ALT耀斑预测抗病毒治疗的慢性乙型肝炎患者中的肝细胞癌：

StephenW

ALT Flare Predicts Hepatocellular Carcinoma Among Antiviral Treated Patients With Chronic Hepatitis B: A Cross-Country Cohort Study
Yanan Du  1 , Bingying Du  1 , Xiaoyan Fang  2 , Meng Shu  2 , Yongjing Zhang  2 , Hsingwen Chung  3 , Ye Sun  1 , Jiaming Teng  1 , Phimphone Visalath  1 , Hong Qiu  3 , Wei Cai  1
Affiliations
Affiliations

    1
    Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
    2
    Department of Epidemiology, Janssen Research and Development, Shanghai, China.
    3
    Global Epidemiology, Janssen Research and Development, Titusville, NJ, United States.

    PMID: 33552989 PMCID: PMC7859526 DOI: 10.3389/fonc.2020.615203

Abstract

Objectives: Alanine aminotransferase (ALT) level is one of the crucial indexes to evaluate disease status for chronic hepatitis B (CHB) patients. However, whether the ALT level after nucleos(t)ide analog (NA) treatment is associated with hepatocellular carcinoma (HCC) development remains unclear.

Materials and methods: We evaluated the association between ALT level and HCC occurrence in NA-treated patients and investigated the predictive value of ALT flare for HCC. The associations between ALT level and HCC were analyzed by logistic regression and Cox proportional hazards models.

Results: There were 21,223 CHB patients at Ruijin Hospital of China and 16,737 CHB patients in the Optum electronic health records (EHR) in the United States (US) treated with NAs between 2010 and 2018. Among them, 8,152 and 4,893 patients who achieved a normal ALT value were included in the study cohorts, respectively. A significant positive dose-dependent correlation between the peak ALT level and HCC was identified in both cohorts. Within the China cohort, ALT flare was significantly associated with increased risks of HCC compared to normal ALT (HR 2.55, 95%CI 1.45-4.50). Stronger increased risks associated with ALT flare were observed in the US cohort (HR 7.62, 95%CI 4.85-11.98).

Conclusions: ALT flare is a strong predictor for HCC occurrence in the CHB patients treated with NAs. Elevation of ALT, especially ALT flare warrants close monitoring for early HCC detection.

Keywords: alanine aminotransferase flare; chronic hepatitis B; hepatocellular carcinoma; nucleos(t)ide analog; risk factor.

Copyright © 2021 Du, Du, Fang, Shu, Zhang, Chung, Sun, Teng, Visalath, Qiu and Cai.
Conflict of interest statement

XF, YZ, MS, HC, and HQ are employees of Janssen Research & Development. YZ and HQ report stock ownership in Johnson and Johnson. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

StephenW

ALT耀斑预测抗病毒治疗的慢性乙型肝炎患者中的肝细胞癌：一项跨国家的队列研究
杜亚楠1，杜炳英1，方小燕2，孟树2，张永静2，钟兴文3，孙野1，滕家明1，留声机Visalath 1，洪秋3，韦彩1
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
    2
    中国上海扬森研究开发中心流行病学系。
    3
    全球流行病学，扬森研究与发展，美国新泽西州蒂特斯维尔。

    PMID：33552989 PMCID：PMC7859526 DOI：10.3389 / fonc.2020.615203

抽象

目的：丙氨酸氨基转移酶（ALT）水平是评估慢性乙型肝炎（CHB）患者疾病状况的关键指标之一。但是，尚不清楚核苷酸（t）ide类似物（NA）治疗后的ALT水平是否与肝细胞癌（HCC）的发展有关。

材料和方法：我们评估了NA治疗患者中ALT水平与HCC发生之间的关联，并研究了ALT爆发对HCC的预测价值。通过logistic回归和Cox比例风险模型分析了ALT水平与HCC之间的关系。

结果：2010年至2018年间，中国瑞金医院的21223例CHB患者和美国（美国）的Optum电子健康记录（EHR）中的16737例CHB患者接受了NAs治疗，其中8,152和4,893例患者达到正常ALT值分别包括在研究队列中。在这两个队列中，均发现ALT峰值水平与HCC之间存在显着的剂量依赖性正相关。与正常ALT相比，在中国人群中，ALT发作与HCC风险增加显着相关（HR 2.55，95％CI 1.45-4.50）。在美国队列中，观察到与ALT爆发相关的风险增加幅度更大（HR 7.62，95％CI 4.85-11.98）。

结论：ALT爆发是接受NAs治疗的CHB患者中HCC发生的强烈预测指标。 ALT升高，尤其是ALT耀斑，需要密切监测以早期发现HCC。

关键词：丙氨酸氨基转移酶耀斑；慢性乙型肝炎肝细胞癌；核苷（核苷酸）类似物;风险因素。

版权所有©2021 Du，Du，Fang，Shu，Zhang，Chung，Sun，Teng，Visalath，Qiu和Cai。
利益冲突声明

XF，YZ，MS，HC和HQ是Janssen Research＆Development的员工。 YZ和HQ报告了强生公司的股票所有权。其余作者宣称，该研究是在没有任何商业或金融关系的情况下进行的，这些商业或金融关系可以被解释为潜在的利益冲突。

StephenW

https://www.frontiersin.org/articles/10.3389/fonc.2020.615203/pdf