Significant histopathology in Chinese chronic hepatitis B patients with persistently high–normal alanine aminotransferase

Abstract

SUMMARY. Current guidelines recommend antiviral therapy for chronic hepatitis B (CHB) patients with elevated alanine aminotransferase (ALT) and high viral load. Scant histological data exist for CHB patients with persistently normal ALT (PNALT) because disease progression is thought to be rare. To identify potential predictors of significant histology in the presence of PNALT, we compared the clinical characteristics and histology of Chinese CHB PNALT patients to those in patients with elevated ALT. Percutaneous liver biopsy was performed in 522 CHB patients with Chinese ethnicity who had not had antiviral treatment. Differences in age, ALT, viral load, hepatitis B e antigen (HBeAg) status and liver histology were compared between eligible PNALT (252) and elevated ALT (270) patients. Of the PNALT patients, 38.5% had normal liver histology, 25.4% had significant necroinflammation and/or fibrosis and 8.4% had established cirrhosis. Furthermore, histopathological differences between patients with high-normal ALT (0.5-1.0 · the upper limit of normal (ULN)) and low-normal ALT (£0.5 · ULN) were evaluated. There was a significantly greater prevalence of histopathology in the high-normal group (40.0%) than in the low-normal group (16.6%) (P < 0.001). Multiple logistic regression identified that significant histopathology findings in PNALT patients correlated with age (P < 0.001) and ALT level (P < 0.001), with age >40 years and ALT >0.5 · ULN predicting significant histopathology. Our data indicate that liver biopsy is recommended in CHB patients >40 years of age, particularly when their ALT is 0.5-1.0 · ULN. The findings above provide evidence for indication of antiviral therapy in patients with PNALT and significant histopathological change.

Predictive value of serum Golgi protein 73 for prominent hepatic necroinflammation in chronic HBV infection

“…Recent studies have demonstrated that a part of chronic HBV‐infected patients with normal or mildly increased ALT had hepatic necroinflammation and fibrosis . Thus, the identification of factors closely correlated to the degree of HBV‐associated hepatic necroinflammatory activity has potentially important clinical significance.…”

Clinical and histopathological features of chronic hepatitis B virus infected patients with high HBV-DNA viral load and normal alanine aminotransferase level: A multicentre-based study in China

“…The Knodell and Metavir scoring systems are commonly used to assess liver necroinflammation, and direct comparisons of the two systems are difficult. Among seven studies carried out in Chinese communities [7, 8, 19–23], except a study in Guangzhou, 13% to 36.5% of PNALT patients had moderate liver necroinflammation. When the studies carried out in Shanghai and Zhejiang are directly compared, the population of PNALT patients with an HAI score ranging from 4 to 6 is increasing.…”

“…Another study conducted in Shanghai suggested that only 38.5% of PNALT chronic HBV infected patients had normal liver histology. The authors noticed that the PNALT HBV patients in the lower half of the normal ALT range had a significantly lower prevalence of histopathology [8]. However, all of these studies were single-centre trials.…”

Role of serum hepatitis B virus marker quantitation to differentiate natural history phases of HBV infection

“…Significant necroinflammation and/or fibrosis is not uncommon in Chinese CHB patients with persistent normal ALT; this is especially true for HBeAgpositive patients over 30 or 40 years old [9,10], who may need a liver biopsy to determine the degree of histopathological lesions. However, liver histology of chronic HBV infected patients with normal ALT cannot be generalized to other patients with normal ALT that have not been biopsied [11].…”