吉林大学第一医院肝胆胰内科  赵旭  摘译

本文首次发表于[PLoS One. 2012;7(2):e32622. Epub 2012 Feb 28]

A Large Population Histology Study Showing the Lack of Association between ALT Elevation and Significant Fibrosis in Chronic Hepatitis B.

Background:

We determined the association between various clinical parameters and significant liver injury in both hepatitis B e antigen (HBe Ag)-positive and HBe Ag-negative patients.

Methods:

From 1994 to 2008, liver biopsy was performed on 319 treatment-naive CHB patients. Histologic  assessment was based on the Knodell histologic activity index for necroinflammation and the Ishak fibrosis staging for fibrosis.

Results:
211 HBe Ag-positive and 108 HBe Ag-negative patients were recruited, with a median age of 31 and 46 years respectively. 9 out of 40(22.5%)HBe Ag-positive patients with normal ALT had significant histologic abnormalities (necroinflammation grading $7 or fibrosis score $3). There was a significant difference in fibrosis scores among HBe Ag-positive patients with an ALT level within the Prati criteria (30U/L for men, 19U/L for women) and patients with a normal ALT but exceeding the Prati criteria (p= 0.024).Age, aspartate aminotransferase and platelet count were independent predictors of significant fibrosis in HBe Ag-positive patients with an elevated ALT by multivariate analysis (p=0.007, 0.047 and 0.045 respectively). HBV DNA and platelet count were predictors of significant fibrosis in HBe Ag-negative disease (p=0.020 and 0.015 respectively). An elevated ALT was not predictive of significant fibrosis for HBe Ag-positive (p=0.345)and -negative(p=0.544) disease. There was no significant difference in fibrosis staging among ALT 1–2*upper limit of normal (ULN) and >2ULN for both HBe Ag-positive (p=0.098) and–negative (p =0.838)disease.

Conclusion:

An elevated ALT does not accurately predict significant liver injury. Decisions on commencing antiviral therapy should not be heavily based on a particular ALT threshold.