Analysis of liver stiffness measurement in chronic hepatitis B patients with persistently normal ALT and persistently or intermittently elevated ALT

Objective Data on liver stiffness measurement (LSM) in chronic hepatitis B (CHB) patients with persistently normal alanine aminotransferase (ALT) (PNALT) and persistently or intermittently elevated ALT (PIEALT) were limited.In this study, we aimed to assess LSMs in these patients and determine the potential influential factors for LSMs, thus providing reference for clinical practice.Methods Two hundred and eight CHB patients without antiviral treatment during the previous one year with ALT < 2 × ULN were included.All of them underwent FibroScan.These patients were grouped according to the results of follow- ups performed at least three times (intervals > 2 months) in the past one year:group 1 (PNALT) , with ALT persistently less than 1 × ULN;group 2 (PIEALT) , with ALT elevated to above 1 × ULN but less than 2 × ULN at least once;group 3 (PIEALT) , with ALT elevated to above 2 × ULN at least once.According to previous studies, the LSM cut- off values to exclude and diagnose advanced liver fibrosis were < 7.4 kPa and ≥10.6 kPa in CHB patients with ALT < 2 × ULN.Results The mean LSM was 6.2 ± 2.9 kPa.Of PNALT patients, 14.3% (18 /126) had an LSM of ≥7.4 kPa, and 2.4% (3 /126) had an LSM of ≥10.6 kPa;the proportions were 35.4% (29 /82) and 13.4% (11 /82) in all PIEALT patients.The multivariate regression analysis showed that ALT > 1 × ULN (OR =2.63, P =0.037) and male (OR =5.29, P =0.012) were independently associated with LSM ≥7.4 kPa;HBV DNA ≥5 log10copies / ml was the independent predictor of LSM ≥10.6 kPa (OR = 13.84, P = 0.046) .Conclusion Among CHB patients, 35% of PIEALT cases and 14% of PNALT cases might progress to advanced liver fibrosis;around 13% of patients with PIEALT could be diagnosed with advanced liver fibrosis.Close follow- ups are recommended for male CHB patients with ALT > 1 × ULN and HBV DNA ≥5 log10copies / ml.