Analysis of predictors of liver injury stage in chronic HBV infection patients with ALT levels lower than 2 × ULN

Objective To investigate the role of various clinical parameters in predicting liver injury stage in patients with chronic hepatitis B virus ( HBV) infection who had alanine aminotransferase ( ALT) levels lower than 2 times the upper limit of normal ( ULN) . Methods Ultrasound- guided liver biopsy was performed in chronic HBV infection patients with ALT levels lower than 2 × ULN. The activity of inflammation and degree of fibrosis in liver tissues were assessed. Meanwhile, liver function, serum HBV markers, and HBV DNA were measured. The role of these clinical parameters in predicting liver injury stage was evaluated by logistic regression analysis. Results Among 122 patients, 94 ( 77. 0%) had significant inflammation or fibrosis ( G≥2 or S≥2) , and 5 ( 4. 1%) had early cirrhosis. There was significant difference in HBV DNA between G ≥2 group and G < 2 group, but other parameters showed no significant differences between the two groups. There were significant differences in age, HBeAg, HBV DNA, AST, and platelet count between S≥2 group and S < 2 group. The logistic regression analysis showed that age, HBeAg, and AST were independent predictors of significant liver fibrosis ( S≥2) . Conclusion Liver biopsy is necessary for chronic HBV infection patients with serum ALT levels of < 2 × ULN, aged over 40 years, negative for HBeAg, or with serum AST levels of > 40 U /L.