Department of Microbiology and Center of Infectious Diseases, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, 100191, China.
Traditional Chinese Medicine Hospital of Guangdong Province, Guangzhou, 510120, China.
Hepatol Int. 2021 Apr;15(2):318-327. doi: 10.1007/s12072-021-10153-2. Epub 2021 Feb 26.
We aimed to assess liver histological changes of HBeAg-negative chronic hepatitis B (CHB) patients with normal ALT, and determined the association between significant liver injury and age, ALT, and HBV DNA levels.
We retrospectively examined 327 patients who underwent liver biopsy from 2009 to 2018. Significant liver histological change is defined as liver necroinflammation ≥ G2 and/or liver fibrosis ≥ F2.
The proportion of patients with significant liver necroinflammation or fibrosis in the high-normal ALT group (ALT > 20 U/L) was higher than that in the low-normal ALT group (ALT ≤ 20 U/L) (44.6% vs 26.5%, 61.0% vs 41.7%, p < 0.01); also the proportion in the group with HBV DNA ≥ 2000 IU/mL was significantly higher than that in the group with HBV DNA < 2000 IU/mL (58.5% vs 27.1%, 67.9% vs 46.2%, p < 0.01). There was no significant difference in hepatic histopathology between < 40 and ≥ 40 years groups. Among 221 patients with normal ALT and low HBV DNA levels (< 2000 IU/mL), 27.1% of them had significant liver necroinflammation and 46.2% had significant liver fibrosis. The multiple logistic regression analysis showed that ALT > 20 U/L and HBV DNA ≥ 2000 IU/mL were independently associated with significant liver histopathology (p < 0.01).
HBeAg-negative CHB patients with normal ALT and low HBV DNA level (< 2000 IU/mL) were suggested to perform liver biopsy or noninvasive methods for histopathology assessment, then to be determined for antiviral therapy. ALT > 20 U/L and HBV DNA ≥ 2000 IU/mL are good independently predictive factors for evaluating significant liver histopathology for HBeAg-negative CHB patients with normal ALT.
Chinese Clinical Trial Registry (ChiCTR-IOR-14005474).
评估 ALT 正常的 HBeAg 阴性慢性乙型肝炎（CHB）患者的肝脏组织学变化，并确定显著肝损伤与年龄、ALT 和 HBV DNA 水平之间的关系。
我们回顾性检查了 2009 年至 2018 年间进行肝活检的 327 名患者。显著的肝脏组织学变化定义为肝坏死性炎症≥G2 和/或肝纤维化≥F2。
高正常 ALT 组（ALT＞20 U/L）中具有显著肝坏死性炎症或纤维化的患者比例高于低正常 ALT 组（ALT≤20 U/L）（44.6%比 26.5%，61.0%比 41.7%，p＜0.01）；HBV DNA≥2000 IU/mL 组的比例也明显高于 HBV DNA＜2000 IU/mL 组（58.5%比 27.1%，67.9%比 46.2%，p＜0.01）。＜40 岁和≥40 岁组之间的肝组织病理学无显著差异。在 221 名 ALT 正常且 HBV DNA 水平低（＜2000 IU/mL）的患者中，27.1%的患者有显著的肝坏死性炎症，46.2%的患者有显著的肝纤维化。多因素逻辑回归分析显示，ALT＞20 U/L 和 HBV DNA≥2000 IU/mL 与显著的肝组织病理学相关（p＜0.01）。
对于 ALT 正常且 HBV DNA 水平低（＜2000 IU/mL）的 HBeAg 阴性 CHB 患者，建议进行肝活检或非侵入性方法进行组织病理学评估，然后决定是否进行抗病毒治疗。ALT＞20 U/L 和 HBV DNA≥2000 IU/mL 是评估 ALT 正常的 HBeAg 阴性 CHB 患者显著肝组织病理学的良好独立预测因素。
中国临床试验注册中心（ChiCTR-IOR-14005474）。
