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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Issue 5
May  2018
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Article Contents

Antiviral therapeutic strategies for chronic hepatitis B patients with a normal alanine aminotransferase level

DOI: 10.3969/j.issn.1001-5256.2018.05.003
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  • Received Date: 2018-01-15
  • Published Date: 2018-05-20
  • Alanine aminotransferase ( ALT) is one of the most sensitive biochemical parameters used to reflect the degree of liver injury. It is generally believed that patients with hepatitis B virus ( HBV) infection and a normal ALT level are in the immune tolerance state, and no antiviral therapy is required in patients without liver inflammation or those with mild liver inflammation. However, these patients are not always in the immune tolerance state, and the disease can insidiously progress to chronic hepatitis B ( CHB) , liver cirrhosis, and even hepatocellular carcinoma. Therefore, antiviral therapy for CHB patients with normal ALT has always been a hot topic of clinical research. This article elaborates on the association between ALT and liver inflammation in CHB patients and the timing of antiviral therapy for CHB patients with normal ALT.

     

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  • [1] Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B:a 2015 update[J].J Clin Hepatol, 2015, 31 (12) :1941-1960. (in Chinese) 中华医学会肝病学分会, 中华医学会感染病学分会.慢性乙型肝炎防治指南 (2015年更新版) [J].临床肝胆病杂志, 2015, 31 (12) :1941-1960.
    [2]TERRAULT NA, BZOWEJ NH, CHANG KM, et al.AASLD guidelines for treatment of chronic hepatitis B[J].Hepatology, 2016, 63 (1) :261-283.
    [3] SARIN SK, KUMAR M, LAU GK, et al.Asian-Pacific clinical practice guidelines on the management of hepatitis B:a 2015 update[J].Hepatol Int, 2016, 10 (1) :1-98.
    [4]European Association for the Study of the Liver.EASL clinical practice guidelines:management of chronic hepatitis B virus infection[J].J Hepatol, 2012, 57 (1) :167-185.
    [5] European Association for the Study of the Liver.EASL 2017 clinical practice guidelines on the management of hepatitis B virus infection[J].J Hepatol, 2017, 67 (2) :370-398.
    [6]WANG L, FAN YX, DING Y, et al.The comparison of liver inflammation and fibrosis between chronic HBV and HCV infection[J].Chin J Hepatol, 2017, 25 (6) :419-423. (in Chinese) 王琳, 樊耀昕, 丁洋, 等.乙型肝炎病毒和丙型肝炎病毒慢性感染者肝组织病理学炎症及纤维化对比分析[J].中华肝脏病杂志, 2017, 25 (6) :419-423.
    [7]LIAW YF, JIA JD, CHAN HL, et al.Shorter durations and lower doses of peginterferon alfa-2a are associated with inferior hepatitis B e antigen seroconversion rates in hepatitis B virus genotypes B or C[J].Hepatology, 2011, 54 (5) :1591-1599.
    [8]ZHENG X, WANG J, YANG D.Antiviral therapy for chronic hepatitis B in China[J].Med Microbiol Immunol, 2015, 204 (1) :115-120.
    [9]LI J, LIU ZQ, LU YF, et al.Analysis of correlations of age with liver pathological change and HBV DNA level in chronic HBV infection patients with normal ALT and mild ALT elevation[J].J Clin Hepatol, 2015, 31 (4) :537-540. (in Chinese) 李静, 刘志权, 路毓峰, 等.ALT正常和轻度升高慢性HBV感染者的年龄与肝组织病理HBV DNA定量的相关分析[J].临床肝胆病杂志, 2015, 31 (4) :537-540.
    [10]ZHANG N, ZHAO YY, OU WN, et al.Slightly elevated alanine aminotransferase level[J/CD].Chin J Exp Clin Infect Dis:Electronic Edition, 2014, 8 (1) :17-21. (in Chinese) 张娜, 赵莹莹, 欧蔚妮, 等.肝功能正常或轻度异常的慢性HBV感染者肝组织病理改变分析[J/CD].中华实验和临床感染病杂志:电子版, 2014, 8 (1) :17-21.
    [11]PRATI D, TAIOLI E, ZANELLA A, et al.Updated definitions of healthy ranges for serum alanine aminotransferase levels[J].Ann Intern Med, 2002, 137 (1) :1-10.
    [12]LIU J, YANG HI, LEE MH, et al.Serum levels of hepatitis B surface antigen and DNA can predict inactive carriers with low risk of disease progression[J].Hepatology, 2016, 64 (2) :381-389.
    [13]CHAYANUPATKUL M, OMINO R, MITTAL S, et al.Hepatocellular carcinoma in the absence of cirrhosis in patients with chronic hepatitis B virus infection[J].J Hepatol, 2017, 66 (2) :355-362.
    [14]TAN Y, YE Y, ZHOU X, et al.Age as a predictor of significant fibrosis features in HBe Ag-negative chronic hepatitis B virus infection with persistently normal alanine aminotransferase[J].PLo S One, 2015, 10 (4) :e0123452.
    [15]SANAI FM, HELMY A, BZEIZI KI, et al.Discriminant value of serum HBV DNA levels as predictors of liver fibrosis in chronic hepatitis B[J].J Viral Hepat, 2011, 18 (7) :e217-e225.
    [16]LI Q, HUANG YX, CHEN L.Independent predictive factors for significant liver histological changes in patients with HBe Ag-positive high-viral-load chronic HBV infection and a normal alanine aminotransferase level[J].J Clin Hepatol, 2016, 32 (7) :1310-1314. (in Chinese) 李强, 黄玉仙, 陈良.ALT正常的HBe Ag阳性高病毒载量慢性HBV感染者明显肝组织学改变的独立预测因素[J].临床肝胆病杂志, 2016, 32 (7) :1310-1314.
    [17]CHO JY, PAIK YH, SOHN W, et al.Patients with chronic hepatitis B treated with oral antiviral therapy retain a higher risk for HCC compared with patients with inactive stage disease[J].Gut, 2014, 63 (12) :1943-1950.
    [18]MILICH D, LIANG TJ.Exploring the biological basis of hepatitis B e antigen in hepatitis B virus infection[J].Hepatology, 2003, 38 (5) :1075-1086.
    [19]CROAGH CM, BELL SJ, SLAVIN J, et al.Increasing hepatitis B viral load is associated with risk of significant liver fibrosis in HBe Ag-negative but not HBe Ag-positive chronic hepatitis B[J].Liver Int, 2010, 30 (8) :1115-1122.
    [20]ZENG LY, LIAN JS, CHEN JY, et al.Hepatitis B surface antigen levels during natural history of chronic hepatitis B:a Chinese perspective study[J].World J Gastroenterol, 2014, 20 (27) :9178-9184.
    [21]CHEN J, XU CR, XI M, et al.Predictors of liver histological changes and a sustained virological response to peginterferon among chronic hepatitis B e antigen-positive patients with normal or minimally elevated alanine aminotransferase levels[J].J Viral Hepat, 2017, 24 (7) :573-579.
    [22] European Association for Study of Liver, Asociación Latinoamericana para el Estudio del Hígado.EASL-ALEH Clinical Practice Guidelines:non-invasive tests for evaluation of liver disease severity and prognosis[J].J Hepatol, 2015, 63 (1) :237-264.
    [23]JIA J, HOU J, DING H, et al.Transient elastography compared to serum markers to predict liver fibrosis in a cohort of Chinese patients with chronic hepatitis B[J].J Gastroenterol Hepatol, 2015, 30 (4) :756-762.
    [24]LOK AS, ZOULIM F, DUSHEIKO G, et al.Hepatitis B cure:from discovery to regulatory approval[J].Hepatology, 2017, 67 (4) :847-861.
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