Background. Chronic hepatitis B (CHB) patients with normal or minimally increased levels of alanine aminotransferase (ALT) are still at the risk of hepatocellular carcinoma, cirrhotic events, and mortality. However, there is a debate over the initiation of antiviral treatment for these patients. This systematic review and mate-analysis aimed to explore this problem. Methods. MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science databases were systematically searched for retrieving relevant studies with risk ratios (RRs) or risk differences (RDs) for virological changes between antivirus-treated and no antivirus-treated CHB patients with ALT levels less than two-fold of the upper limit of normal. Retrieved data ranged from January 1990 to October 2020. Results. Of 6783 abstracts screened, 9 studies met the criteria for inclusion in the systematic review and had a low risk of bias. Among studies that were involved in the meta-analyses, it was found that the rates of HBsAg loss (RR = 12.22, 95% confidence interval (CI): 4.28–34.95, ), HBsAg seroconversion (RR = 19.90, 95% CI: 2.75–144.09, ), and undetectable HBV DNA (RR = 11.89, 95% CI: 2.44–57.89, ) were both higher in the antiviral treatment group compared with placebo or no treatment group. Subgroup analysis suggested that patients who received interferon (IFN)-based therapy were more inclined to achieve HBsAg loss (), HBsAg seroconversion (), and HBeAg loss (). Conclusion. From a sizable population, it was revealed that CHB patients with normal or minimally increased levels of ALT could benefit from the antiviral therapy, especially those who received IFN-based treatment.

中文翻译：

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谷丙转氨酶水平轻微升高的慢性乙型肝炎患者的病毒学变化：荟萃分析和系统评价

背景。丙氨酸氨基转移酶 (ALT) 水平正常或轻​​微升高的慢性乙型肝炎 (CHB) 患者仍有发生肝细胞癌、肝硬化事件和死亡的风险。然而，对于这些患者是否开始抗病毒治疗存在争议。本系统回顾和配对分析旨在探索这个问题。方法。系统地搜索了 MEDLINE (PubMed)、EMBASE、Cochrane 对照试验中央登记册和 Web of Science 数据库，以检索具有抗病毒处理和未抗病毒处理之间病毒学变化的风险比 (RR) 或风险差异 (RD) 的相关研究ALT 水平低于正常上限两倍的 CHB 患者。检索到的数据范围为 1990 年 1 月至 2020 年 10 月。结果。在筛选的 6783 份摘要中，有 9 项研究符合纳入系统评价的标准，并且偏倚风险较低。在参与荟萃分析的研究中，发现 HBsAg 消失率 (RR = 12.22，95% 置信区间 (CI)：4.28–34.95，), HBsAg 血清转化率 (RR = 19.90, 95% CI: 2.75–144.09,),和检测不到 HBV DNA (RR = 11.89, 95% CI: 2.44–57.89,)在抗病毒治疗组中均高于安慰剂或无治疗组。亚组分析表明，接受基于干扰素 (IFN) 治疗的患者更倾向于实现 HBsAg 消失（), HBsAg 血清学转换 (),和 HBeAg 损失 (). 结论。大量人群发现，ALT 水平正常或轻​​微升高的 CHB 患者可以从抗病毒治疗中获益，尤其是那些接受基于 IFN 治疗的患者。