慢性乙型肝炎患者血清丙氨酸氨基转移酶水平与肝脏相关死

StephenW

Serum Alanine Aminotransferase Level and Liver-related Mortality in Patients with Chronic Hepatitis B: A Large National Cohort Study

    Jae-Jun Shim1, Jung Wook Kim1, Chi Hyuck Oh1, Ye-Rin Lee2, Ji Sung Lee3, So-Youn Park4, Byung-Ho Kim1 andIn-Hwan Oh2,*

DOI: 10.1111/liv.13705

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Liver International

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Keywords:

    Alanine transaminase;Chronic hepatitis B;Mortality;Hepatocellular carcinoma

Abstract
Background

The serum alanine aminotransferase (ALT) level has been used to identify at-risk patients with chronic hepatitis B (CHB) who need antiviral therapy. However, the level associated with increased liver-related mortality requiring active treatment is still unclear.
Methods

We used a Health Examination Cohort of the National Health Insurance Service of Korea that included approximately 0.5 million individuals aged 40–79 years. In total, 12,486 patients with CHB and no other concurrent liver disease were enrolled, and patients’ liver-related mortality, including that due to liver cancer, was investigated over 9 years.
Results

The serum ALT level was correlated positively with liver-related mortality. The rates in men were 0.14, 0.17, 0.24, 0.57, 0.63, and 0.85 per 100 person-years (%) for serum ALT levels of <20, 20–29, 30–39, 40–49, 50–79, and ≥80 U/L, respectively, and the corresponding liver-related mortality rates in women were 0.03%, 0.09%, 0.12%, 0.63%, 0.65%, and 0.32%. In patients with ALT levels of 40–79 U/L, the liver-related mortality rates were 0.60% in men and 0.64% in women, which were similar to the overall mortality rate of age- and sex-matched subjects without CHB (0.69%). The best cut-off values for liver-related mortality prediction were >34 U/L in men and >30 U/L in women.
Conclusions

The liver-related mortality rate increased significantly, even in CHB patients with relatively low serum ALT levels. Careful monitoring or earlier antiviral therapy should be considered for patients aged >40 years with serum ALT levels above the upper limit of normal.

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StephenW

慢性乙型肝炎患者血清丙氨酸氨基转移酶水平与肝脏相关死亡率的一项国家队列研究

    Jae-Jun Shim1，Jung Wook Kim1，Chi Hyuck Oh1，Ye-Rin Lee2，Ji Sung Lee3，So-Youn Park4，Kim Byung Ho1和Oh-Oh Oh2，*

DOI：10.1111 / liv.13705

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肝脏国际

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关键词：

    丙氨酸转氨酶;慢性乙型肝炎;死亡率;肝细胞癌

抽象
背景

血清丙氨酸氨基转移酶（ALT）水平已被用于鉴定需要抗病毒治疗的慢性乙型肝炎（CHB）的高危患者。然而，与需要积极治疗的肝脏相关死亡率增加有关的水平仍不清楚。
方法

我们使用了韩国国民健康保险服务的健康检查队列，其中包括大约50万40-79岁的个人。总共有12,486例慢性乙型肝炎患者，没有其他并发肝病患者入组，其中肝癌相关死亡率（包括肝癌死亡率）经过9年的调查。
结果

血清ALT水平与肝脏相关死亡率呈正相关。男性的血清ALT水平<20,20-29,30-39,40-49,50-79分别为0.14,0.17,0.24,0.57,0.63和0.85 / 100人年（％） ≥80U / L，女性相应的肝脏相关死亡率分别为0.03％，0.09％，0.12％，0.63％，0.65％和0.32％。在ALT水平为40-79 U / L的患者中，男性肝脏相关死亡率为0.60％，女性为0.64％，与无CHB的年龄和性别相匹配的受试者总体死亡率相似（0.69 ％）。肝脏相关死亡率预测的最佳临界值在男性> 34U / L，女性> 30U / L。
结论

即使在血清ALT水平相对较低的CHB患者中，肝脏相关死亡率也显着增加。对于血清ALT水平高于正常上限的年龄> 40岁的患者，应考虑谨慎监测或早期抗病毒治疗。

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