ALT持续正常的HBeAg阴性慢性HBV感染者临床特征

目的 分析ALT持续正常的HBeAg阴性慢性HBV感染者临床特征。 方法 回顾性收集60例2013年9月—2020年1月于延安大学附属医院感染病科门诊就诊的ALT持续正常HBeAg阴性慢性HBV感染者。比较患者基线和随访终点各指标的差异,统计随访结束时患者HBV DNA、HBsAg自然转阴以及肝炎活动、肝硬化和肝癌的累计发生率。计量资料两组间比较采用配对t检验或Wilcoxon符号秩和检验。 结果 所有患者随访24.00~72.00月,其中31例患者在随访过程中行肝组织活检,18例（58.1%）患者肝脏伴有轻度损伤,13例（41.9%）患者肝脏存在中度损伤。患者的HBsAg、HBeAb、HBcAb、ALT和ALB水平随访前和随访后差异均有统计学意义（P均<0.05）,而HBV DNA、AST和LSM水平差异均无统计学意义（P均>0.05）。随访结束时6例患者检测不到HBV DNA;4例患者出现HBsAg自然阴转;2例患者出现肝炎活动;2例患者发展为肝硬化;1例患者进展为肝细胞癌。 结论 约30.0%的ALT持续正常HBeAg阴性慢性HBV感染者有抗病毒治疗指征。此类患者如果条件允许应积极行肝组织活检评估肝脏损伤程度;临床医生也可以根据患者的病毒学、影像学和人口学特征直接给予抗病毒治疗。

Clinical characteristics of ALT persistent normal HBeAg-negative chronic HBV infection

Objective To analyse the clinical characteristics of HBeAg-negative chronic HBV infection with persistent normal ALT. Methods A retrospective study was conducted for 60 patients of ALT persistent normal HBeAg negative chronic HBV infection who were followed up in the outpatient department of Infection Department of the Affiliated Hospital of Yan'an University from September 2013 to January 2020. The indexes difference of baseline and end points of patients were compared . The cumulative rates of HBV DNA negative conversion, spontaneously HBsAg seroclearance, hepatitis activity, cirrhosis, and hepatocellular carcinoma at the end of follow-up were analyzed. The paired-samples t test or the Wilcoxon signed ranks test was used for comparison of continuous data between groups. Results All patients were followed up for 24.00-72.00 months,31 patients underwent liver biopsy during follow-up, 18（58.1%） had mild liver injury and 13（41.9%） had moderate liver injury. There were significant differences in the levels of HBsAg, HBeAb, HBcAb, ALT and ALB between the baseline and follow-up endpoints（P<0.05）, but the levels of HBV DNA, AST and LSM were no significant differences（P>0.05）. At the end of follow-up, 6 patients HBV DNA was not detected, 4 patients spontaneously occurred HBsAg seroclearance, 2 patients appeared hepatitis activity, 2 patients developed liver cirrhosis and 1 patient became liver cancer. Conclusion About 30.0% patients of HBeAg-negative chronic HBV infection with persistent normal ALT have indications of antiviral therapy. If conditions permit, the patients should actively perform liver biopsies to evaluate the degree of liver injury, otherwise clinicians can directly give antiviral treatment according to the virological, imaging and demographic characteristics of the patients.