摘要
[目的]探明慢性乙型肝炎病毒（HBV）感染者接受核苷（酸）类似物（NA）治疗至HBV DNA降至不可检测水平后,丙氨酸氨基转移酶（ALT）仍然异常的高危因素.[方法]2006年1月至2014年2月期间,回顾加前瞻性随访核苷（酸）类似物初始治疗至HBV DNA阴转（＜20 IU/mL）后的慢性HBV感染者（n=388）,对比ALT复常者（n=298）及异常者[n=90;定义为在每1～3个月的随访间隔中,连续2次以上ALT＞ 40 U/L（男）或＞35 U/L（女）]的临床特征,使用logistic多因素回归分析ALT异常的高危因素.[结果]总随访中位数为42.0月.两组在人口学和病史数据（性别、年龄、乙肝/肝硬化/肝癌家族史、既往嗜酒史等）,基线特征（HBeAg阳性率、ALT、AST、HBV DNA水平等）,核苷（酸）类似物治疗方案构成比,治疗后的病毒学突破和优化治疗率、治疗中的肝癌发生率等,均无显著差异.但ALT异常组体质指数[（24.1±3.5） vs.（22.5±3.2）kg/m2,t=4.165,P＜0.001]、基线肝硬化比例（45.6％ vs.27.2％,P=0.001）和HBeAg转换率[58.1％（25/43） vs.39.2％（49/125）,P=0.016]高于ALT复常组.Logtistic多因素回归分析发现：抗病毒基线时即诊断肝硬化（OR=2.472,95％ CI=1.424-4.292,P=0.001）、高体质量指数（OR=1.170,95％ CI=1.077-1.271,P＜0.001）和治疗1年时HBV DNA水平（OR=1.727,95％ CI=1.017-2.933,P=0.043）是NA治疗至HBV DNA不可测后ALT仍然异常的独立危险因素.[结论]治疗前有肝硬化,更高的体质指数和治疗1年时HBV DNA的对数水平是慢性HBV感染者核苷（酸）类似物治疗至HBV DNA＜ 20 U/mL后,ALT持续异常的独立危险因素.
[Objective]To define the risk factors correlated with biochemical abnormality after complete viral response （CVR） in chronic hepatitis B （CHB） patients treated with nucleos（t）ide analogs （NA）.[Methods]A total of 388 chronically HBV infected patients ongoing naive NA therapy,who achieved undetectable serum HBV DNA （〈 20 U/mL） during January 2006 and February 2014,were retro-and prospectively followed.Patients were divided into two groups：patients with normal alanine aminotransferase （ALT） （n =298） and with abnormal ALT （n =90） （defined as serum ALT 〉 40 U/L in male or 〉35 U/L in female at least twice consecutively with a interval of 1-3 months after achieving undetectable HBV DNA）.Logistic regression analysis was used to screen the risk factors of ALT abnormality.[Results]The median follow-up duration was 42.0 months.The demographic characteristics （gender,age,family history of HBV infection/cirrhosis/hepatocellular carcinoma （HCC）,alcohol abuse history,et al）,baseline data （HBeAg positivity,ALT,AST,HBV DNA level,et al）,antiviral agents,rates of viral breakthrough or optimized therapy and progressing to HCC during therapy,were comparable in both groups.The body mass index （BMI） （24.1±3.5 vs.22.5±3.2 kg/m2,P 〈 0.001）,rates of preexisting cirrhosis （45.6% vs.27.2%,P =0.001） and HBeAg seroconversion （58.1% （25/43） vs.39.2% （49/ 125）,P =0.016） in the patients with abnormal ALT levels were higher than patients with normal ALT levels.Multivariate logistic regression analysis showed preexisting cirrhosis （OR =2.472,95% CI =1.424-4.292,P =0.001）,higher BMI （OR=1.170,95% CI =1.077-1.271,P〈0.001）,and HBV DNA levels at year 1 （OR=1.727,95% CI =1.017-2.933,P =0.043） rather than baseline HBV DNA levels,antiviral agents or alcohol intake,were independent risk factors for ALT abnormality after achieving undetectable HBV DNA.[Conclusion]Patients with preexisting cirrhosis,higher BMI and HBV DNA levels at year 1 were more likely to show abnormal ALT levels even after achieving undetectable HBV DNA during NA therapy.
出处
《中山大学学报（医学科学版）》
CAS
CSCD
北大核心
2014年第4期525-532,共8页
Journal of Sun Yat-Sen University:Medical Sciences
基金
"十二五"重大科技专项:艾滋病和病毒性等重大传染病防治(2012ZX10004-902)
关键词
核苷(酸)类似物
慢性乙型肝炎
病毒学应答
生化学异常
nucleos （t）ide analogues
chronic hepatitis B
complete viral response
biochemical abnormality
