体重减轻使ALT正常化并改善了慢性乙型肝炎的长期结果

StephenW

Weight Loss Normalizes ALT and Improves Long-Term Outcomes in Chronic Hepatitis B
Virginia A. Schad, PharmD, RPh
High body mass index (BMI) is an independent risk factor for longitudinal alanine aminotransferase (ALT) elevation after complete hepatitis B virus DNA suppression; therefore, weight loss may help to normalize ALT and improve long-term outcomes, according to a study published in the Journal of Infectious Diseases.

Although the majority of patients with chronic hepatitis B achieve sustained viral control and normal ALT with long-term antiviral treatment, some patients may still present with an elevated ALT, which is often associated with unfavorable outcomes. However, little is known about the underlying cause and means of intervention for ALT elevation after complete viral suppression. Thus, researchers conducted a real-life, prospective cohort study with 1965 patients with chronic hepatitis B who achieved complete viral control by nuceleos(t)ide analogs therapy and maintained undetectable levels of hepatitis B virus DNA for at least 6 months. They found that at a median follow-up of 18.36 months, one-third of patients experienced ALT elevation, and that baseline high BMI (equal to or over 25 kg/m2), younger age, and liver cirrhosis independently increased the risk for longitudinal ALT elevation.
Related Articles

    Women of Reproductive Age: An Important Opportunity to Curtail the HCV Epidemic
    Minimal Response to Entecavir/Peginterferon in Children With Immune-Tolerant Chronic HBV
    Chemical Biology, Protein Engineering Led to Targeted HBV Treatment Advances

At the end of follow-up, 89 (4.8%) patients reverted to a low BMI and 92 (5.0%) reverted to a high BMI. The researchers observed that compared with persistent high BMI, reversion to a low BMI reduced the risk for ALT elevation, whereas compared with persistent low BMI, onset of high BMI increased the risk for ALT elevation.

“In conclusion, ALT elevation is common in [chronic hepatitis B] patients after complete viral suppression by [nuceleos(t)ide analogs], and high BMI is an independent predictor,” stated the authors. They added: “Improvement of BMI, probably underlying reductions in steatosis, may have a beneficial effect on ALT normalization.”

Disclosure: Some study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Wang K, Lin W, Kuang Z, et al. Longitudinal change of body mass index is associated with alanine aminotransferase elevation after complete viral suppression in chronic hepatitis B patients. J Infect Dis. 2019;220:1469-1476.

StephenW

体重减轻使ALT正常化并改善了慢性乙型肝炎的长期结果
弗吉尼亚·夏德（Virginia A.
高体重指数（BMI）是完全抑制乙型肝炎病毒DNA后纵向丙氨酸氨基转移酶（ALT）升高的独立危险因素；因此，根据《传染病杂志》发表的一项研究，减肥可能有助于使ALT正常化并改善长期结果。

尽管大多数慢性乙型肝炎患者可通过长期抗病毒治疗实现持续的病毒控制和ALT正常，但一些患者可能仍会出现ALT升高，这通常与不良预后相关。然而，对于完全抑制病毒后ALT升高的根本原因和干预手段知之甚少。因此，研究人员对1965名慢性乙型肝炎患者进行了一项真实的前瞻性队列研究，他们通过核苷类似物疗法实现了完全的病毒控制，并在至少6个月内无法检测到乙型肝炎病毒DNA的水平。他们发现，在中位随访18.36个月时，三分之一的患者出现了ALT升高，并且基线BMI高（等于或超过25 kg / m2），年龄较小和肝硬化独立增加了患上肝硬化的风险。 ALT升高。
相关文章

    育龄妇女：遏制HCV流行的重要机会
    恩替卡韦/聚乙二醇干扰素对免疫耐受性慢性乙型肝炎儿童的最小反应
    化学生物学，蛋白质工程促成靶向HBV治疗的进展

随访结束时，有89名（4.8％）患者恢复为低BMI，有92名（5.0％）患者恢复为高BMI。研究人员观察到，与持续高BMI相比，恢复为低BMI可以降低ALT升高的风险，而与持续低BMI相比，高BMI的发作会增加ALT升高的风险。

这组作者说：“总之，在[慢性乙型肝炎]患者中，通过[核苷类似物]完全抑制病毒后，ALT升高很常见，而高BMI是一个独立的预测因子。”他们补充说：“ BMI的改善，可能是脂肪变性的降低，可能对ALT正常化具有有益的作用。”

披露：一些研究作者宣布与制药行业有从属关系。请参阅原始参考资料，以获得作者披露的完整列表。

参考

Wang K，Lin W，Kuang Z，et al。慢性乙型肝炎患者完全抑制病毒后，体重指数的纵向变化与丙氨酸转氨酶升高有关。感染杂志2019; 220：1469-1476。