Analysis Of The Efficacy Of Antiviral Therapy In HBV Infected Patients With Normal ALT

Objective: To analyze the liver puncture data of HBV infected patients with normal ALT,to clarify the liver inflammation and fibrosis of HBV infected patients with normal ALT,and to evaluate the necessity of antiviral therapy in these patients.The clinical data and auxiliary examination data of patients without antiviral therapy and patients with antiviral therapy were followed,and the necessity and effectiveness of aggressive antiviral therapy in HBV infected patients with normal ALT were evaluated through comparison between the two groups and intra-group comparison.Methods: To collect data on HBV-infected patients with normal ALT and liver biopsy who attended the Department of Infectious Diseases of the Affiliated Hospital of Yan’an University between January 2016 and March 2019.According to the inclusion and exclusion criteria,216 patients were finally enrolled,and then divided into no antiviral treatment group and antiviral therapy group according to the patient’s willingness to antiviral therapy,81 patients were included in the unantiviral treatment group,and 135 patients were included in the antiviral therapy group,of which the antiviral treatment regimen included NAs(ETV/TDF)oral,1 time/day;Peg-IFNα-2b(pegbin)180ug,subcutaneously,1 time/week.The general data of the two groups of patients(sex,age,whether there is a family history of hepatitis B),the pathological results and clinical data of liver puncture at baseline,auxiliary examination data(liver function,hs HBV DNA quantification,hepatitis B virus series quantification,alpha-fetoprotein,abdominal ultrasound,liver hardness value,hyaluronic acid,laminin,etc.)were recorded,and the clinical data and auxiliary examination data of 1 year,2 years and 3 years after antiviral group treatment and non-antiviral patients were recorded.Collect the data required for this study,analyze it,and draw conclusions.SPSS25.0 was used for statistical data analysis to observe the changes of ALT,AST,TBi L,ALB,HBs Ag levels and negative rate,HBe Ag negative rate,HBV DNA level and negative conversion rate,alpha-fetoprotein,hyaluronic acid,laminin,LSM,portal vein width and spleen thickness in the two groups.Results:1.Analyzing the liver histopathological results of all patients at baseline,HBV infection with normal ALT level still had obvious liver inflammation and fibrosis(G≥2 89 cases;accounted for 41.2%),(S≥2 99 cases;accounted for 45.8%);The results showed that G0(6 cases;accounted for 2.8%),S0(21 cases;accounted for 9.7%),G1(121cases;accounted for 56.0%),S1(96 cases;accounted for 44.4%),G2(83 cases;accounted for 38.4%),S2(80 cases;accounted for 37.0%),G3(6 cases;accounted for 2.8%),S3(16cases;accounted for 7.4%),S4(3 cases;1.4%).2.Comparing the baseline data of the two groups,there were no significant differences(P>0.05)in age,sex,family history,ALT,AST,TBi L,ALB,HBs Ag,HBe Ag negative rate,HBV DNA level,alpha-fetoprotein,hyaluronic acid,laminin,LSM,portal vein width,and spleen thickness 0.05),the two groups were comparable;3.At the second year of follow-up between the two groups,the levels of HBs Ag were compared(P=0.039),and the levels of HBs Ag were statistically different between the two groups,and at the third year of follow-up,2 patients(1.5%)in the treatment group received HBs Ag clearance,and no HBs Ag clearance occurred in the untreated group,and the difference between the two groups(P=0.271)was not statistically significant.After 3 years of antiviral therapy in the treatment group,there were 118 cases(87.4%)who were negative for HBe Ag and 62 cases(P=0.038)in the untreated group,and 62 cases(P=0.038)in the untreated group,the difference was statistically significant.There were 90 cases(66.7%)in the treatment group with all hs HBV DNA below the lower limit of detection,and 7 cases(P<0.001)in the untreated group with all hs HBV DNA below the lower limit of detection,with a significant difference.The ALT and AST levels of the two groups were compared with(P<0.001),the difference was statistically significant,the difference in HBs Ag level between the two groups was statistically significant,(P=0.004),hyaluronic acid,laminin,LSM and spleen thickness were compared between the two groups,and there were no differences in(P<0.05)TBi L,ALB,AFP,portal vein width,(P>0.05)。4.After 3 years of follow-up antiviral therapy,2 cases of HBs Ag turned negative,accounting for 1.5%,118 cases(87.4%)were HBe Ag-negative,and 90 cases(66.7%)had hs HBV DNA below the lower limit of detection.In the intra-group comparison,there were significant differences between baseline ALT levels and 1,2 and 3 years after treatment(P<0.05),and there was no difference between AST and different treatment years,but the AST levels of all patients in the treatment group were within the normal range.The other two indexes of liver function,TBi L and ALB,1 year and 2 years after treatment,TBi L and ALB levels were different from baseline(P<0.001),HBs Ag levels 1 year and 3 years after treatment were different from baseline(P<0.005),hs HBV DNA levels 1,2 and 3 years after treatment were different from baseline(P<0.001),and there were no significant differences in AFP levels,HA levels,LN levels,and portal vein width values at 1,2 and 3years after treatment(P> 0.05),LSM values at 1 year after treatment were statistically different from baseline(P<0.05),and spleen thickness values at 1 and 3 years after treatment were statistically different from baseline(P <0.05)。Conclusions: 1.Liver histopathological examination was performed for HBV infected patients with ALT level within the normal range,and the results showed that 130patients(130 cases/216 cases,accounting for 60.2%)had obvious liver inflammation/fibrosis(G≥2 and/or S≥2),indicating that ALT level does not fully reflect liver inflammation,and is not always in a parallel relationship,which is necessary for early antiviral treatment for HBV infected patients with ALT level in the normal range;2.Compared with the untreated group,there were obvious differences in the treatment group in terms of reduced HBs Ag level,HBe Ag conversion negative,hs HBV DNA conversion negative,ALT level reduction,liver stiffness value,liver fibrosis improvement,and spleen thickness decrease.3.After antiviral treatment,the treatment group had significant improvements in HBs Ag level,HBe Ag negative,hs HBV DNA negative,ALT level,liver hardness value,and spleen thickness.It shows that antiviral therapy for HBV infected patients with normal ALT can obtain a good therapeutic effect.