低ALT水平时开始治疗

Start Treatment for Low ALT
Nancy W.Y. Leung
Alice Ho Miu Ling Nethersole Hospital & the Chinese University of Hong Kong， Hong Kong SAR
On the second of APASL， Professor Nancy W.Y. Leung gave a lecture titled as “Start Treatment for Low ALT – PRO”. She presented some reasons to treat patients with low ALT：
1. ALT may fluctuate， higher ALT levels are easily missed in usual clinical practice.

2. The “normal” ALT used formerly is above the new suggested normal of 30IU/L for males and 19IU/L for females.

3. Recent research indicate patients with “persistent” low or normal ALT have significant liver diseases that require therapy.

4. Some CHB patients have very high viral load but normal ALT. This prolonged duration of viraemia results in higher risk of fibrosis and hepatocelluar carcinoma .

5. In HBeAg negative CHB， the ALT may be even more difficult to monitor，but these patients have a higher probability of significant liver disease.

6. In patients with advanced fibrosis or cirrhosis， withholding therapy will hasten decompensation and death.

 However， she emphasized that the recommendation to treat CHB patients with low ALT did not supersede a proper full assessment of the patient.

在APSAL大会第二天，Nancy W.Y. Leung教授做了关于低ALT水平时开始乙肝抗病毒治疗的大会报告。就此观点，她列举了如下理由：ALT水平是波动的，常规监测不能完全覆盖；新建议的ALT正常值较前降低；“持续”正常或低水平ALT患者仍可能出现肝病进展；进展期肝纤维化或肝硬化患者不开始治疗可能加速病情进展。同时，她也强调开始治疗前仍应对患者进行全面评估。