ALT持续正常的慢乙肝患者组织学特点及相关影响因素研究进展

Research Progress in Histological Features and Related Influencing Factors of Chronic Hepatitis B Patients with Persistent Normal ALT

摘要: 慢性乙型肝炎(Chronic Hepatitis B, CHB)是由乙型肝炎病毒(HBV)引起的一种慢性肝炎，是引起肝癌的主要病因。临床上评估肝脏炎症的常见无创指标为丙氨酸氨基转移酶(ALT)，一般认为，ALT水平正常的乙肝病毒(HBV)感染患者，要么处于乙肝自然史的免疫耐受阶段，要么处于低复制阶段，肝组织没有或只有轻度炎症，不建议进行抗病毒治疗。然而，ALT水平正常的慢性HBV感染患者并不总是处于稳定状态，最近有大量研究表明，ALT保持正常的CHB患者存在不同程度的中度和重度炎症或明显的纤维化，甚至肝硬化，对于此类患者，是否抗病毒治疗以及何时开始抗病毒治疗仍是临床实践中的热点问题，本文就ALT持续正常的CHB患者的肝组织学特点及其相关影响因素进行综述，旨在改善临床对于此类患者抗病毒治疗指征。

Abstract: Chronic Hepatitis B (CHB) is a chronic hepatitis caused by the hepatitis B virus (HBV) and is the leading cause of liver cancer. Alanine aminotransferase (ALT) is a common noninvasive marker for clinical evaluation of liver inflammation. It is generally believed that patients infected with hepati-tis B virus (HBV) with normal ALT level are either at the immune tolerance stage of the natural his-tory of hepatitis B or at the low replication stage, with no or only mild inflammation of the liver tis-sue, and antiviral therapy is not recommended. However, patients with chronic HBV infection with normal ALT levels are not always in a stable state. A large number of recent studies have shown that patients with CHB who maintain normal ALT have varying degrees of moderate and severe inflam-mation or significant fibrosis or even cirrhosis. For such patients, is antiviral therapy available? When to start antiviral therapy? It is still a hot topic in clinical practice. This paper reviews the liver histological features and related influencing factors of CHB patients with persistent normal ALT, aiming to improve clinical indications for antiviral therapy in such patients.