The clinical significance of persistently normal ALT in chronic hepatitis B infection
The clinical significance of persistently normal ALT in chronic hepatitis B infection
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DOI：
10.1016/j.jhep.2007.07.022
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发表时间：
2007-12-01
影响因子：
25.7
通讯作者：
Afdhal, Nezam H.
中科院分区：
文献类型：
--
作者：
Lai, Michelle;Hyatt, Benjamin J.;Afdhal, Nezam H.
背景/目的：慢性B型肝炎病毒（HBV）疾病是由坏死性炎症和活跃的病毒复制引起的。ALT水平作为肝损伤的预测因子的作用最近受到质疑。本研究的目的是确定ALT正常是否与接受肝活检的HBV患者队列中的肝损伤相关。方法：这是对慢性HBV患者分为3组的回顾性研究;（1）持续正常ALT（PNALT）;（2）ALT 1-1.5X ULN和（3）ALT > 1.5X ULN。结果：192例患者符合纳入标准，59例PNALT，26例ALT 1-1.5X ULN，107例ALT > 1.5X ULN。年龄增加、ALT升高、活检炎症分级升高和HBeAg阳性可预测纤维化。18%的PNALT患者患有2+期纤维化，34%患有2级或3级炎症。总体而言，37%的PNALT患者有显著的纤维化或炎症。亚组分析显示，大多数纤维化属于高正常ALT组，只有少数谁是年轻的和免疫耐受有显着的结果在biopsiz.Conclusions：有显着的纤维化和炎症在37%的患者PNALT和肝活检应考虑在40岁以上的患者ALT正常高。(c)2007年欧洲肝脏研究协会。Elsevier B. V.出版，保留所有权利。
Background/Aims: Chronic hepatitis B virus (HBV) disease is caused by both necroinflammation and active viral replication. The role of ALT levels as a predictor of liver injury has recently been questioned. The aim of the study was to determine whether normal ALT is associated with liver injury in a cohort of HBV patients undergoing liver biopsy.Methods: This is a retrospective review of chronic HBV patients divided into 3 groups; (1) persistently normal ALT (PNALT); (2) ALT 1-1.5X ULN and (3) ALT > 1.5X ULN. Multiple clinical, biochemical, virological variables were evaluated.Results: One hundred and ninety-two patients met the inclusion criteria, 59 with PNALT, 26 with ALT 1-1.5X ULN, and 107 with ALT > 1.5X ULN. Increasing age, higher ALT, higher grade of inflammation on biopsy, and HBeAg positivity predicted fibrosis. 18% of patients with PNALT had stage 2+ fibrosis and 34% had grade 2 or 3 inflammation. Overall 37% of patients with PNALT had significant fibrosis or inflammation. Subgroup analysis showed the majority with fibrosis belonged to the high normal ALT group and that only a minority who were young and immune tolerant had significant findings on biopsy.Conclusions: There is significant fibrosis and inflammation in 37% of patients with PNALT and a liver biopsy should be considered in patients older than 40 with high normal ALT. (c) 2007 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.