Comparison of Histologic Characteristics of Chinese Chronic Hepatitis B Patients with Persistently Normal or Mildly Elevated ALT

Abstract

Liver disease can develop in chronic hepatitis B (CHB) patients with normal or mildly elevated alanine aminotransferase (ALT) who seldom undergo liver biopsy. We aimed to determine histologic characteristics of a large cohort of Chinese CHB patients undergoing liver biopsy and to evaluate the utility of ALT and HBV DNA values at the time of biopsy in predicting liver disease in this population. This prospective study enrolled 230 treatment-naïve patients with persistently normal or mildly elevated ALT. All patients had a liver biopsy. ALT, aspartate aminotransferase (AST), and HBV DNA levels were some of the other parameters measured. Using Scheuer's classification, significant histology was defined as stage ≧2 fibrosis and/or stage 1 fibrosis plus≧ grade 2 inflammation. Liver disease was observed in 34.4% and 61.8% of patients with normal ALT and mildly elevated ALT, respectively. Patients with mildly elevated ALT levels had significantly more events, including liver disease, elevated AST, and moderate to severe inflammation and liver fibrosis, than patients with normal ALT (all P≤0.005). A total of 107 patients (46.5%) had liver disease and 123 (53.5%) did not. PLT and ALT were significantly associated with liver disease (both P<0.001). Patients with elevated ALT, lower platelet count and HBV DNA < 7 log10copies/mL may have histologically significant changes associated with liver disease. Multivariate analysis showed that PLT and HBV DNA levels were significantly associated with liver disease in patients with normal ALT while gender and HBV DNA levels were significantly associated with liver disease in patients with mildly elevated ALT. Assessing liver damage via biopsy in patients with normal or mildly elevated ALT may help to identify those who would benefit from antiviral therapy.

Decrease of Pericytes is Associated With Liver Disease Caused by Ligature‐Induced Periodontitis in Rats

“…12,33 Reduced GSH and increased MDA may, in part, explain changes observed in hepatic tissues in animals with periodontitis. Serum AST and ALT levels, two enzymes that indicate hepatocellular injury, 34 were not increased in mice with induced periodontitis. This result is consistent with previously published data.…”

The gamma‐glutamyl transpeptidase‐to‐platelet ratio predicts liver fibrosis and cirrhosis in HBeAg‐positive chronic HBV infection patients with high HBV DNA and normal or mildly elevated alanine transaminase levels in China

“…An elevated ALT level classically differentiates immune clearance from immune tolerance in HBeAg‐positive CHBVI patients with high HBV DNA levels. Nevertheless, studies have shown ALT to be an inaccurate marker of liver fibrosis and cirrhosis, especially in HBeAg‐positive patients with ALT≤2 ULN . Even though this patient population is considered to be at low risk of liver fibrosis, there is still a non‐negligible proportion with severe fibrosis and cirrhosis who are in need of treatment and could benefit from further screening.…”

HBV, HCV, and HBV/HCV co‐infection among HIV‐positive patients in Hunan province, China: Regimen selection, hepatotoxicity, and antiretroviral therapy outcome

“…based on the Chinese standards. [27][28][29] The ART regimen patients used was recorded at ART initiation and during the treatment for each patient. The study compared the ALT level in different regimen groups, including EFV versus NVP from NNRTIs, TDF versus AZT/D4T from NRTIs, and first-line regimen versus second-line regimen (LPV/r).…”