A Study Of The Relation Between The Baseline Alanine Aminotransferase Levels And The Treatment Effect Of Chronic Hepatitis B

Background and objectiveChronic hepatitis B(CHB)remains a major global public health problem.It is estimated that at least 2 billion people worldwide are affected by hepatitis B virus(HBV)infection.340 million to 400 million are chronic HBV carriers.In Asia,it is estimated that more than half of HCC are due to HBV infection.In China,at least 97 million people are still HBV carriers,of which at least 20 million patients are diagnosed as chronic HBV infection,cirrhosis or/and hepatocellular carcinoma(HCC).At present,antiviral drugs for the treatment of CHB include the following two categories:a-interferon(IFN-?)and nucleoside(t)ide analogues(NAs).Both have their own advantages and disadvantages.IFN-a can get higher hepatitis B e antigen(HBeAg)clearance rate and hepatitis B surface antigen(HBsAg)clearance rate,and the sustained off-treatment response is more persistent.Currently commonly used drugs include PegIFN-? and IFN-?.NAs has a more stable and higher virological response rate(HBV DNA is lower than the limit of detection),and it is much more convenient to use,has few side effects,less contraindications,and has a wide range of applications.CHB patients who choose NAs for treatment still account for the majority.The most commonly used NAs is entecavir(ETV).There has been consensus on the use of antiviral therapy for NAs in patients who with cirrhosis,but antiviral therapy for CHB patients without evidence of cirrhosis,especially for patients with mild liver cell inflammation,is still controversial.Because of the different advantages and disadvantages of NAs and IFN-?,the treatment effects of patients with different inflammation are also not the same,so there is still some confusion about how to select antiviral drugs appropriately.In order to provide a clearer and more simple basis for clinicians to treat CHB patents with appropriate antiviral drugs,this study mainly analyzed the relation about the baseline alanine aminotransferase(ALT)levels and different antiviral drugs(ETV,IFN-?)and CHB antiviral efficacy.MethodsA total of 369 CHB patients grouped by different treatment and baseline ALT levels were retrospectively analyzed.The treatment effect,which was based on different treatments and ALT levels,was assessed by analyzing Virological Response,HBeAg Clearance,and the decline of HBsAg.Results1.Virological Response:After 48 weeks treatment,in ETV groups,the Virological Response rates were 83.3%,91.4%and 95.5%in ALT?5×upper limits of normal(ULN)(group 1),5?10×ULN(group 2),>10×ULN(group 3)respectively;In IFN-a groups,those were 19.7%,40%,42.9%respectively.There were significant differences among the different treatment groups and different ALT groups.2.HBeAg Clearance Rate:After 48 weeks treatment,in ETV groups,the HBeAg Clearance rates were 8.3%,16.7%and 35.5%separately;In IFN-a groups,those were 1.8%,41.9%,38.1%separately.There were significant differences among the different ALT groups in the same treatment.Significant difference between the different treatment groups in the same ALT group was only found in group 2.3.The decline of HBsAg:After 48 weeks treatment,in ETV group,the rate of HBsAg less than 200IU/ml were 2.5%and 13.8%in baseline ALT<5×ULN and>5×ULN respectively,the difference between the two ALT groups wasn't significant.In IFN-a group,the rates were 30.6%and 33.3%separately,which no significant difference was found between them.And between the different treatment group in the same ALT group,the difference was significant.Conclusion1.The Virological Response rates of ETV group were higher than IFN-? group in all the ALT groups after 48 weeks treatment.2.In the group of baseline ALT in 5?10×10×ULN,the HBeAg Clearance rate of IFN-a was higher than ETV group after 48 weeks treatment.But in the group of baseline ALT?5×ULN and>5×ULN,the differences are not significant.3.As for the decline of HBsAg,IFN-a showed better effect than ETV group in all the ALT groups after 48 weeks treatment.4.In the different ALT groups for the same treatment,the high baseline ALT level group showed higher Virological Response rate and HBeAg Clearance rate than the low baseline ALT level group.While the decline of HBsAg was not significantly different between the different baseline ALT levels.5.We thus recommend IFN-a for patients with a baseline ALT of 5-10×ULN and ETV for patients with a baseline ALT either below 5×ULN or beyond 10×ULN to get better effect.