丙氨酸氨基转移酶正常或轻度升高的 HBeAg 阴性慢性乙型肝炎

StephenW

丙氨酸氨基转移酶正常或轻度升高的 HBeAg 阴性慢性乙型肝炎患者抗病毒治疗的有效性：一项回顾性研究

    Sufang Wei, Meixin Hu, Hongjie Chen, Qiuli Xie, Peng Wang, Hong Li & Jie Peng

BMC Gastroenterology 第 22 卷，文章编号：387 (2022) 引用本文

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抽象的
背景

关于丙氨酸氨基转移酶 (ALT) 正常或轻度升高的乙型肝炎 e 抗原 (HBeAg) 阴性慢性乙型肝炎 (CHB) 患者的抗病毒治疗效果的数据不充分，也没有组织学证据。本研究调查了抗病毒治疗对这些患者的影响。
方法

我们回顾性分析了 ALT 正常或轻度升高的 HBeAg 阴性 CHB 患者接受核苷/核苷酸类似物 (NAs) 治疗长达 96 周的抗病毒治疗结果。
结果

共有 128 名患者入组； 74名患者ALT正常，54名患者ALT轻度升高。在第 24、48 和 96 周时，病毒抑制的总累积率分别为 64.06%、81.97% 和 96.39%。在第 24、48 和 96 周时，ALT 正常组和轻度升高组的病毒抑制累积率分别为 67.85% 和 58.97%、86.39% 和 76.31%，以及 93.13% 和 97.04%。第 12 周的血清 HBV DNA 水平和第 24 周的乙型肝炎表面抗原 (HBsAg) 水平是 96 周病毒学应答的重要预测指标。在 128 名患者中，54 名 ALT 正常和 33 名 ALT 轻度升高在基线时接受了 FibroScan。 ALT正常组和ALT轻度升高组分别有44.4%（n = 24）和51.5%（n = 17）患者出现明显纤维化（F ≥ 2）。与基线值相比，肝脏硬度值在第 48 周（8.12 kPa 对 6.57 kPa；p < 0.001）和第 96 周（8.87 kPa 对 6.43 kPa；p < 0.001）分别显着下降。
结论

与 ALT 轻度升高的患者相似，ALT 正常的 HBeAg 阴性 CHB 患者可受益于 NAs 抗病毒治疗。强烈建议对 ALT 正常的 HBeAg 阴性 CHB 患者进行抗病毒治疗。此外，在 ALT 低于正常上限两倍的 HBeAg 阴性 CHB 患者中，明显的肝纤维化并不罕见，应定期对这些患者进行 FibroScan。

StephenW

Effectiveness of antiviral treatment in HBeAg-negative chronic hepatitis B patients with normal or mildly elevated alanine aminotransferase: a retrospective study

    Sufang Wei, Meixin Hu, Hongjie Chen, Qiuli Xie, Peng Wang, Hong Li & Jie Peng

BMC Gastroenterology volume 22, Article number: 387 (2022) Cite this article

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Abstract
Background

There are inadequate data and no histological evidence regarding the effects of antiviral treatment for hepatitis B e-antigen (HBeAg)-negative chronic hepatitis B (CHB) patients with normal or mildly elevated alanine aminotransferase (ALT). This study investigated the effects of antiviral treatment on these patients.
Methods

We retrospectively analysed the outcomes of antiviral treatment for HBeAg-negative CHB patients with normal or mildly elevated ALT who were treated with nucleoside/nucleotide analogues (NAs) for up to 96 weeks.
Results

A total of 128 patients were enrolled; 74 patients had normal ALT and 54 patients had mildly elevated ALT. The total cumulative rates of viral suppression were 64.06%, 81.97%, and 96.39%, at weeks 24, 48, and 96, respectively. The cumulative rates of viral suppression for the normal and mildly elevated ALT groups were 67.85% and 58.97%, 86.39% and 76.31%, and 93.13% and 97.04% at weeks 24, 48, and 96, respectively. The serum HBV DNA levels at week 12 and hepatitis B surface antigen (HBsAg) levels at week 24 were significant predictors of the 96-week virological response. Of the 128 patients, 54 with normal ALT and 33 with mildly elevated ALT underwent FibroScan at baseline. Significant fibrosis (F ≥ 2) was found in 44.4% (n = 24) and 51.5% (n = 17) of the patients in the normal ALT group and mildly elevated ALT group, respectively. Compared with the values at baseline, liver stiffness values significantly decreased at week 48 (8.12 kPa vs. 6.57 kPa; p < 0.001) and week 96 (8.87 kPa vs. 6.43 kPa; p < 0.001), respectively.
Conclusions

HBeAg-negative CHB patients with normal ALT could benefit from antiviral therapy with NAs, similar to patients with mildly elevated ALT. Antiviral treatment is strongly recommended for HBeAg-negative CHB patients with normal ALT. Additionally, significant liver fibrosis is not rare in HBeAg-negative CHB patients with ALT less than two-times the upper limit of normal, and FibroScan should be performed regularly for these patients.

StephenW

https://bmcgastroenterol.biomedc ... /s12876-022-02471-y