丙氨酸氨基转移酶正常的慢性乙型肝炎病毒感染患者的重要

StephenW

Significant Histological Changes and Satisfying Antiviral Efficacy in Chronic Hepatitis B Virus Infection Patients With Normal Alanine Aminotransferase. Antiviral Therapy Decision in Chronic HBV Patients With Normal ALT
Zhao Wu  1 , An-Lin Ma  2 , Qing Xie  3 , Xu-Qing Zhang  4 , Jun Cheng  5 , Da-Zhi Zhang  6 , Gui-Qiang Wang  7 , Hong Zhao  8
Affiliations
Affiliations

    1
    Department of Infectious Disease, Center for Liver Disease, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, China. Electronic address: [email protected].
    2
    Department of Infectious Disease, China-Japan Friendship Hospital, Beijing, China. Electronic address: [email protected].
    3
    Department of Infectious Disease, Rui Jin Hospital Shanghai Jiao Tong, University School of Medicine, Shanghai, China. Electronic address: [email protected].
    4
    Department of Infectious Diseases, South West Hospital affiliated to Third, Military Medical University, Chongqin, China. Electronic address: [email protected].
    5
    Department of Infectious Diseases, Di Tan Hospital affiliated to Capital, Medical University, Beijing, China. Electronic address: [email protected].
    6
    Department of Infectious Diseases, Second Affiliated Hospital of Chongqing, Medical University, Chongqing, China. Electronic address: [email protected].
    7
    Department of Infectious Disease, Center for Liver Disease, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, China; The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, Zhejiang, China; Peking University International Hospital, Beijing, China. Electronic address: [email protected].
    8
    Department of Infectious Disease, Center for Liver Disease, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, China; Peking University International Hospital, Beijing, China. Electronic address: [email protected].

    PMID: 32571749 DOI: 10.1016/j.clinre.2020.05.011

Abstract

Background and aims: A proportion of chronic hepatitis B virus (HBV) infection patients with normal alanine aminotransferase (ALT) should start antiviral therapy based on liver biopsy. We aim to evaluate the proportion of such patients, find noninvasive methods for identifying and then evaluate antiviral efficacy.

Methods: 253 chronic HBV infection patients with normal ALT were analyzed at baseline and 57 patients with histological indication for antiviral therapy (Histology activity index ≥5 and/or Ishak fibrosis score ≥3) and 140 patients with elevated ALT received entecavir therapy and were followed-up to 78 weeks with a second liver biopsy in this multi-center study.

Results: 127 (50.2%) of 253 patients with normal ALT fulfilled histological indication for antiviral therapy. Aspartate aminotransferase (P=0.049), anti-hepatitis B virus core antibody (P=0.001) and liver stiffness measurement (P=0.000) were independent variables for identifying histological indication for antiviral therapy. A noninvasive model (AAF) performed best among independent variables and other noninvasive models with area under the operating characteristic curve of 0.887. Antiviral efficacy showed that 38 (66.7%) of 57 patients had undetectable HBV DNA. 12 (41.4%) of 29 patients who were hepatitis B e antigen (HBeAg)-positive at baseline achieved HBeAg loss and 3 (10.3%) achieved HBeAg seroconversion. 25 (43.9%) of 57 patients achieved histological response. Moreover, 57 patients with normal ALT had a similar antiviral therapy efficacy with 140 patients with elevated ALT (P>0.1) except proportion of inflammation improvement and histological response (P=0.005, P=0.049).

Conclusions: Half of chronic HBV patients with normal ALT should start antiviral therapy based on liver biopsy. A noninvasive model could be used as a reliable tool for antiviral therapy decision. Patients with normal or elevated ALT had a similar antiviral efficacy.

Keywords: Antiviral efficacy; Hepatitis B virus; Histological indication for antiviral therapy; Noninvasive methods

StephenW

丙氨酸氨基转移酶正常的慢性乙型肝炎病毒感染患者的重要组织学变化和令人满意的抗病毒效力。 ALT正常的慢性HBV患者的抗病毒治疗决策
赵武1，马安林2，情谢3，张绪清4，君程5，张大志6，王桂强7，​​赵宏8
隶属关系
隶属关系

    1个
    北京大学第一医院肝病中心传染病科，北京市西城区西四库街8号。电子地址：[email protected]。
    2
    中日友好医院传染病科，北京。电子地址：[email protected]。
    3
    上海大学医学院上海交通大学瑞金医院传染病科，上海电子地址：[email protected]。
    4
    重庆军医大学第三附属医院西南医院感染科电子地址：[email protected]。
    5
    北京医科大学附属首都医院地坛医院传染病科。电子地址：[email protected]。
    6
    重庆医科大学附属重庆市第二医院感染科电子地址：[email protected]。
    7
    北京大学第一医院肝病中心传染病科，北京市西城区西四库街8号；浙江大学传染病诊治合作创新中心，浙江杭州北京大学国际医院，北京，中国。电子地址：[email protected]。
    8
    北京大学第一医院肝病中心传染病科，北京市西城区西四库街8号；北京大学国际医院，北京，中国。电子地址：[email protected]。

    PMID：32571749 DOI：10.1016 / j.clinre.2020.05.011

抽象

背景与目的：一定比例的丙氨酸氨基转移酶（ALT）正常的慢性乙型肝炎病毒（HBV）感染患者应根据肝活检开始抗病毒治疗。我们旨在评估此类患者的比例，找到非侵入性方法进行识别，然后评估抗病毒疗效。

方法：基线时分析253例ALT正常的慢性HBV感染患者，对57例组织学指征抗病毒治疗（组织学活性指数≥5和/或Ishak纤维化评分≥3）的患者和140例ALT升高的患者接受恩替卡韦治疗，并进行随访在这项多中心研究中，最多需要78周的时间进行第二次肝活检。

结果：253名ALT正常的患者中有127名（50.2％）达到了抗病毒治疗的组织学指征。天冬氨酸转氨酶（P = 0.049），抗乙型肝炎病毒核心抗体（P = 0.001）和肝硬度测定（P = 0.000）是用于确定抗病毒治疗组织学指征的独立变量。在独立变量和其他非侵入性模型中，非侵入性模型（AAF）在操作特征曲线下的面积为0.887时表现最佳。抗病毒功效显示57例患者中有38例（66.7％）具有无法检测到的HBV DNA。在基线时为乙型肝炎e抗原（HBeAg）阳性的29例患者中，有12例（41.4％）实现了HBeAg丢失，有3例（10.3％）实现了HBeAg血清转化。 57例患者中有25例（43.9％）获得了组织学应答。此外，除炎症改善和组织学反应的比例（P = 0.005，P = 0.049）外，57例ALT正常的患者与140例ALT升高的患者具有相似的抗病毒治疗效果（P> 0.1）。

结论：一半ALT正常的慢性HBV患者应根据肝活检开始抗病毒治疗。无创模型可以用作抗病毒治疗决策的可靠工具。 ALT正常或升高的患者具有相似的抗病毒功效。

关键词：抗病毒药效；乙型肝炎病毒;抗病毒治疗的组织学适应症；无创方法

StephenW

https://www.sciencedirect.com/sc ... 2030156X?via%3Dihub