| Background:Hepatitis B virus(HBV)infection is a serious public health problem in the world.With the use of entecavir and tenofovir,a great majority of patients with chronic hepatitis B can obtain sustained viral control.However,some patients did not achieve normalization of ALT and some patients still develop unfavorable outcomes.Objective:In this study with CHB patients who achieved complete viral control by nucleos(t)ide analogs(NAs)therapy,we conducted the following two parts of study:1.We assessed the prevalence of ALT elevation and identified related factors.We also investigated the impact of longitudinal change of BMI on the risk of ALT elevation and explore possible intervention measures.2.We assessed the cumulative incidence of hepatocellular carcinoma(HCC)and identified related factors.We also investigated the impact of overweight and obesity on the risk of HCC occurrence.Methods:1.Study PopulationThe patients in this study were derived from a real-world,prospective,observational cohort study established by the Hepatology Unit of Nanfang Hospital in 2014.The main purpose of this cohort was to observe the long-term outcomes in chronic hepatitis B patients who underwent antiviral therapy.Based on this large cohort,the present study screened patients who were enrolled in the cohort between May 2014 and September 2017.2.Clinical evaluationIf patients agree to be enrolled,they need to sign the informed consent form,complete a questionnaire,physical examination and laboratory tests with the assistance of trained staff.The patients are followed up every 6 months.3.Definitions(1).ALT elevation:Serum ALT>35 U/L in males and>25 U/L in females.(2).Overweight and obesity patients:Patients with BMI>25 kg/m2.Results:1.Overweight and obesity and ALT elevationA total of 1965 patients were included in this part of the study.At baseline,the proportion of patients with ALT elevation was 19.7%.Compared with the patients with normal ALT,the patients with elevated ALT had higher BMI level,higher proportion of overweight and obesity higher proportion of liver cirrhosis.During a median follow-up period of 18.3 months,serum ALT remained normal in 27.5%of patients had intermittent elevation and 7.3%had persistent elevation.Overweight and obesity were independently associated with intermittent ALT elevation and persistent ALT elevation.The proportions of intermittent ALT elevation and persistent ALT elevation were higher in overweight and obese patients.During follow-up,the proportion of ALT elevation in overweight and obese patients was significantly higher than that in patients with normal ALT.During follow-up,the risk of ALT elevation decreased in patients with decreased BMI.The risk of ALT elevation was also increased in patients with elevated BMI.2.Overweight and obesity and risk of HCCA total of 2701 CHB patients were included in this part of the study.During a median follow-up period of 2.65 years,45 patients developed HCC.The patients with HCC were older,and had higher proportion of liver cirrhosis and overweight and obesity(BMI?25 kg/m2).The 3-years cumulative incidence of HCC was 2.08%in total population.The 3-years cumulative incidence of HCC in patients with baseline BMI?25 kg/m2 was 3.5%,and that in patients with BMI<25 kg/m2 was 1.6%(P=0.026).We included five parameters(age,sex,liver cirrhosis,HBeAg negative and BMI)and metabolic status)for univariate and multivariate analysis.We found that age>50 years,liver cirrhosis and BMI(aHR 1.0995%Cl 1.00 to 1.19)were independent risk factors for HCC occurrence.Conclusion:1.ALT elevation is not uncommon in chronic hepatitis B patients whose virus have been suppressed for a long time.Overweight and obesity are risk factors for ALT elevation in these patients.Weight loss and reduction of hepatic steatosis may contribute to the recovery of serum ALT.2.Chronic hepatitis B patients whose virus have been suppressed for a long time still have a risk of HCC.Overweight and obesity are potential risk factors for HCC in these patients. |
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