丙氨酸氨基转移酶正常或轻度升高的慢性乙型肝炎患者抗病毒疗效的影响因素

The related factors of antiviral response in ALT normal or mild elevated patients with chronic hepatitis B

目的探讨肝组织学、丙氨酸氨基转移酶(ALT)等因素与慢性乙型肝炎抗病毒疗效的相关性。方法回顾性分析首都医科大学附属北京地坛医院2005至2010年住院行肝组织活检后抗病毒治疗的慢性HBV感染者共81例,采集患者抗病毒治疗基线人口学、生化学、病毒学及肝组织学结果并收集患者抗病毒治疗随访过程中病毒学指标动态下降情况,分析此类患者抗病毒治疗应答相关因素。结果共纳入患者81例,其中男性60例;平均年龄36.5岁。肝组织学活检提示,肝脏炎症和纤维化≥G2S2者54例(66.7%);肝脏炎症和纤维化<G2S2者27例(33.3%);治疗24周病毒学应答患者63例(77.8%)。肝组织学炎症或纤维化等级、ALT水平及患者平均年龄在抗病毒治疗应答组与无应答组差异均具有统计学意义(P均<0.05)。抗病毒药物类型[干扰素/核苷(酸)类似物]与患者病毒学应答无显著相关。结论 ALT持续正常或轻度异常(<2×ULN)的慢性乙型肝炎患者抗病毒疗效与患者肝组织学炎症/纤维化程度及ALT水平显著相关,建议此类患者行肝组织活检以评价抗病毒指征及预测抗病毒疗效。

Objective To investigate the relationship among liver histology features, alanine aminotransferase （ALT） level or other factors with the effect of antiviral treatment for patients with chronic hepatitis B （CHB）. Methods Total of 81 cases with CHB who accepted liver biopsy in Beijing Ditan Hospital, Capital Medical University from 2005 to 2010 were analyzed, respectively. The baseline demographic for antiviral therapy, results of biochemistry, viral and liver histology were collected, meanwhile with the dynamic decline of indicators of viral during the follow-up process and the possible related factors of antiviral response were also analyzed. Results Among the 81 patients, there were 60 males, with the mean age of 36.5 years old. Liver infammation and fbrosis of these patients were detected. There were 54 cases （66.7%） with liver infammation and fbrosis ≥ G2S2, and 27 cases （33.3%） were 〈 G2S2. There were 63 cases （77.8%） with 24 weeks of treatment achieved viral response. There were signifcant differences on the degree of liver infammation, fbrosis ALT levels and average ages between the CHB patients who received antiviral treatment and had better virological response and with poor virological response （P all 〈 0.05）. While there were no significant differences between the types of antiviral treatment [interferon （IFN） vs nucleoside （acid） analogue] of the patients with CHB virological response. Conclusions Antiviral treatment effect of CHB patients with persistently normal or mildly abnormal ALT level （〈 2 × ULN） were signifcantly correlated with the levels of ALT in patients with liver fbrosis and the degree of liver infammation and fbrosis, so the patients with persistently normal or mildly abnormal ALT level （〈 2 × ULN） were advised to accept liver biopsy to evaluate antiviral condictions and effects.