A large population histology study showing the lack of association between ALT elevation and significant fibrosis in chronic hepatitis B.

Abstract

OBJECTIVE:

We determined the association between various clinical parameters and significant liver injury in both hepatitis B e antigen (HBeAg)-positive and HBeAg-negative patients.

METHODS:

From 1994 to 2008, liver biopsy was performed on 319 treatment-naïve CHB patients. Histologic assessment was based on the Knodell histologic activity index for necroinflammation and the Ishak fibrosis staging for fibrosis.

RESULTS:

211 HBeAg-positive and 108 HBeAg-negative patients were recruited, with a median age of 31 and 46 years respectively. 9 out of 40 (22.5%) HBeAg-positive patients with normal ALT had significant histologic abnormalities (necroinflammation grading ≥ 7 or fibrosis score ≥ 3). There was a significant difference in fibrosis scores among HBeAg-positive patients with an ALT level within the Prati criteria (30 U/L for men, 19 U/L for women) and patients with a normal ALT but exceeding the Prati criteria (p = 0.024). Age, aspartate aminotransferase and platelet count were independent predictors of significant fibrosis in HBeAg-positive patients with an elevated ALT by multivariate analysis (p = 0.007, 0.047 and 0.045 respectively). HBV DNA and platelet count were predictors of significant fibrosis in HBeAg-negative disease (p = 0.020 and 0.015 respectively). An elevated ALT was not predictive of significant fibrosis for HBeAg-positive (p = 0.345) and -negative (p = 0.544) disease. There was no significant difference in fibrosis staging among ALT 1-2 × upper limit of normal (ULN) and > × 2 ULN for both HBeAg-positive (p = 0.098) and -negative (p = 0.838) disease.

CONCLUSION:

An elevated ALT does not accurately predict significant liver injury. Decisions on commencing antiviral therapy should not be heavily based on a particular ALT threshold.

• Authors: Wai-Kay Seto, Ching-Lung Lai, Philip P C Ip, James Fung, Danny Ka-Ho Wong, John Chi-Hang Yuen, Ivan Fan-Ngai Hung, Man-Fung Yuen
• Journal: PloS one (PLoS One) Vol. 7 Issue 2 Pg. e32622 ( 2012) ISSN: 1932-6203 [Electronic] United States
• PMID: 22389715 (Publication Type: Journal Article)

Chemical References

• Hepatitis B e Antigens
• Alanine Transaminase

Topics

• Adolescent
• Adult
• Alanine Transaminase (metabolism)
• Female
• Hepatitis B e Antigens (metabolism)
• Hepatitis B, Chronic (enzymology, pathology)
• Humans
• Liver Cirrhosis (enzymology, pathology)
• Male
• Middle Aged
• Young Adult