ALT正常伴肝脏病理轻度炎症或肝纤维化慢性乙型肝炎患者的长期治疗结局  

Long-term therapeutic outcomes of antiviral treatment in patients with chronic hepatitis B infection with normal alanine aminotransferase,mild liver inflammation,and fibrosis

作　　者：时怡纯 谭友文 Shi Yichun;Tan Youwen(Dingshu Town Health Center,Yixing 214200,China;Department of Hepatology,The Third Hospital of Zhenjiang Affiliated Jiangsu University,Zhenjiang 212003,China)

机构地区：[1]宜兴市丁蜀镇卫生院,宜兴214200 [2]江苏大学附属镇江三院肝病科,镇江212003

出　　处：《中华肝脏病杂志》2024年第S2期8-13,共6页Chinese Journal of Hepatology

基　　金：江苏大学医教协同创新基金(JDY2023019)

摘　　要：目的探讨丙氨酸转氨酶(ALT)正常伴轻度及以下的炎症或肝纤维化慢性乙型肝炎(CHB)患者抗病毒治疗的远期预后结局。方法采用回顾性研究的方法。收集2005年1月至2022年7月期间于江苏大学附属镇江第三人民医院进行过肝穿刺活组织检测的CHB患者。收集基线数据、随访终点时的临床资料以及临床结局事件。用cox比例风险回归以及Kaplan-Meier生存分析评估临床事件的发生风险。结果共纳入了149例ALT正常的CHB患者,均伴轻度及以下炎症或纤维化,86例行抗病毒治疗,63例未予抗病毒治疗。随访时间为82.00(45.50,153.00)个月。随访终点事件:抗病毒组有4例(4.65%,4/86)发生肝硬化,未有患者发生肝细胞癌;未抗病毒组有5例肝硬化(7.94%,5/63),2例(3.17%,2/63)肝细胞癌。Kaplan-Meier生存分析显示未抗病毒治疗组与基线ALT正常但高水平患者组发生临床事件的累积风险升高,但差异无统计学意义(P>0.05);存在肝纤维化与临床事件风险增加相关(P<0.05)。Cox分析示基线年龄、ALT正常但高水平、存在肝纤维化是临床事件发生的独立危险因素。两组之间在末次HBV DNA低于检测值的比例及ALT正常的比例方面均存在显著差异(P<0.05)。然而,末次乙型肝炎表面抗原转阴率在两组之间差异无统计学意义(P>0.05)。结论对于ALT正常且伴轻度及以下炎症或肝纤维化的慢性乙型肝炎患者,抗病毒治疗未能显著改善远期肝脏不良事件的发生风险,但基线年龄、ALT水平较高和肝纤维化存在与临床结局不良相关,提示这些因素为临床事件发生的独立危险因素。Objective To study the long-term prognostic outcomes of antiviral therapy in patients with chronic hepatitis B(CHB)accompanied with normal alanine aminotransferase(ALT),mild or slight inflammation,and/or liver fibrosis.Methods A retrospective study method was used.Patients with CHB who underwent liver biopsy at Zhenjiang Third People's Hospital,affiliated with Jiangsu University,from January 2005 to July 2022 were included.Baseline data,clinical data,and clinical outcome events at the end of follow-up were collected.Cox proportional hazards regression and Kaplan-Meier survival analysis were used to assess the risk of clinical events.Results A total of 149 CHB cases with normal ALT with mild or slight inflammation or fibrosis were included.Eighty-six cases were treated with antiviral therapy,while 63 were not.The median follow-up time was 82.00(45.50,153.00)months.In the follow-up endpoint events,four cases(4.65%,4/86)in the antiviral group had liver cirrhosis,while none had progressed to hepatocellular carcinoma.Five cases(7.94%,5/63)in the non-antiviral group had liver cirrhosis,and two cases(3.17%,2/63)had hepatocellular carcinoma.Kaplan-Meier survival analysis showed that the cumulative risk of clinical events did not significantly increase in the non-antiviral group(P>0.05).The presence of liver fibrosis with high-normal ALT levels at baseline were associated with an increased risk of clinical events(P<0.05).Cox analysis showed that baseline age,high ALT level,and presence of liver fibrosis were independent risk factors for clinical events.The two groups differed significantly in terms of the proportion of HBVDNA below the detection value and ALT normalization rate at the endpoint(P<0.05).However,there was no significant difference in the HBsAg negative conversion rate between the two groups at the end(P>0.05).Conclusion The occurrence risk of long-term liver adverse events was not significantly improved by antiviral treatment in patients with chronic hepatitis B accompanied by normal ALT levels,mild or sligh

关 键 词：慢性乙型肝炎 丙氨酸转氨酶 抗病毒治疗 肝细胞癌 肝硬化 

分 类 号：R51[医药卫生—内科学]