Regression Analysis On Hepatoprotection Treatment In 252 Patients With Chronic Hepatitis B For 13 Years Follow-up

Background and Aim:Eleveted ALT level in chronic hepatitis B is an important marker of liver injury or inflammation。Sustained eleveted ALT level may lead to cirrhosis and HCC。However,the management of eleveted ALT for treatment is greatly different in the world,such as sex,BMI index,diet and exercise,especially what is the normal ALT levels。AASLD2007,US Algorithm2008, EASL2009 have different standards in choosen anti-viral treatment and what acceptable ALT level to start。The patients with ALT＜2×ULN,virus-resistant, ALT repeatedly eleveted,pregnancy or refused anti-virus treament,still need to accept hepatoprotection treatment。Hepatoprotection treatment still play an important role in the treatment of chronic hepatitis B。Most of the hepatoprotection drugs,made from traditional Chinese medicine,is used widely.These drugs can protect the liver cell,recover the liver function effectly。However,there is significant difference in the study of relevance hetweent elevated ALT and cirrhosis。In China,the studys in hepatoprotection treatment for eleveted ALT are small samples,lack of long-term prognosis assessment。So we analyzed retrospectively a cohort of 252 treated with 1-13 years follow-up,observe the influence in sustain normal ALT and bad prognosis。Methods:A cohort of 252 hepatoprotection treated(147 HBeAg-positive chronic hepatitis B comparised with 233 untreated patients from TAIWAN, 105HBeAg-negative chronic hepatitis B comparised with 195 untreated patients from Greece,and ALT stratification research comparised with 188 untreated patients from Korea) were closely followed for 1-13 years.We statisticsed the difference of biochemical and viral respond between before and after treatment,so as the difference of cirrhosis,decompensated liver disease and/or HCC between the treated and the untreated.Results:The cumulative incidence of cirrhosis decompensation at the end of 13 years of follow-up in the treated patients and controls was:in the HbeAg-positive group,0.174%vs.14.6%(P=0.002),and in the HbeAg-negative group 0.697%vs.18%(P＜0.005).and no patience in the treated group had hepatocellular carcinoma.Signicant reduction of biochemical and viral marker was observed after treatment(P＜0.05).Compared with untreated HbeAg-positive controls showed signicantly lower incidence of cirrhosis(P =0.003).Multivariate analysis showed that surem ALT and HBV-DNA are independent factors for cirrhosis.The probabilities of developing cirrhosis were signicantly higher in patients whose ALT levels were persistently elevated without normalization(400U/L＞ALT＞40U/L)tban in patients whose ALT levels are flare-up then normalized or were normally sustained,and signicant difference to the control.Conclusions:Long-term hepatoprotection treatment can effectivly control hepatitis activity and help liver cells repair,reduce the secretion of extracellular matrix,then prevent the progression to cirrhosis and HCC, improve survival in patients.1.persistently elevated ALT levels were independent factors for cirrhosis2.effective control of hepatitis activity might reduce signicantly the cumulative incidence of cirrhosis,decompensation.3.hepatoprotection treatment might effective control hepatitis activity and reduce excretion of extraeellular matrix.4.hepatoprotection might treat as one of replacement therapy.