ALT 正常且无肝纤维化可检测到 HBV DNA 的亚洲慢性乙型肝炎患

StephenW

ALT 正常且无肝纤维化可检测到 HBV DNA 的亚洲慢性乙型肝炎患者存在肝脏炎症
刘嘉诚#1 、王建#2 3 、晓敏2 3 、薛瑞飞4 、捷展4 、苏灵江4 、于庚1 、刘依林1 、毛敏新1 、夏娟2 3 、殷盛夏2 3 、新同2 3 , 陈宇新3 5 , 魏茂丁6 , 黄瑞2 3 , 吴超1 2 3
隶属关系
隶属关系

    1
    【作者单位】： 南京中医药大学南京鼓楼医院中西医结合临床学院感染科,江苏南京
    2
    南京大学医学院附属南京鼓楼医院感染科，江苏南京。
    3
    南京大学病毒与传染病研究所，南京，江苏，中国。
    4
    南京医科大学南京鼓楼医院临床学院感染科，江苏南京。
    5
    南京大学医学院附属医院南京鼓楼医院检验科，江苏省南京市。
    6
    【作者单位】： 江苏省淮安市淮安市第四人民医院肝病科;

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同等贡献。

    PMID：34783181 DOI：10.1002/hep4.1859

抽象的

对于 HBV DNA 升高但没有其他抗病毒治疗指征的慢性乙型肝炎 (CHB) 患者，建议进行肝活检以排除明显的肝脏炎症。我们旨在调查具有可检测 HBV DNA 的亚洲 CHB 患者显着炎症的比例和决定因素。我们进行了一项横断面研究，该研究回顾性纳入了 581 名接受肝活检且可检测到 HBV DNA 的 CHB 患者。肝脏炎症和纤维化按 Scheuer 分类进行分期。显着炎症和显着纤维化分别定义为 G ≥ 2 和 S ≥ 2。 179 (30.8%) 名丙氨酸氨基转移酶 (ALT) < 1 × 正常上限 (ULN) 的患者，205 (35.3%) 名 ALT 1-2 × ULN 的患者和 197 (33.9%) 名 ALT > 2 的患者× ULN。共有 397 (68.3%) 名患者有明显的炎症，340 (58.5%) 名患者有明显的纤维化。在 85% 的有明显纤维化的患者和 44.8% 没有明显纤维化的患者中发现了明显的炎症。此外，在没有明显纤维化的情况下，28.7% 具有可检测到的 HBV DNA 和正常 ALT 的 CHB 患者有明显的炎症。中度 HBV DNA (5-7 log10 IU/mL) 是可检测到 HBV DNA 的 CHB 患者显着炎症的危险因素（优势比 [OR] 6.929，95% 置信区间 [CI] 2.830-16.966，P < 0.001） ，特别是对于在没有明显纤维化的情况下可检测到 HBV DNA 和正常 ALT 的患者（调整后的 OR 13.161，95% CI 1.026-168.889，P = 0.048）。结论：在没有明显纤维化的情况下，高比例的可检测到 HBV DNA 和正常 ALT 的 CHB 患者有明显的肝脏炎症。建议进行肝活检以评估此类患者的肝脏炎症，尤其是那些具有中度 HBV DNA 的患者。

© 2021 作者。由 Wiley Periodicals LLC 代表美国肝病研究协会出版的 Hepatology Communications。

StephenW

Presence of Liver Inflammation in Asian Patients With Chronic Hepatitis B With Normal ALT and Detectable HBV DNA in Absence of Liver Fibrosis
Jiacheng Liu #  1 , Jian Wang #  2   3 , Xiaomin Yan  2   3 , Ruifei Xue  4 , Jie Zhan  4 , Suling Jiang  4 , Yu Geng  1 , Yilin Liu  1 , Minxin Mao  1 , Juan Xia  2   3 , Shengxia Yin  2   3 , Xin Tong  2   3 , Yuxin Chen  3   5 , Weimao Ding  6 , Rui Huang  2   3 , Chao Wu  1   2   3
Affiliations
Affiliations

    1
    Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
    2
    Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
    3
    Institute of Viruses and Infectious Diseases, Nanjing University, Nanjing, Jiangsu, China.
    4
    Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China.
    5
    Department of Laboratory Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
    6
    Department of Hepatology, Huai'an No. 4 People's Hospital, Huai'an, Jiangsu, China.

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Contributed equally.

    PMID: 34783181 DOI: 10.1002/hep4.1859

Abstract

Liver biopsies are recommended to exclude significant liver inflammation in patients with chronic hepatitis B (CHB) with elevated HBV DNA but without other indications for antiviral treatment. We aimed to investigate the proportions and determinants of significant inflammation in Asian patients with CHB with detectable HBV DNA. We conducted a cross-sectional study that retrospectively included 581 patients with CHB with detectable HBV DNA who had undergone liver biopsy. Liver inflammation and fibrosis were staged by Scheuer's classification. Significant inflammation and significant fibrosis were defined as G ≥ 2 and S ≥ 2, respectively. There were 179 (30.8%) patients with alanine aminotransferase (ALT) < 1 × upper limit of normal (ULN), 205 (35.3%) patients with ALT 1-2 × ULN, and 197 (33.9%) patients with ALT > 2 × ULN. A total of 397 (68.3%) patients had significant inflammation, and 340 (58.5%) patients had significant fibrosis. Significant inflammation was found in 85% of patients with significant fibrosis and in 44.8% of patients without significant fibrosis. Furthermore, 28.7% of patients with CHB with detectable HBV DNA and normal ALT in the absence of significant fibrosis had significant inflammation. Moderate HBV DNA (5-7 log10 IU/mL) was a risk factor for significant inflammation (odds ratio [OR] 6.929, 95% confidence interval [CI] 2.830-16.966, P < 0.001) in patients with CHB with detectable HBV DNA, especially for patients with detectable HBV DNA and normal ALT in the absence of significant fibrosis (adjusted OR 13.161, 95% CI 1.026-168.889, P = 0.048). Conclusion: A high proportion of CHB patients with detectable HBV DNA and normal ALT in the absence of significant fibrosis have significant liver inflammation. Liver biopsies are recommended to evaluate liver inflammation in such patients, especially for those with moderate HBV DNA.

© 2021 The Authors. Hepatology Communications published by Wiley Periodicals LLC on behalf of American Association for the Study of Liver Diseases.

StephenW

https://aasldpubs.onlinelibrary. ... t/10.1002/hep4.1859