Lowering the threshold of alanine aminotransferase for enhanced identification of significant hepatic injury in chronic hepatitis B patients  

作　　者：Hong-Sheng Yu Hao Jiang Ming-Kai Li Bi-Lan Yang Abdukyamu Smayi Jian-Ning Chen Bin Wu Yi-Dong Yang 

机构地区：[1]Department of Gastroenterology,The Third Affiliated Hospital of Sun Yat-Sen University,Guangzhou 510630,Guangdong Province,China [2]Department of Liver Disease,Guangdong Provincial Key Laboratory of Liver Disease Research,Guangzhou 510630,Guangdong Province,China [3]Department of Pathology,The Third Affiliated Hospital of Sun Yat-Sen University,Guangzhou 510630,Guangdong Province,China

出　　处：《World Journal of Gastroenterology》2023年第35期5166-5177,共12页世界胃肠病学杂志（英文版）

基　　金：The Natural Science Foundation of Guangdong Province for Distinguished Young Scholar,No.2022B1515020024;National Natural Science Foundation of China,No.82070574;The Natural Science Foundation Team Project of Guangdong Province,No.2018B030312009.

摘　　要：BACKGROUND The clinical and histological features of chronic hepatitis B(CHB)patients who fall into the"grey zone(GZ)"and do not fit into conventional natural phases are unclear.AIM To explore the impact of varying the threshold of alanine aminotransferase(ALT)levels in identifying significant liver injury among GZ patients.METHODS This retrospective analysis involved a cohort of 1617 adult patients diagnosed with CHB who underwent liver biopsy.The clinical phases of CHB patients were determined based on the European Association for the Study of the Liver 2017 Clinical Practice Guidelines.GZ CHB patients were classified into four groups:GZ-A(HBeAg positive,normal ALT levels,and HBV DNA≤10^(7) IU/mL),GZ-B(HBeAg positive,elevated ALT levels,and HBV DNA<10^(4) or>10^(7) IU/mL),GZC(HBeAg negative,normal ALT levels,and HBV DNA≥2000 IU/mL),and GZ-D(HBeAg negative,elevated ALT levels,and HBV DNA≤2000 IU/mL).Significant hepatic injury(SHI)was defined as the presence of notable liver inflammation(≥G2)and/or significant fibrosis(≥S2).RESULTS The results showed that 50.22%of patients were classified as GZ,and 63.7%of GZ patients developed SHI.The study also found that lowering the ALT treatment thresholds to the American Association for the Study of Liver Diseases 2018 treatment criteria(35 U/L for men and 25 U/L for women)can more accurately identify patients with significant liver damage in the GZ phases.In total,the proportion of patients with ALT≤40 U/L who required antiviral therapy was 64.86%[(221+294)/794].When we lowered the ALT treatment threshold to the new criteria(30 U/L for men and 19 U/L for women),the same outcome was revealed,and the proportion of patients with ALT≤40 U/L who required antiviral therapy was 75.44%[(401+198)/794].Additionally,the proportion of SHI was 49.1%in patients under 30 years old and increased to 55.3%in patients over 30 years old(P=0.136).CONCLUSION These findings suggest the importance of redefining the natural phases of CHB and using new ALT treatment thresholds for bet

关 键 词：Chronic hepatitis B Grey zone Indeterminate phase Alanine aminotransferase Antiviral therapy 

分 类 号：R512.62[医药卫生—内科学]