ALT异常的初治CHB患者抗病毒疗效分析  

Analysis of antiviral efficacy in initial treatment of CHB patients with abnormal ALT

作　　者：艾骞 赵智蓉 吴月 李海雯 李晓非 杨永锐 AI Qian;ZHAO Zhirong;WU Yue;LI Haiwen;LI Xiaofei;YANG Yongrui(School of Public Health,Dali University,Dali Yunnan 671000,China;Department of Science and Education and Academy,Third People's Hospital of Kunming/Yunnan Provincial Clinical Medical Center,Kunming Yunnan 650041,China)

机构地区：[1]大理大学公共卫生学院,云南大理671000 [2]昆明市第三人民医院/云南省传染性疾病临床医学中心科教学术部,云南昆明650041

出　　处：《云南医药》2024年第6期38-43,共6页Medicine and Pharmacy of Yunnan

基　　金：昆明市科技计划项目(2023-1-NS-03)。

摘　　要：目的分析新版指南下ALT异常初治CHB患者给予抗病毒治疗的疗效。方法选取2020年4月-2024年4月昆明市第三人民医院就诊的初治CHB患者,分析治疗组和未治疗组在时间段上临床指标变化。结果(1)治疗组48周HBV-DNA载量和HBsAg滴度较治疗前降低,差异有统计学意义(P<0.05),未治疗组呈上升趋势,差异无统计学意义(P>0.05)。(2)治疗组48周ALT、TBIL、GGT、AFP较治疗前明显下降,高病毒载量组GGT较基线差异具有统计学意义(P<0.05),未治疗组48周ALT、AFP较基线升高,其AFP值较基线显著升高,差异具有统计学意义(P<0.05)。(3)治疗组高、低病毒载量患者ALT复常率分别为46.15%(24/52)和57.41%(31/54),未治疗组为9.52%(4/42)。(4)治疗组高病毒载量患者的APRI和FIB-4分别较基线下降0.04和0.01,差异有统计学意义(P<0.05)。结论治疗组48周HBV-DNA载量、生化学指标及肝纤维化程度均较未治疗组明显改善,新版指南下对ALT异常初治CHB患者给予抗病毒治疗可获益。Objective To analyze the curative effect of antiviral therapy in CHB patients with abnormal ALT under the new guidelines.Methods Newly treated CHB patients from Kunming Third People's Hospital from April 2020 to April 2024 were selected to analyze the changes of clinical indicators in the treated group and the untreated group.Results 1.HBV-DNA load and HBsAg titer at 48 weeks in the treated group were lower than those before treatment,the difference was statistically significant(P<0.05),while the untreated group showed an increasing trend,the difference was not statistically significant(P>0.05).2.ALT,TBIL,GGT and AFP at 48 weeks in the treatment group were significantly lower than before treatment,and GGT in the high viral load group had statistically significant difference from baseline(P<0.05),while ALT and AFP were significantly higher than baseline in the untreated group at 48 weeks,and the AFP value was significantly higher than baseline,with statistical significant difference(P<0.05).3.ALT relapse rates in patients with high and low viral load were 46.15%(24/52)and 57.41%(31/54)in the treated group,and 9.52%(4/42)in the untreated group.4.APRI and FIB-4 of patients with high viral load in the treatment group were decreased by 0.04 and 0.01 from baseline,respectively,with statistical significant difference(P<0.05).Conclusions The HBV-DNA load,biochemical indexes and degree of liver fibrosis at 48 weeks in the treatment group were significantly improved compared with those in the untreated group,and antiviral therapy for initial treatment of CHB patients with abnormal ALT could benefit from the new guidelines.

关 键 词：慢性乙型病毒性性肝炎 HBV-DNA阳性 ALT阈值 抗病毒治疗 

分 类 号：R512.62[医药卫生—内科学]