Demographic and clinical information of participants
As shown in Figure 1A, 1709 patients with CHB who had undetectable serum HBV DNA levels for at least 12 months after antiviral treatment were screened. In total, 208 participants were excluded at baseline, and 263 participants were excluded during follow-up (median follow-up: 2.42 years). Finally, 1238 patients with CHB were included in the analysis. Among these patients, 510 (41.19%) experienced elevated ALT during follow-up, 40 (3.23%) showed PeALT at all visits, and only 55.57% maintained PnALT.
To further investigate the potential reason for elevated ALT, we matched 40 patients with PeALT and 40 with PnALT using propensity score matching. Confounding factors, including sex, age, body mass index (BMI), follow-up duration, serum triglyceride (TG) and cholesterol levels, and CAP, were well-matched between these two groups. Baseline demographics and clinical information of the patients are summarized in Table 1. The serum ALT (49.5 [42, 64.5] vs. 21 [14, 25.75)]) and AST (31 [25.25, 38] vs. 20 [19, 25] levels were significantly higher in the PeALT group than in the PnALT group. The dynamic changes in ALT and AST levels are shown in Figure 1B and 1C. In addition to ALT levels, the serum AST level in patients with PeALT was consistently and significantly higher than that in patients with PnALT, indicating sustained liver injury.