期刊
HEPATOLOGY RESEARCH
卷 53, 期 1, 页码 35-42出版社
WILEY
DOI: 10.1111/hepr.13839
关键词
alanine aminotransferase; hepatitis B virus; hepatocellular carcinoma; nucleoside; nucleotide analog
The aim of this study was to establish a target value of ALT level during NA treatment as a risk marker for HCC. The results showed that patients with ALT <21 IU/L at 1 year after NA initiation had a lower risk of HCC.
Aim Alanine aminotransferase (ALT) is a criterion for the introduction of nucleotide/nucleoside analog (NA), and ALT levels are decreased by NA treatment. However, the association between post-treatment ALT levels and hepatocellular carcinoma (HCC) risk remains unclear. To fill this gap, we aimed to establish a target value of ALT level during NA treatment. Methods In total, 413 patients with chronic hepatitis B who received entecavir, tenofovir alafenamide, or tenofovir disoproxil fumarate were enrolled. The subsequent development of HCC was examined and a target value of ALT level during NA treatment as a risk marker for HCC was evaluated. Results The median follow-up duration was 5.1 years, during which time 27 patients (8.6%) developed HCC. ALT level at the start of treatment was not associated with HCC development (p = 0.08). When stratified by ALT at 1 year after NA initiation, the cumulative 3- and 5-year rates of HCC for patients with ALT >= 21 IU/L were 11.5% and 18.1%, and those with ALT <21 IU/L was 2.3% and 6.5%, respectively. Patients with ALT <21 IU/L had a significantly lower risk of HCC development compared with patients with ALT >= 21 IU/L (p = 0.002). In multivariable analysis adjusting age, sex, and platelet counts, ALT >= 21 IU/L was an independent risk factor of HCC development with hazard ratio of 4.5 (95% confidence interval: 1.01-20.4). Conclusions ALT <21 IU/L at 1 year after NA initiation has a lower risk of HCC and could be used as a target value for NA treatment.
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