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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 37 Issue 8
Aug.  2021
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Article Navigation >  Journal of Clinical Hepatology  > 2021  >  37(8): 1789-1792

Clinical effect of entecavir antiviral therapy in chronic hepatitis B patients with persistently normal alanine aminotransferase and mild liver histological abnormalities

DOI: 10.3969/j.issn.1001-5256.2021.08.009

  • Guangxi Key Laboratory of AIDS Prevention and Treatment, Department of Infectious Diseases, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China

Research funding:

National "Thirteenth Five-Year Plan" AIDS and Viral Hepatitis and Other Major Infectious Diseases Prevention and Control Technology Major Special Projects (2017ZX10202201)

  • Received Date: 2020-12-16
  • Accepted Date: 2021-02-01
  • Published Date: 2021-08-20
    Abstract
  •   Objective  To investigate the clinical effect of entecavir antiviral therapy in chronic hepatitis B (CHB) patients with persistently normal alanine aminotransferase (PNALT) and mild liver histological abnormalities.  Methods  A retrospective analysis was performed for 181 patients with hepatitis B virus (HBV) infection who were admitted to The First Affiliated Hospital of Guangxi Medical University from January 2008 to January 2018, and according to the baseline ALT level, they were divided into study group (61 patients with PNALT at baseline), control group 1 [62 patients with an ALT level of (1-2)×upper limit of normal (ULN)], and control group 2 (58 patients with an ALT level of > 2×ULN). Entecavir antiviral therapy was given for at least 1 year, and clinical outcome was compared between the three groups. The life-table method was used to calculate the cumulative progression rates and annual incidence rates of virologic response, HBeAg serological response, and virologic breakthrough. An analysis of variance was used for comparison of continuous data between groups, and the SNK method was used for further comparison between two groups; the chi-square test was used for comparison of categorical data between groups.  Results  Among the 181 patients enrolled in this study, there were 124 male patients (68.5%) and 80 patients with positive HBeAg (44.2%), with a mean follow-up time of 3.63 years. The three groups had a mean annual incidence rate of virologic response of 74.37%, 71.89%, and 74.21%, respectively (χ2=2.91, P=0.371) and an annual incidence rate of virologic breakthrough of 3.48%, 5.17%, and 2.73%, respectively (χ2=1.72, P=0.097). For the patients with positive HBeAg, the three groups had a mean annual clearance rate of 9.79%, 37.16%, and 38.24%, respectively (χ2=1.37, P=0.01) and a mean annual HBeAg seroconversion rate of 9.10%, 31.35%, and 36.74%, respectively (χ2=5.61, P=0.021); the study group had significantly lower mean annual clearance rate and seroconversion rate of HBeAg than the control groups 1 and 2 (all P < 0.05).  Conclusion  CHB patients with PNALT level can obtain satisfactory virologic response after entecavir antiviral therapy, while immunological response needs to be further improved.

     

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    • References(19)
  • [1]
    LIAW YF, LEUNG N, KAO JH, et al. Asian-Pacific consensus statement on the management of chronic hepatitis B: A 2008 update[J]. Hepatol Int, 2008, 2(3): 263-283. DOI: 10.1007/s12072-008-9080-3.
    [2]
    HAN SH. Natural course, therapeutic options and economic evaluation of therapies for chronic hepatitis B[J]. Drugs, 2006, 66(14): 1831-1851. DOI: 10.2165/00003495-200666140-00005.
    [3]
    CHU CM, HUNG SJ, LIN J, et al. Natural history of hepatitis B e antigen to antibody seroconversion in patients with normal serum aminotransferase levels[J]. Am J Med, 2004, 116(12): 829-834. DOI: 10.1016/j.amjmed.2003.12.040.
    [4]
    CHEN CJ, YANG HI, SU J, et al. Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level[J]. JAMA, 2006, 295(1): 65-73. DOI: 10.1001/jama.295.1.65.
    [5]
    ILOEJE UH, YANG HI, SU J, et al. Predicting cirrhosis risk based on the level of circulating hepatitis B viral load[J]. Gastroenterology, 2006, 130(3): 678-686. DOI: 10.1053/j.gastro.2005.11.016.
    [6]
    HSU YS, CHIEN RN, YEH CT, et al. Long-term outcome after spontaneous HBeAg seroconversion in patients with chronic hepatitis B[J]. Hepatology, 2002, 35(6): 1522-1527. DOI: 10.1053/jhep.2002.33638.
    [7]
    BOXALL EH, SIRA J, STANDISH RA, et al. Natural history of hepatitis B in perinatally infected carriers[J]. Arch Dis Child Fetal Neonatal Ed, 2004, 89(5): f456-f460. DOI: 10.1136/adc.2002.009837.
    [8]
    LIAW YF. Prevention and surveillance of hepatitis B virus-related hepatocellular carcinoma[J]. Semin Liver Dis, 2005, 25 (Suppl 1): 40-47. DOI: 10.1055/s-2005-915649.
    [9]
    DU X, WANG J, SHAO L, et al. Histological improvement of long-term antiviral therapy in chronic hepatitis B patients with persistently normal alanine aminotransferase levels[J]. J Viral Hepat, 2013, 20(5): 328-335. DOI: 10.1111/jvh.12034.
    [10]
    PAPACHRYSOS N, HYTIROGLOU P, PAPALAVRENTIOS L, et al. Antiviral therapy leads to histological improvement of HBeAg-negative chronic hepatitis B patients[J]. Ann Gastroenterol, 2015, 28(3): 374-378.
    [11]
    Chinese Society of Infectious Diseases, Chinese Medical Association; Chinese Society of Hepatology, Chinese Medical Association. Guidelines for the prevention and treatment of chronic hepatitis B (version 2019)[J]. J Clin Hepatol, 2019, 35(12): 2648-2669. DOI: 10.3969/j. issn.1001-5256. 2019. 12. 007.

    中华医学会感染病学分会, 中华医学会肝病学分会. 慢性乙型肝炎防治指南(2019年版)[J]. 临床肝胆病杂志, 2019, 35(12): 2648-2669. DOI: 10.3969/j.issn.1001-5256.2019.12.007.
    [12]
    DING Y, DOU XG. Antiviral therapeutic strategies for chronic hepatitis B patients with a normal alanine aminotransferase level[J]. J Clin Hepatol, 2018, 34(5): 926-929. DOI: 10.3969/j.issn.1001-5256.2018.05.003.

    丁洋, 窦晓光. ALT正常的慢性乙型肝炎抗病毒治疗策略[J]. 临床肝胆病杂志, 2018, 34(5): 926-929. DOI: 10.3969/j.issn.1001-5256.2018.05.003.
    [13]
    OU WN, ZHANG N, WANG XM, et al. The related factors of antiviral response in ALT normal or mild elevated patients with chronic hepatitis B[J/CD]. Chin J Exp Clin Infect Dis(Electronic Edition), 2016, 10(4): 417-421. DOI: 10.3877/cma.j.issn.1674-1358.2016.04.007.

    欧蔚妮, 张娜, 王笑梅, 等. 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[J/CD]. 中华实验和临床感染病杂志(电子版), 2016, 10(4): 417-421. DOI: 10.3877/cma.j.issn.1674-1358.2016.04.007.
    [14]
    WANG ZY, WEI W. Retrospective analysis of lamivudine in the treatment of 104 HBeAg positive carriers[J]. Chin J Integr Tradit West Med Liver Dis, 2004, 14(5): 301-303. DOI: 10.3 969/j.issn.1005-0264.2004.05.022.

    王震宇, 魏蔚. 拉米夫定治疗104例HBeAg阳性携带者回顾性分析[J]. 中西医结合肝病杂志, 2004, 14(5): 301-303. DOI: 10.3 969/j.issn.1005-0264.2004.05.022.
    [15]
    CHAN HL, CHAN CK, HUI AJ, et al. Effects of tenofovir disoproxil fumarate in hepatitis B e antigen-positive patients with normal levels of alanine aminotransferase and high levels of hepatitis B virus DNA[J]. Gastroenterology, 2014, 146(5): 1240-1248. DOI: 10.1053/j.gastro.2014.01.044.
    [16]
    CAO H, ZHANG W. Research progress of Immunological factors influencing HBeAg seroconversion across chronic hepatitis B patients treated with nucleos (t)ide analogues[J]. J Prac Hepatol, 2017, 20(3): 372-376. DOI: 10.3969/j.issn.1672-5069.2017.03.035.

    曹辉, 张玮. 核苷(酸)类药物治疗慢性乙型肝炎患者影响HBeAg血清转换的免疫学因素研究进展[J]. 实用肝脏病杂志, 2017, 20(3): 372-376. DOI: 10.3969/j.issn.1672-5069.2017.03.035.
    [17]
    FU JX, JIANG JN, SU MH, et al. Analysis on factors affecting hbeag seroconversion in hbeag positive patients after initial treatment with nucleotide analogues[J]. J Guangxi Med Univ, 2016, 33(2): 262-265. DOI: 10.16190/j.cnki.45-1211/r.2016.02.020.

    付嘉鑫, 江建宁, 苏明华, 等. 核苷酸类似物初治HBeAg阳性患者发生HBeAg血清学转换的影响因素分析[J]. 广西医科大学学报, 2016, 33(2): 262-265. DOI: 10.16190/j.cnki.45-1211/r.2016.02.020.
    [18]
    YU LF, LIANG WF, ZHANG SP, et al. Baseline HBsAg and ALT levels are important forecasting factors of HBeAg seroconversion in HBeAg positive chronic hepatitis B treated with telbivudine[J]. Chin J Microecol, 2014, 26(2): 184-187. DOI: 10.13381/j.cnki.cjm.201402015.

    俞立飞, 梁伟峰, 章松平, 等. 基线HBsAg和ALT水平是替比夫定治疗HBeAg阳性慢性乙型肝炎患者e抗原血清学转换的重要预测因素[J]. 中国微生态学杂志, 2014, 26(2): 184-187. DOI: 10.13381/j.cnki.cjm.201402015.
    [19]
    WU P, CONG R, YOU H. Influencing factors of HBeAg seroconversion in patients with chronic hepatitis B[J]. J Prac Hepatol, 2010, 13(6): 474-476. DOI: 10.3969/j.issn.1672-5069.2010.06.029.

    吴鹏, 丛瑞, 尤红. 慢性乙型肝炎患者HBeAg血清学转换的影响因素[J]. 实用肝脏病杂志, 2010, 13(6): 474-476. DOI: 10.3969/j.issn.1672-5069.2010.06.029.
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