高度正常的丙氨酸氨基轉移酶是HBeAg陰性慢性乙型肝炎肝組織

StephenW

High-normal alanine aminotransferase is an indicator for liver histopathology in HBeAg-negative chronic hepatitis B
Menghui Duan #  1 , Xiaoling Chi #  2 , Huanming Xiao  2 , Xueen Liu  3 , Hui Zhuang  4
Affiliations
Affiliations

    1
    Department of Microbiology and Center of Infectious Diseases, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China.
    2
    Traditional Chinese Medicine Hospital of Guangdong Province, Guangzhou, 510120, China.
    3
    Department of Microbiology and Center of Infectious Diseases, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China. [email protected].
    4
    Department of Microbiology and Center of Infectious Diseases, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China. [email protected].

#
Contributed equally.

    PMID: 33638049 DOI: 10.1007/s12072-021-10153-2

Abstract

Objective: We aimed to assess liver histological changes of HBeAg-negative chronic hepatitis B (CHB) patients with normal ALT, and determined the association between significant liver injury and age, ALT, and HBV DNA levels.

Methods: We retrospectively examined 327 patients who underwent liver biopsy from 2009 to 2018. Significant liver histological change is defined as liver necroinflammation ≥ G2 and/or liver fibrosis ≥ F2.

Results: The proportion of patients with significant liver necroinflammation or fibrosis in the high-normal ALT group (ALT > 20 U/L) was higher than that in the low-normal ALT group (ALT ≤ 20 U/L) (44.6% vs 26.5%, 61.0% vs 41.7%, p < 0.01); also the proportion in the group with HBV DNA ≥ 2000 IU/mL was significantly higher than that in the group with HBV DNA < 2000 IU/mL (58.5% vs 27.1%, 67.9% vs 46.2%, p < 0.01). There was no significant difference in hepatic histopathology between < 40 and ≥ 40 years groups. Among 221 patients with normal ALT and low HBV DNA levels (< 2000 IU/mL), 27.1% of them had significant liver necroinflammation and 46.2% had significant liver fibrosis. The multiple logistic regression analysis showed that ALT > 20 U/L and HBV DNA ≥ 2000 IU/mL were independently associated with significant liver histopathology (p < 0.01).

Conclusion: HBeAg-negative CHB patients with normal ALT and low HBV DNA level (< 2000 IU/mL) were suggested to perform liver biopsy or noninvasive methods for histopathology assessment, then to be determined for antiviral therapy. ALT > 20 U/L and HBV DNA ≥ 2000 IU/mL are good independently predictive factors for evaluating significant liver histopathology for HBeAg-negative CHB patients with normal ALT.

Clinical trials registration: Chinese Clinical Trial Registry (ChiCTR-IOR-14005474).

Keywords: Age; Antiviral therapy; Chronic hepatitis B (CHB) patient; HBV DNA level; HBeAg negative; Histological assessment; Inactive carrier; Liver biopsy; Low-normal ALT; Normal alanine aminotransferase (ALT).

StephenW

高度正常的丙氨酸氨基轉移酶是HBeAg陰性慢性乙型肝炎肝組織病理學的指標
段夢輝＃1，小玲池＃2，肖煥明2，劉學恩3，回莊4
隸屬關係
隸屬關係

    1個
    北京大學健康科學中心基礎醫學學院微生物學教研室，傳染病中心，北京100191
    2個
    廣東省中醫院，廣東廣州510120
    3
    北京大學健康科學中心基礎醫學學院微生物學教研室，傳染病中心，北京100191 [email protected]。
    4
    北京大學健康科學中心基礎醫學學院微生物學教研室，傳染病中心，北京100191 [email protected]。

＃
貢獻均等。

    PMID：33638049 DOI：10.1007 / s12072-021-10153-2

抽象的

目的：我們旨在評估ALT正常的HBeAg陰性慢性乙型肝炎（CHB）患者的肝臟組織學變化，並確定嚴重肝損傷與年齡，ALT和HBV DNA水平之間的關係。

方法：我們回顧性分析了從2009年至2018年接受肝活檢的327例患者。肝組織學顯著改變的定義為肝壞死性炎症≥G2和/或肝纖維化≥F2。

結果：高正常ALT組（ALT> 20 U / L）中有嚴重肝壞死性炎症或纖維化的患者比例高於低正常ALT組（ALT≤20 U / L）（44.6％vs 26.5％，61.0％和41.7％，p <0.01）； HBV DNA≥2000 IU / mL的組的比例也明顯高於HBV DNA <2000 IU / mL的組（58.5％比27.1％，67.9％比46.2％，p <0.01）。在<40歲和≥40歲的組中，肝組織病理學無顯著差異。在ALT正常且HBV DNA水平低（<2000 IU / mL）的221例患者中，27.1％的患者出現嚴重的肝壞死性炎症，46.2％的患者發生了明顯的肝纖維化。多元邏輯回歸分析顯示，ALT> 20 U / L和HBV DNA≥2000 IU / mL與顯著的肝臟組織病理學獨立相關（p <0.01）。

結論：ALT正常且HBV DNA水平低（<2000 IU / mL）的HBeAg陰性CHB患者建議進行肝活檢或無創性方法進行組織病理學評估，然後確定用於抗病毒治療。 ALT> 20 U / L和HBV DNA≥2000 IU / mL是評估ALT正常的HBeAg陰性CHB患者的重要肝組織病理學的良好獨立預測因素。

臨床試驗註冊：中國臨床試驗註冊中心（ChiCTR-IOR-14005474）。

關鍵字：年齡；抗病毒治療；慢性乙型肝炎（CHB）患者； HBV DNA水平； HBeAg陰性；組織學評估；無效的運營商；肝活檢； ALT偏低；正常的丙氨酸氨基轉移酶（ALT）。