抗病毒药效益乙肝患者的正常或升高ALT

StephenW

Bryant Furlow
November 17, 2015
Antivirals Benefit Hep B Patients With Normal or Elevated ALT

SAN FRANCISCO, CA—Antiviral therapy in patients with non-cirrhotic chronic hepatitis B (CHB) and normal to minimally-elevated alanine aminotransferase (ALT) levels significantly reduced the risk of hepatocellular carcinoma (HCC), reported Joseph K. Hoang from Stanford University Medical Center, Palo Alto, CA, at The Liver Meeting® 2015.

"In patients with ALT less than 2 times ULN [upper limit of normal], we also observed significantly higher HCC incidence in untreated patients compared to treated patients," the research team reported. Non-cirrhotic patients with ALT less than 2 times ULN who are older than 40 may benefit from antiviral therapy, they concluded.

The AASLD guideline for CHB identify ALT ≥2 times ULN as a major criteria to initiate antiviral therapy.

"However, patients with ALT less than 2 times the ULN may still be at risk for future complications such as HCC," the researchers explained. They therefore sought to evaluate whether ALT levels below the AASLD guidelines threshold also affect HCC risk in patients with noncirrhotic CHB.

Their team performed a retrospective cohort study of 3,649 treatment-naïve, non-cirrhotic CHB patients age ≥40 years who had been evaluated at 4 U.S. clinics between 1991 and 2014, and in Taiwan during 1991–1992 as part of the REVEAL HBV Cohort. Patients were categorized as either ALT ≥2 x ULN (30 IU/L for men; ≥19 IU/L for women) or <2 x ULN.

In both categories, treated patients had significantly lower HCC incidence rates than untreated patients.

"At 10-year follow-up, the cumulative probability of developing HCC [in the ALT <2x ULN category] was 0.9% in the untreated group and 0% in the treated group," (P=0.0042) the researchers reported. For the ALT ≥2 x ULN category, the cumulative probability of HCC at 10-year follow-up was 12.7% vs. 5.2% in untreated and treated patients, respectively (P<0.0218), the researchers reported.

REACH-B score was a "significant, independent predictor of HCC, with each point increase in REACH-B score associated with a 36% increase in the development of HCC," they reported (hazard ratio [HR] 1.59; 95% CI: 1.49, 1.70; P<0.0001).

StephenW

科比Furlow
二○一五年十一月十七日
抗病毒药效益乙肝患者的正常或升高ALT

新浪科技讯北京时间患者的非肝硬化的慢性乙型肝炎（CHB）和正常的CA-抗病毒治疗微创提升的丙氨酸转氨酶（ALT）水平显著减少肝细胞癌（HCC）的风险，报告约瑟夫K.晃斯坦福大学医疗中心，帕洛阿尔托，加利福尼亚州，在肝脏Meeting®2015年

“患者的ALT小于2倍ULN [正常上限]，我们也观察显著高于肝癌的发病率在未经治疗的病人相比，治疗的患者，”研究小组报告。非肝硬化患者ALT小于2倍正常值上限谁是40岁以上可以从抗病毒治疗中获益，他们的结论。

在AASLD指引CHB确定ALT≥2倍ULN作为主要标准，开始抗病毒治疗。

“然而，患者的ALT小于2倍正常值上限可能仍面临风险为未来的并发症，如肝癌，”研究人员解释说。因此，他们试图评估低于AASLD指南阈值ALT水平是否也会影响患者的肝硬化的慢性乙肝肝癌的风险。

他们的团队进行的3,649治疗初治，非肝硬化CHB患者年龄≥40年谁一直在评估美国4诊所1991年和2014年间的回顾性队列研究，并在台湾地区1991 - 1992年期间，作为REVEAL HBV队列的一部分。患者被归类为ALT≥2x ULN（30 IU / L，男性;​​≥19IU / L为女性）或<2×ULN。

在这两个类别，治疗的患者有显著降低肝癌发病率比未治疗的患者。

“在10年的随访，发展为HCC [在ALT <2×ULN类]的累积概率为0.9％，在模型组和0％，治疗组”（P = 0.0042），研究人员报告。对于ALT≥2x ULN类，肝癌的10年随访的累积概率为12.7％和5.2％，未经治疗和治疗的患者，分别为（P <0.0218），研究人员报告。

REACH-B的评分是“肝癌显著，独立预测因子，每点增加，在肝癌的发展增加了36％，相关的REACH-B的分数，”他们的报告（危险比[HR] 1.59; 95％CI： 1.49，1.70，P <0.0001）。

囧图

总结：无论ALT值低于正常值2倍还是高于2倍，服用抗病毒药可以降低肝癌发生几率。
当然，今天来看，这已经不再是新闻。但此资料无论对医生还是病人，是有影响意义的。