Background Liver fibrosis or inflammatory reaction may still exist in chronic hepatitis B (CHB) patients with persistent normal alanine transaminase (ALT), and some patients may develop into cirrhosis or liver cancer insidiously.
Objective To identify the high-risk factors associated with obvious hepatic fibrosis or inflammation in such patients.
Methods Patients with normal ALT and biopsy-proven CHB, admitted to the Fifth Medical Center of Chinese PLA General Hospital from August 2002 to August 2022 were selected from the electronic medical record. Their clinical information was retrospectively retrieved. Hepatic fibrosis (S0-4) and inflammation (G0-4) were evaluated according to Scheuer scoring system. The patients were divided into two groups (with or without obvious liver fibrosis/inflammation) according to the pathological (inflammation or fibrosis) score ≥ 2. Multivariate logistic regression analysis was used to analyze the independent risk factors.
Results Totally 1493 patients were enrolled, with an average age of (36.9 ± 11.0) years. Male accounted for 60.5% (903 cases). Among them, 608 (40.7%) patients presented obvious hepatic fibrosis, and 388 (26.0%) patients presented inflammation. Multivariate logistic regression showed having family history of CHB, >30 years-old, AST >1 × ULN (upper limit of normal), and PLT ≤184 × 109/L were associated with higher likelihood of obvious fibrosis. HBV DNA between 3.5-8.0 lg IU/mL, AST >1 × ULN, TBIL >2 × ULN, and PLT ≤184 × 109/L were associated with higher likelihood of obvious hepatic inflammation. Whereas, patients with HBV DNA>8.0 lg IU/mL had relatively lower likelihood of hepatic fibrosis or inflammation (all P＜0.05).
Conclusion An unexpected high proportion of obvious hepatic fibrosis or inflammation still exists in CHB with persistent normal ALT, whose antiviral treatment should be timely initiated based on high-risk factors mentioned above.
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