丙氨酸氨基转移酶正常或轻度升高的慢性乙型肝炎患者的抗

StephenW

Anti-viral effect in chronic hepatitis B patients with normal or mildly elevated alanine aminotransferase
Qingqing Zhao  1 , Kehui Liu  2 , Xiaojun Zhu  3 , Lei Yan  1 , Yezhou Ding  1 , Yumin Xu  1 , Shike Lou  1 , Gangde Zhao  1 , Qing Xie  1 , Yueqiu Gao  4 , Shisan Bao  5 , Hui Wang  6
Affiliations
Affiliations

    1
    Department of Infectious Diseases, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
    2
    Department of Infectious Diseases, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China; Department of Infectious Diseases, Rui Jin North Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201801, China.
    3
    Department of Hepatopathy, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
    4
    Department of Hepatopathy, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China. Electronic address: [email protected].
    5
    Discipline of Pathology, School of Medical Sciences, Faculty of Medicine and Sciences, University of Sydney, Sydney, NSW, 2006, Australia. Electronic address: [email protected].
    6
    Department of Infectious Diseases, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China. Electronic address: [email protected].

    PMID: 33065138 DOI: 10.1016/j.antiviral.2020.104953

Abstract

Background & aims: Normal/mildly elevated ALT (<2×ULN) CHB patients are potentially at risk of progression to cirrhosis and/or hepatocellular carcinoma (HCC). We aimed to assess the outcomes of anti-viral therapy for normal/mild elevation of ALT CHB patients. CHB patients (n=432) were liver biopsied was determined.

Methods: It was determined that the outcomes of anti-viral therapy in CHB patients with normal/mild elevation of ALT, in response to nucleoside/nucleotide analogues (NAs) (n=190) and pegylated interferon (PEG-IFN) (n=30) treatment for up to 72 weeks. Non-antiviral treated patients were used as control (n=40).

Results: There was about 50% of the CHB patients showed hepatic inflammatory necrosis ≥ G2 and/or fibrosis ≥ S2, and were >30-years. The rate of undetectable HBV DNA in NAs and PEG-IFN groups was ∼50%, ∼80% or ∼90% at week 24, 48 or 72, respectively. HBeAg clearance rate was lower in NAs treated than that in PEG-IFN group at week 48 (6% vs 20%, P<0.05). ALT normalization rate was increased by 1.18-fold at week 72. HBsAg decline in HBeAg+ patients treated with NAs or PEG-IFN was 0.418 or 1.217 log IU/mL (P<0.0001) at week 48; whereas HBsAg decline was 0.176 or 0.816 log IU/mL (P<0.001) in HBeAg- patients. HBsAg at baseline and week 24 were strong predictors of "low HBsAg at week 48".

Conclusion: Long term antiviral therapy inhibits HBV replication effectively in ALT<2×ULN CHB patients. PEG-IFN therapy is recommended for HBeAg+ patients with baseline HBsAg<4.37 log IU/ml and HBeAg- patients with baseline HBsAg<2.66 log IU/ml to achieve "low HBsAg at week 48".

Keywords: ALT; Chronic hepatitis B; HBV DNA; HBsAg; NAs; PEG-IFN.

StephenW

丙氨酸氨基转移酶正常或轻度升高的慢性乙型肝炎患者的抗病毒作用
赵庆清1，刘克辉2，刘晓军3，雷岩1，叶州鼎1，徐雨敏1，史克楼1，赵刚德1，庆谢1，月球高4，石三宝5，王晖6
隶属关系
隶属关系

    1个
    上海交通大学医学院附属瑞金医院传染病科，上海200025
    2
    上海交通大学医学院附属瑞金医院传染病科，上海200025；上海交通大学医学院附属瑞金北医院感染科，上海，201801
    3
    上海中医药大学附属曙光医院肝病科，上海
    4
    上海中医药大学附属曙光医院肝病科，上海电子地址：[email protected]。
    5
    悉尼大学，医学与科学学院，医学院，病理学学科，新南威尔士州悉尼，2006年，澳大利亚。电子地址：[email protected]。
    6
    上海交通大学医学院附属瑞金医院传染病科，上海200025电子地址：[email protected]。

    PMID：33065138 DOI：10.1016 / j.antiviral.2020.104953

抽象

背景与目的：正常/轻度升高的ALT（<2×ULN）CHB患者有发展为肝硬化和/或肝细胞癌（HCC）的风险。我们旨在评估抗病毒治疗对ALT CHB患者正常/轻度升高的效果。对CHB患者（n = 432）进行了肝活检。

方法：已确定，对核苷/核苷酸类似物（NAs）（n = 190）和聚乙二醇化干扰素（PEG-IFN）（n = 30）治疗长达72周。未经抗病毒治疗的患者用作对照（n = 40）。

结果：大约50％的CHB患者肝炎性坏死≥G2和/或纤维化≥S2，并且> 30年。在第24、48或72周，NAs和PEG-IFN组中未检测到HBV DNA的比率分别为〜50％，〜80％或〜90％。在第48周时，NAs的HBeAg清除率低于PEG-IFN组（6％vs 20％，P <0.05）。 ALT标准化率在第72周增加了1.18倍。在第48周，接受NAs或PEG-IFN治疗的HBeAg +患者的HBsAg下降为0.418或1.217 log IU / mL（P <0.0001）；而HBeAg患者的HBsAg下降为0.176或0.816 log IU / mL（P <0.001）。基线和第24周的HBsAg是“第48周的HBsAg低”的有力预测指标。

结论：长期抗病毒治疗可有效抑制ALT <2×ULN CHB患者的HBV复制。对于基线HBsAg <4.37 log IU / ml的HBeAg +患者和基线HBsAg <2.66 log IU / ml的HBeAg-患者，推荐PEG-IFN治疗以达到“第48周HBsAg低”。

关键词：ALT;慢性乙型肝炎； HBV DNA；乙肝表面抗原NAs； PEG-IFN。

StephenW

https://www.sciencedirect.com/sc ... 20303673?via%3Dihub