丙氨酸转氨酶复常在乙型肝炎抗病毒治疗中的价值

Alanine aminotransferase normalization with antiviral therapies in hepatitis B

中国当前的慢性乙型肝炎病毒(HBV)携带者占全球的三分之一。对于中国庞大的HBV感染人群,制定可达到病毒学抑制并改善临床预后的治疗策略至关重要。研究显示,丙氨酸转氨酶(ALT)水平与肝病进展和肝脏并发症的发生率显著关联,而ALT水平亦是决定是否开始抗HBV治疗的一项重要指标。临床上通常只在ALT水平高于2倍正常值上限时,才考虑开始抗病毒治疗。然而,ALT水平正常或低水平升高并不代表肝组织无变化。数项研究提示,ALT水平正常或低水平升高与肝病进展显著关联。如果把ALT水平高水平升高作为抗HBV治疗适应证的必要条件之一,许多患者可能会被忽略而延误治疗。这提示或许应考虑将抗HBV治疗的关口前移。现主要探讨ALT水平对抗HBV治疗的指导意义以及ALT复常对慢性乙型肝炎患者病情进展与临床预后的价值,并比较不同抗HBV药物ALT复常率的差异,讨论目前乙型肝炎抗病毒治疗适应证的局限性,为完善乙型肝炎抗病毒治疗指征提供参考。

Currently, one-third of the world's chronic hepatitis B virus (HBV) carriers are in China. Therefore, it is important to develop treatment strategies that can accomplish virological suppression and improve clinical outcomes for China's huge HBV-infected population. Studies have shown that alanine aminotransferase (ALT) levels are significantly associated with the progression of liver disease, incidence of liver complications as well as an important indicator for deciding whether to initiate anti-HBV treatment. Clinically, antiviral therapy is usually only considered when the ALT level is greater than 2 times the upper limit of normal. However, a normal or low and elevated level of ALT does not mean that there is no change in liver tissues status. Several studies have suggested that normal or low and elevated levels of ALT are significantly associated with the progression of liver disease. In this context, if the level of ALT is considered as one of the mandatory requirements for the indication of anti-HBV therapy, many patients may be neglected and delayed in treatment, suggesting that the anti-HBV treatment threshold should be considered. Now, from the above discussion, this article mainly summarizes the guiding significance of ALT level in anti-HBV treatment and the value of ALT normalization in the state of illness and clinical prognosis, and also compares the difference of ALT normalization rates among different anti-HBV drugs for chronic hepatitis B patients. Besides this, it also states the limitations of current indications for anti-HBV therapy, so as to provide reference for improving the indications.