎患者并不少

StephenW

PLoS One. 2013 Oct 25;8(10):e78672. doi: 10.1371/journal.pone.0078672.
Significant Fibrosis Is Not Rare in Chinese Chronic Hepatitis B Patients with Persistent Normal ALT.
Liao B, Wang Z, Lin S, Xu Y, Yi J, Xu M, Huang Z, Zhou Y, Zhang F, Hou J.
Source

Hepatology Unit and Key Lab for Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China ; Department of Hepatology, Guangzhou No.8 People's Hospital, Guangzhou Medical University, Guangzhou, China.
Abstract
BACKGROUND:

Limited studies have been done on chronic hepatitis B (CHB) patients defined according to the latest Asian-Pacific Association for the Study of the Liver guideline with liver histology by a large sample size.
METHODS:

We retrospectively evaluated liver histological characteristics on a cohort of consecutive treatment-naive CHB patients with persistent normal alanine aminotransferase (PNALT) or elevated ALT from May 2005 to October 2011. Histological assessment was based on the Metavir scoring system, significant abnormality was defined as necroinflammation grade ≥A2 and/or fibrosis stage ≥F2.
RESULTS:

A total of 675 CHB patients were recruited, including 516 HBeAg-positive and 159 HBeAg-negative patients. In HBeAg-positive patients, significant fibrosis was found 49.4% (42/85) in PNALT, 69.8% (88/126) in ALT 1-2×upper limit normal (ULN) and 81.6% (249/305) in ALT>2×ULN group, respectively. In HBeAg-negative patients, significant fibrosis was found 30.9% (17/55) in PNALT, 73.3% (33/45) in ALT 1-2×ULN and 94.9% (56/59) in ALT>2×ULN group, respectively. HBeAg-positive patients with PNALT over 30 years old had a higher frequency of significant fibrosis than those under 30 years old (87.5% vs. 45.5%, P = 0.058). Multivariate logistic regression analysis indicated increasing age (P = 0.012), higher aspartate aminotransferase (AST) (P < 0.001) and lower HBV DNA (P < 0.001) were associated with significant necroinflammation, while higher AST (P < 0.001), lower albumin (P = 0.027) and HBV DNA (P = 0.004) were associated with significant fibrosis in HBeAg-positive patients with elevated ALT. Higher AST was associated with significant necroinflammation in HBeAg-negative patients with elevated ALT (P = 0.009).
CONCLUSIONS:

Significant fibrosis is not rare in Chinese CHB patients with PNALT, especially HBeAg-positive patients over 30 years old.

StephenW

PLoS一。 2013年10月25 ， 8（10） ： e78672 。 DOI ： 10.1371/journal.pone.0078672 。
重大纤维化是在中国持续ALT正常的慢性乙型肝炎患者并不少见。
廖，王Z，林珊珊，徐永昌，易J ，许呒，黄真，周跃，张锋，侯J.
源

肝病单位和器官功能衰竭研究重点实验室，南方医科大学南方医院，南方医科大学，广州，中国肝脏病杂志，广州市第八人民医院，广州医学院，广州，中国。
抽象
背景：

有限的研究已经完成对慢性乙型肝炎（ CHB ）患者根据最新的亚洲太平洋肝指引由一个大的样本量与肝脏组织学研究协会定义。
方法：

我们回顾性分析了在队列中谷丙转氨酶持续正常（ PNALT ）或ALT升高，从2005年5月至10月的连续治疗天真慢性乙型肝炎患者的肝组织学特征。组织学评估的基础上的METAVIR得分系统，显着的异常被定义为炎症坏死≥级A2和/或纤维化≥ F2 。
结果：

共有675例慢性乙型肝炎患者的招募，其中516例HBeAg阳性和HBeAg阴性患者159 。在HBeAg阳性患者，显着纤维化被发现在PNALT 49.4％ （42/ 85 ） ，69.8 ％ （ 88 /126） ， ALT 1-2 ×正常上限（ ULN ）和81.6 ％ （249 / 305） ， ALT > 2 × ULN组，分别为。 HBeAg阴性患者，显着纤维化被发现30.9％ （17/ 55 ）在PNALT ， 73.3 ％（ 33 /45） ， ALT 1-2 × ULN和94.9％ （56/ 59 ）在ALT > 2 × ULN组，分别HBeAg阳性患者与PNALT超过30岁比30岁以下（ 87.5 ％比45.5 ％， P = 0.058 ）有较高的频率显着纤维化。多因素Logistic回归分析表明，年龄的增加（P = 0.012 ），谷草转氨酶（AST ） （P <0.001 ）和较低的HBV DNA （ P < 0.001 ），伴有明显的坏死性炎症，而高AST （P <0.001 ） ，低白蛋白（P = 0.027 ）和HBV DNA （P = 0.004 ） ， ALT升高的HBeAg阳性患者伴有明显纤维化。高等教育AST明显炎症坏死伴有HBeAg阴性患者ALT升高（ P = 0.009） 。
结论：

重大纤维化是罕见的在中国CHB患者与PNALT ，特别是HBeAg阳性患者30岁以上。