Significant Histologic Changes Are Not Rare in Treatment-naive Hepatitis B Patients with Normal Alanine Aminotransferase Level:A Meta-analysis  

作　　者：Chi Zhang Jia-Wen Li Zhao Wu Hong Zhao Gui-Qiang Wang 

机构地区：[1]Department of Infectious Disease,Center for Liver Disease,Peking University First Hospital,Xicheng District,Beijing,China [2]The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases,Zhejiang University,Hangzhou,Zhejiang,China [3]Peking University International Hospital,Beijing,China

出　　处：《Journal of Clinical and Translational Hepatology》2021年第5期615-625,共11页临床与转化肝病杂志（英文版）

基　　金：This study was supported by the China Mega-Project for Infectious Diseases(Grant Nos.2017ZX10203202 and 2013ZX10002005);the China Mega-Project for Innovative Drugs(Grant No.2016ZX09101065).

摘　　要：Background and Aims:Chronic hepatitis B is the main cause of liver cancer.However,the most neglected group has been treatment-naive chronic hepatitis B patients with normal alanine aminotransferase(ALT).People have tended to subjectively assume that the liver lesions of these patients are not serious and do not need antiviral treatment.However,the truth is not as optimistic as we thought.We aimed in this study to analyze the proportion of significant inflammation or fibrosis in aforementioned patients.Methods:Medline,Embase,and Cochrane Library were searched up to January 10th 2020,to identify studies of these patients with liver biopsy.The double arcsine method was used with a random-effect model to combine the proportion of significant inflammation or fibrosis.Potential heterogeneity was explored by subgroup analysis and meta-regression.Outcome of interests included the proportion of significant inflammation or fibrosis and cirrhosis.The secondary outcome was to find the risk factors of significant histological changes.Results:Nineteen eligible studies,with 2,771 participants,were included.The pooled proportion of significant inflammation or fibrosis was 35%[95%confidence interval(CI):27 to 43]and 30%(95%CI:25 to 36),respectively.The pooled proportion of cirrhosis was 3%[95%CI:1 to 5,(12 studies;1,755 participants)].In subgroup analysis,old age[vs.young(<40 years-old),44%vs.26%,p=0.012]was significantly associated with higher fibrosis stage as well as cirrhosis[vs.young(<40 years-old),4.8%vs.1.8%,p<0.001].Conclusions:About 1/3 of the treatment-naive chronic hepatitis B patients with normal ALT show significant histological changes,and some even have cirrhosis.

关 键 词：Significant histologic changes Chronic hepatitis B Normal ALT META-ANALYSIS 

分 类 号：R57[医药卫生—消化系统]