Longitudinal Change of Body Mass Index Is Associated With Alanine Aminotransferase Elevation After Complete Viral Suppression in Chronic Hepatitis B Patients
Longitudinal Change of Body Mass Index Is Associated With Alanine Aminotransferase Elevation After Complete Viral Suppression in Chronic Hepatitis B Patients
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慢性乙型肝炎患者完全病毒抑制后体重指数的纵向变化与丙氨酸转氨酶升高相关
DOI：
10.1093/infdis/jiz326
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发表时间：
2019-11-01
影响因子：
6.4
通讯作者：
Hou, Jinlin
中科院分区：
文献类型：
--
作者：
Wang, Kaifeng;Lin, Weiyin;Hou, Jinlin
背景慢性B型肝炎（CH B）患者病毒完全抑制后丙氨酸氨基转移酶（ALT）升高的原因和干预措施知之甚少。在这项前瞻性队列研究中，入组了接受核苷（酸）类似物治疗并维持B型肝炎病毒（HBV）脱氧核糖核酸（DNA）不可检测水平至少6个月的CH B患者。患者每6个月随访一次，并进行人体测量、生化和病毒学评估。在1965例中位随访18.36个月的患者中，三分之一的患者发生ALT升高。基线高体重指数（BMI定义为>= 25 kg/m2）、年轻和肝硬化独立增加纵向ALT升高的风险。随访结束时，89例（4.8%）患者恢复为低BMI，92例（5.0%）患者发展为高BMI。与持续高BMI相比，恢复至低BMI降低了ALT升高的风险（校正比值比[aOR]，0.38; 95%可信区间[CI]，0.19-0.77）;与持续低BMI相比，高BMI的发生增加了ALT升高的风险（aOR，1.78; 95%CI，1.02-3.11）。高BMI是HBV DNA完全抑制后ALT升高的独立预测因子。BMI的改善可能对ALT正常化甚至长期结果产生有益影响。
Background. Little is known about cause and intervention for alanine aminotransferase (ALT) elevation after complete viral suppression in patients with chronic hepatitis B (CHB).Methods. In this prospective cohort study, patients with CHB who were treated with nucleos(t)ide analogs and maintained undetectable levels of hepatitis B virus (HBV) deoxyribonucleic acid (DNA) for at least 6 months were enrolled. Patients were followed up at 6-month intervals, and anthropometric, biochemical, and virological assessments were performed.Results. Of 1965 patients with median follow-up of 18.36 months, one third of patients experienced ALT elevation. Baseline high body mass index ([BMI] defined as >= 25 kg/m(2)), younger age, and liver cirrhosis independently increased the risk of longitudinal ALT elevation. At the end of follow-up, 89 (4.8%) patients reverted to low BMI, and 92 (5.0%) developed to high BMI. Compared with persistent high BMI, reversion to low BMI reduced the risk of ALT elevation (adjusted odds ratio [aOR], 0.38; 95% confidence interval [CI], 0.19-0.77); compared with persistent low BMI, onset of high BMI increased the risk of ALT elevation (aOR, 1.78; 95% CI, 1.02-3.11).Conclusions. High BMI is an independent predictor for ALT elevation after complete HBV DNA suppression. Improvement of BMI may have a beneficial effect on ALT normalization and even long-term outcomes.