在具有正常或极低升高的丙氨酸氨基转移酶水平的慢性乙型

StephenW

J Viral Hepat. 2017 Jan 20. doi: 10.1111/jvh.12679. [Epub ahead of print]
Predictors of liver histological changes and a sustained response to peginterferon among chronic hepatitis B e antigen-positive patients with normal or minimally elevated alanine aminotransferase levels.Chen J1, Xu CR2, Xi M1, Hu WW1, Tang ZH1, Zhang GQ1,2.
Author information

• 1Department of Infectious Disease, The Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, 200023, People's Republic of China.
• 2Department of Infection Diseases, Southeast Hospital, Xiamen University, Zhangzhou, 363000, People's Republic of China.
  

AbstractBACKGROUND: A proportion of chronic hepatitis B (CHB) patients with normal or only minimally elevated ALT levels display significant histologic changes, and would benefit from antiviral therapy.
OBJECTIVES: We aim to evaluate the histologic abnormalities seen in these patients, and then determine which of them would most likely respond to peginterferon therapy.
METHODS: One hundred and thirteen hepatitis B e antigen (HBeAg)-positive patients with a normal or minimally elevated ALT level and moderate to severe histologic changes in their liver tissue were selected to receive peginterferon monotherapy and participate in a followup analysis.
RESULTS: A multiple logistic regression analysis indicated that increasing age (P = 0.049) and lower hepatitis B virus (HBV) DNA levels (P = 0.038) were associated with significant histological abnormalities in patients with a normal or minimally elevated ALT. Our predictive model which incorporated HBeAg testing at treatment week 12 combined with hepatitis B surface antigen (HBsAg) testing at treatment week 24 was able to identify which patients with a normal ALT level would achieve a SVR (PPV: 66.7%, NPV: 90.0%). Lower HBsAg and HBeAg levels at treatment week 24 were associated with a SVR in patients with a minimally elevated ALT level (PPV: 100.0%, NPV: 100.0%).
CONCLUSIONS: A liver biopsy and antiviral therapy should be strongly considered when treating HBeAg-positive patients with a normal or minimally elevated ALT level, low HBV DNA level, and aged > 35 years. On-treatment quantification of combined HBsAg and HBeAg test results may be useful for predicting a SVR to peginterferon monotherapy in these patients. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

KEYWORDS: alanine aminotransferase (ALT); chronic (CHB); hepatitis B; histological activity; peginterferon; sustained virological response (SVR)

PMID:28107601DOI:10.1111/jvh.12679

StephenW

J病毒Hepat。 2017年1月20日。doi：10.1111 / jvh.12679。 [打印前的电子版]
在具有正常或极低升高的丙氨酸氨基转移酶水平的慢性乙型肝炎e抗原阳性患者中肝组织学变化和聚乙二醇干扰素的持续反应的预测因子。
陈J1，徐CR2，Xi M1，胡WW1，唐ZH1，张GQ1,2。
作者信息

    1上海交通大学第六人民医院传染病科，上海，200023，中华人民共和国。
    2.厦门大学东南医院感染疾病科，漳州，363000，中华人民共和国。

摘要
背景：

一部分慢性乙型肝炎（CHB）患者正常或只有最低程度升高的ALT水平显示出显着的组织学变化，并将受益于抗病毒治疗。
目标：

我们的目的是评估这些患者中观察到的组织学异常，然后确定哪些患者最有可能对聚乙二醇干扰素治疗有反应。
方法：

选择一百十三个乙型肝炎e抗原（HBeAg）阳性患者，其正常或最低程度升高的ALT水平和其肝组织中的中度至重度组织学变化，以接受聚乙二醇化干扰素单一疗法并参与随访分析。
结果：

多重逻辑回归分析表明，在正常或最低程度升高的ALT患者中，年龄增加（P = 0.049）和低乙型肝炎病毒（HBV）DNA水平（P = 0.038）与显着的组织学异常相关。我们的预测模型在治疗第12周结合HBeAg测试，并在治疗第24周结合乙型肝炎表面抗原（HBsAg）测试，能够识别具有正常ALT水平的患者将达到SVR（PPV：66.7％，NPV：90.0％ ）。在治疗24周时，较低的HBsAg和HBeAg水平与ALT水平最低的患者的SVR相关（PPV：100.0％，NPV：100.0％）。
结论：

当治疗正常或极低升高的ALT水平，低HBV DNA水平和年龄> 35岁的HBeAg阳性患者时，应当强烈考虑肝活检和抗病毒治疗。联合HBsAg和HBeAg测试结果的治疗定量可用于在这些患者中预测聚乙二醇干扰素单一疗法的SVR。本文受版权保护。版权所有。

本文受版权保护。版权所有。
关键词：

丙氨酸氨基转移酶（ALT）;慢性（CHB）;乙型肝炎;组织学活性;聚乙二醇干扰素持续病毒学应答（SVR）

PMID：
    28107601
DOI：
    10.1111 / jvh.12679