Division of GI/Hepatology, University of California Irvine School of Medicine, Orange, CA 92868, USA.
J Clin Gastroenterol. 2010 Aug;44(7):510-6. doi: 10.1097/MCG.0b013e3181d34c65.
To evaluate the proportion of patients with histologic evidence of active liver disease (HEALD) who have chronic hepatitis B (CHB) and normal/minimally elevated serum alanine aminotransferase (ALT). Sub-analysis was performed to determine whether HEALD based upon liver biopsy better correlates with ALT using modified ALT (30 men/19 women) upper limit of normal (ULN) criteria compared with local conventional laboratory.
There are limited data on CHB with normal range ALT (NRALT). We designed a study to evaluate histologic damage in this cohort of patients.
A retrospective, multicenter study evaluated CHB patients with normal/minimally elevated ALT [< or = 1.2 x ULN (hepatitis B e antigen positive) or < or = 1.5 x ULN (hepatitis B e antigen negative)]. Liver biopsy specimens were reviewed by an independent histopathologist. HEALD was defined as Knodell necroinflammatory score greater than 5 and Ishak fibrosis stage greater than 1.
Forty-five patients met criteria: median age of 40 years; 51% males; 73% Asian; and 67% hepatitis B e antigen negative. Median hepatitis B virus DNA was 6.04 log10 copies/mL, aspartate aminotransferase (AST) 30 IU/L, and ALT 42 IU/L; and 40% of the patients had ALT greater than ULN. Overall, 20% had HEALD and among patients with NRALT, 4 of 27 (15%) and 0 of 5 (0%) had HEALD through conventional or modified ALT ULN, respectively.
One fifth of patients with CHB and normal/minimally elevated ALT had HEALD. Among the subset of patients with NRALT, 15% (4 of 27) had HEALD when using conventional laboratory compared with 0% (0 of 5) patients by modified ALT ULN criteria. Use of the modified ALT ULN will likely improve accuracy in identifying patients who may have HEALD compared with conventional laboratory ULN.
评估组织学上有活动期肝疾病（HEALD）证据的患者中慢性乙型肝炎（CHB）和正常/轻度升高血清丙氨酸氨基转移酶（ALT）的比例。进行了亚分析，以确定使用改良 ALT（30 名男性/19 名女性）正常值上限（ULN）标准，与当地常规实验室相比，肝活检中基于 HEALD 是否与 ALT 相关性更好。
正常范围 ALT（NRALT）的 CHB 数据有限。我们设计了一项研究来评估这一患者队列的组织学损伤。
一项回顾性、多中心研究评估了正常/轻度升高 ALT [<或= 1.2 x ULN（乙型肝炎表面抗原阳性）或<或= 1.5 x ULN（乙型肝炎表面抗原阴性）]的 CHB 患者。肝活检标本由独立的组织病理学家进行评估。HEALD 定义为 Knodell 坏死性炎症评分大于 5 分和 Ishak 纤维化分期大于 1 期。
45 名患者符合标准：中位年龄 40 岁；51%为男性；73%为亚洲人；67%乙型肝炎表面抗原阴性。中位乙型肝炎病毒 DNA 为 6.04 log10 拷贝/ml，天冬氨酸氨基转移酶（AST）为 30 IU/L，丙氨酸氨基转移酶（ALT）为 42 IU/L；40%的患者 ALT 大于 ULN。总体而言，20%的患者有 HEALD，在 NRALT 的患者中，通过常规或改良 ALT ULN，分别有 4 例（15%）和 0 例（0%）有 HEALD。
五分之一的 CHB 和正常/轻度升高 ALT 的患者有 HEALD。在 NRALT 的亚组中，使用常规实验室检测时，15%（27 例中有 4 例）有 HEALD，而使用改良 ALT ULN 标准时，0%（5 例中无 1 例）有 HEALD。与常规实验室 ULN 相比，使用改良 ALT ULN 可能会提高识别可能有 HEALD 的患者的准确性。
