慢性乙型肝炎病毒感染患者具有持续高正常或低正常丙氨酸

MP4

neilhbver 发表于 2017-3-2 23:22
记得国外临床测量alt指标就是大于20就算alt升高

http://hbvhbv.info/forum/thread-1199598-1-1.html

StephenW

Study population

A total of 1,521 consecutive chronic HBV infection patients who underwent liver biopsies and routine laboratory tests at Shanghai Public Health Clinical Center between May 2008 and January 2016 were retrospectively screened for inclusion in the study. Chronic HBV infection was defined as the persistent presence of serum HBV surface antigen (HBsAg) for more than 6 months (Sarin et al., 2016). The included subjects were treatment-naive patients with PNALT levels defined as normal ALT (≤40 IU/L) measured on at least three occasions at intervals of more than 2 months apart over a period of 12 or more months before liver biopsy. Patients with the following conditions were excluded from this study: significant alcohol consumption (>20 g/day) (132 patients); accompanied by non-alcoholic fatty liver disease (136 patients); accompanied by autoimmune liver disease (54 patients); co-infection with hepatitis C virus, hepatitis D virus, or human immunodeficiency virus (106 patients); prior or current antiviral treatment (252 patients); and ALT>40 IU/L (449 patients). Finally, 392 treatment-naive chronic HBV infection patients with PNALT levels were included. Among the 392 eligible patients, 291 patients had HNALT levels (defined as 0.5 ULN<ALT≤1 ULN measured on at least three occasions at intervals of more than 2 months apart over a period of 12 or more months before liver biopsy), and 101 patients had LNALT levels (defined as ALT≤0.5 ULN measured on at least three occasions at intervals of more than 2 months apart over a period of 12 or more months before liver biopsy) (Sarin et al., 2016). In this study, the ULN of ALT is 40 IU/L.

Baseline characteristics of enrolled patients
Table 1.

Table 1. Baseline characteristics of enrolled patients.

392 chronic HBV infection patients were enrolled, and baseline characteristics were summarized in Table 1. The majority of enrolled patients were male (209, 53.3%), HBeAg positive (231, 58.9%) and middle-aged [36 (30-42) years]. Median HBV DNA, ALT, AST, ALP, GGT, total bilirubin, albumin, globulin, and WBC were 4.8 log10 copies/ml (IQR=3.6-7.2), 27 IU/L (IQR=20-33), 24 IU/L (IQR=21-29), 70 IU/L (IQR=59-85), 18 IU/L (IQR=13-28), 12 μmol/L (IQR=10-17), 44 g/L (IQR=41-47), 29 g/L (IQR=27-32), and 5.3×109/L (IQR=4.5-6.4), respectively. Mean platelet count was 178×109/L. Among 392 enrolled patients, 106 patients (27%) had significant liver inflammation, 119 patients (30.4%) had significant liver fibrosis, and 126 patients (32.1%) had SLHC.

Among 392 enrolled patients, 291 (74.2%) had HNALT and 101 (25.8%) had LNALT. The HNALT patients had significantly higher age (37 vs. 34 years, p=0.003), proportion of male (60.8% vs. 31.7%, p<0.001), ALT (30 vs. 16 IU/L, p<0.001), AST (26 vs. 20 IU/L, p<0.001), ALP (73 vs. 64 IU/L, p<0.001), GGT (19 vs. 14 IU/L, p<0.001), proportion of significant liver inflammation (30.9% vs. 15.8%, p=0.003), proportion of significant liver fibrosis (35.7% vs. 14.9%, p<0.001), and proportion of SLHC (36.4% vs. 19.8%, p=0.002) compared with LNALT patients. No significant statistical differences were seen in the proportion of HBeAg positive, HBV DNA, total bilirubin, albumin, globulin, WBC, and platelet count between HNALT group and LNALT group.

StephenW

研究人群

对2008年5月至2016年1月间在上海市公共卫生临床中心接受肝脏活检和常规实验室检查的1,521例连续性慢性HBV感染患者进行回顾性筛选纳入本研究。慢性HBV感染定义为持续存在血清HBV表面抗原（HBsAg）超过6个月（Sarin等，2016）。包括的受试者是在肝活检之前在12个月或更多月的时间内以至少三次间隔以大于2个月的间隔测量的具有被定义为正常ALT（≤40IU/ L）的PNALT水平的未治疗的患者。具有以下病症的患者从该研究中排除：显着的饮酒（> 20g /天）（132名患者）;伴有非酒精性脂肪性肝病（136例）;伴有自身免疫性肝病（54例）;与丙型肝炎病毒，丁型肝炎病毒或人类免疫缺陷病毒（106名患者）的共感染;预先或当前的抗病毒治疗（252名患者）;和ALT> 40IU / L（449名患者）。最后，包括392治疗初始慢性HBV感染患者PNALT水平。在392名合格患者中，291名患者具有HNALT水平（定义为在肝活检前12个月或更长时间内至少三次间隔超过2个月测量的0.5ULN <ALT≤1ULN）和101患者的LNALT水平（定义为ALT≤0.5ULN，在肝活检前12个月或更长时间内至少三次间隔超过2个月测量）（Sarin等，2016）。在本研究中，ALT的ULN为40IU / L。

入选患者的基线特征
表格1。

表1.入选患者的基线特征。

392名慢性HBV感染患者入组，基线特征总结见表1.大多数入组患者为男性（209,53.3％），HBeAg阳性（231,58.9％）和中年[36（30-42）年份]。中位HBV DNA，ALT，AST，ALP，GGT，总胆红素，白蛋白，球蛋白和WBC分别为4.8log10拷贝/ ml（IQR = 3.6-7.2），27IU / L（IQR = 20-33） L（IQR = 21-29），70IU / L（IQR = 59-85），18IU / L（IQR = 13-28），12μmol/ L（IQR = 10-17），44g / L IQR = 41-47），29g / L（IQR = 27-32）和5.3×109 / L（IQR = 4.5-6.4）。平均血小板计数为178×109 / L。在392名招募的患者中，106名（27％）有显着肝炎症，119名（30.4％）有显着肝纤维化，126名（32.1％）有SLHC。

在392例入选患者中，291例（74.2％）有HNALT，101例（25.8％）有LNALT。 HNALT患者具有显着较高的年龄（37比34岁，p = 0.003），男性比例（60.8％比31.7％，p <0.001），ALT（30比16IU / AST（26vs20IU / L，p <0.001），ALP（73vs64IU / L，p <0.001），GGT（19vs14IU / L，p <0.001） （30.9％比15.8％，p = 0.003），显着肝纤维化的比例（35.7％比14.9％，p <0.001）和SLHC比例（36.4％比19.8％，p = 0.002）耐心。在HNALT组和LNALT组之间HBeAg阳性，HBV DNA，总胆红素，白蛋白，球蛋白，WBC和血小板计数的比例没有显着统计学差异。

StephenW

http://www.discoverymedicine.com ... anine-transaminase/

TRUMPHILARY

tacolynn 发表于 2017-3-2 09:23
这个研究结论就是说，只要感染了乙肝病毒，即使ALT＜40，甚至＜20，随着年龄的增长还是有肝纤维化的可能的 ...

这观点，我认为有道理。

TRUMPHILARY

在慢性乙肝治疗中历程中，只有表面抗原逐渐降低，才是有治疗效果的体现。
若长期维持高载量的表面抗原定量，那说明，慢性乙肝没有得到有效治疗

StephenW

回复 TRUMPHILARY 的帖子

替诺福韦/恩替卡韦只能抑制hbvdna的形成，即是，降低血清病毒载量.

100％抑制hbvdna产生, 可以导致治愈吗？