HBV中的ALT发作低，与未治疗患者的血清学转换有关

StephenW

ALT flares in HBV low, linked to seroconversion in untreated patients

Brahmania M, et al. Clin Gastroenterol Hepatol. 2019;doi:10.1016/j.cgh.2019.02.005.
February 11, 2019

Among patients with chronic hepatitis B, the cumulative incidence of severe alanine aminotransferase flares was low and correlated with decreased HBV DNA levels and loss of HBV e-antigen, according to recently published data.

“With the advent of sensitive HBV assays and new therapeutic agents, our understanding of the natural history, clinical outcomes, and management of ALT flares in chronic HBV infection has evolved,” Mayur Brahmania, MD, from Toronto General Hospital in Canada, and colleagues wrote. “Although ALT flares are infrequent, they do occur and can be associated with significant rises in ALT values ... which probably warrant close monitoring in patients with advanced liver disease given the risk of decompensation.”

Brahmania and colleagues collected data from the Hepatitis B Research Network on 1,587 untreated patients with HBV to determine the incidence and outcomes of ALT flares. Of those enrolled, 102 experienced an ALT flare defined as more than 10 times the upper limit of normal.

Factors that correlated independently with an increased risk for an ALT flare included male sex (OR = 3.02; 95% CI, 1.59-5.74), higher HBV DNA values (OR = 1.41 per log 10; 95% CI, 1.24-1.6), alcohol misuse compared with moderate to no drinking (OR = 2.27; 95% CI, 1.16-4.42), and higher Fibrosis-4 Index values (OR = 1.85 per doubled value; 95% CI, 1.38-2.49).

In contrast, older age correlated with a lower risk for an ALT flare (OR = 0.63 per 10 years; 95% CI, 0.48-0.86).

Untreated patients with an ALT flare were significantly more likely to experience HBV DNA decreases of more than 1 log compared with those without a flare (59 vs. 23 per 100 person-years; P = .003). Similarly, HBeAg loss rates were significantly different between patients with and without an ALT flare (47 vs. 15 per 100 person-years; P = .002).

After the patients began treatment, the researchers observed no significant difference in HBV DNA decreases or HBeAg loss between those who had an ALT flare and those who did not.

Rates of HBV surface antigen loss were low in both groups and no significant difference in loss rates between the groups. Additionally, neither group had higher rates of hepatocellular carcinoma, liver transplantation or mortality.

“Our results should be interpreted in the context of a cohort with relatively mild disease ... and that ALT flares were part of the natural history of chronic HBV infection as we excluded ALT flares during/after antiviral therapy, and in the setting of immunosuppression, chemotherapy, or superimposed infection,” the researchers wrote. “Thus, from this study no conclusions can be drawn as to when treatment is needed in patients with ALT flares.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.

StephenW

HBV中的ALT发作低，与未治疗患者的血清学转换有关

Brahmania M，et al。 Clin Gastroenterol Hepatol。 2019; DOI：10.1016 / j.cgh.2019.02.005。
2019年2月11日

根据最近公布的数据，在慢性乙型肝炎患者中，重度丙氨酸氨基转移酶突发的累积发生率较低，并且与HBV DNA水平降低和HBV e抗原丧失相关。

“随着敏感的HBV检测和新的治疗药物的出现，我们对慢性HBV感染中ALT突发的自然病史，临床结果和管理的理解已经发生变化，”来自加拿大多伦多综合医院的医学博士Mayur Brahmania及其同事中写道。 “虽然ALT突发很少发生，但它们确实发生并且可能与ALT值的显着升高有关......这可能需要对患有晚期肝病的患者进行密切监测，因为这会导致失代偿的风险。”
也可以看看

    阿片类药物流行病中的HCV：有关外展的5份报告......
    修订HBV患儿的ALT参数...
    ACIP更新成人免疫计划......

Brahmania及其同事收集了来自乙型肝炎研究网络的1,587名未接受过HBV治疗的患者的数据，以确定ALT发作的发生率和结局。在那些登记的人中，102人经历了ALT突发，其被定义为正常上限的10倍以上。

与ALT突发风险增加独立相关的因素包括男性性别（OR = 3.02; 95％CI，1.59-5.74），HBV DNA值较高（OR = 1.41 / log 10; 95％CI，1.24-1.6），酒精滥用与中度饮酒与不饮酒（OR = 2.27; 95％CI，1.16-4.42），以及较高的Fibrosis-4指数值（OR = 1.85 / doubled值; 95％CI，1.38-2.49）。

相反，年龄较大与ALT突发风险相关（OR = 0.63 / 10年; 95％CI，0.48-0.86）。

ALT突发的未治疗患者HBV DNA降低超过1 log的可能性明显高于没有突发的患者（59对23/100人年; P = .003）。同样，有和没有ALT突发的患者之间的HBeAg丢失率有显着差异（47对15每100人年; P = .002）。

在患者开始治疗后，研究人员观察到，患有ALT突发的患者与未患有ALT突发的患者之间HBV DNA降低或HBeAg消失无显着差异。

两组HBV表面抗原丢失率均较低，各组间损失率无显着差异。此外，两组均未出现较高的肝细胞癌，肝移植或死亡率。

“我们的结果应该在具有相对轻微疾病的队列的背景下进行解释......并且ALT突发是慢性HBV感染的自然史的一部分，因为我们在抗病毒治疗期间/之后排除ALT突发，并且在免疫抑制的情况下，化疗或叠加感染，“研究人员写道。 “因此，从这项研究中可以得出关于何时需要治疗ALT发作的患者的结论。” - 作者：Talitha Bennett

披露：作者报告没有相关的财务披露。