高正常ALT慢性乙型肝炎患者应否启动抗病毒治疗  

Should antiviral treatment be initiated for chronic hepatitis B patients with high-normal alanine aminotransferase?

作　　者：李欣洁 沈弢 庄辉 LI Xinjie;SHEN Tao;ZHUANG Hui(Department of Microbiology and Center of Infectious Diseases,Peking University Health Science Center,Beijing 100191,China)

机构地区：[1]北京大学医学部病原生物学系和感染病中心,北京100191

出　　处：《临床肝胆病杂志》2023年第8期1769-1774,共6页Journal of Clinical Hepatology

摘　　要：现行指南建议对ALT升高和HBV DNA阳性慢性乙型肝炎(CHB)患者给予抗病毒治疗。但越来越多的研究表明,血清高正常ALT(0.5~1倍正常值上限)慢性HBV感染者的肝组织可见显著坏死炎症和/或纤维化,并存在进展性肝病如肝硬化、肝细胞癌、乙型肝炎相关并发症甚至死亡的风险。本文讨论了血清高正常ALT的定义、血清高正常ALT慢性乙型肝炎患者的临床和病毒学特点,以及对此类患者应否启动抗病毒治疗。Current guidelines recommend antiviral treatment for chronic hepatitis B(CHB)patients with elevated alanine aminotransferase(ALT)and positive HBV DNA.However,more and more studies have shown that CHB patients with high-normal ALT 0.5 to 1 times the upper limit of normal have significant necroinflammation and/or fibrosis in the liver and the risk of progressive liver diseases such as liver cirrhosis,hepatocellular carcinoma,hepatitis B-related complications,and even death.This article discusses the definition of high-normal ALT and the clinical and virological features of CHB patients with high-normal ALT,as well as whether antiviral treatment should be initiated for such patients.

关 键 词：乙型肝炎 慢性 丙氨酸转氨酶 治疗学 

分 类 号：R512.62[医药卫生—内科学]