Clinical features and liver pathology in chronic hepatitis B virus-infected patients with normal liver function

Objective To study the clinical features and liver pathology in chronic hepatitis B( HBV)-infected patients with normal liver function,and to explore the influencing factors. Methods A total of 316 chronic HBV-infected patients with normal liver function who were admitted to our hospital from August 2008 to August 2012 were enrolled as subjects. Hepatic tissue was collected by ultrasound-guided biopsy and analyzed by hematoxylin-eosin staining,Masson staining,and anti-HBs Ag and anti-HBc Ag immunohistochemistry staining.The Knodell inflammatory score and Ishak fibrosis score were evaluated,and their relationships with age,gender,HBe Ag,alanine aminotransferase( ALT) level,serum HBV DNA replication,and hepatic expression of HBs Ag and HBc Ag were analyzed. Comparisons of continuous data between two groups and between multiple groups were performed by t test and one-way analysis of variance,respectively. The further pairwise comparison was performed by SNK-q test. Comparison of categorical data was performed by χ2test. Results In all the chronic HBV-infected patients with normal liver function,there were 260( 82. 3%) patients with at least moderate inflammation and necrosis,256( 81. 0%) patients with at least moderate fibrosis,13( 4. 1%) patients with severe inflammation and necrosis,and 26( 8. 2%)patients with severe fibrosis( cirrhosis). The average age,Knodell score,and Ishak score were significantly higher in the female patients than in the male patients( t = 3. 526,P < 0. 05; t = 6. 65,P < 0. 05; t = 5. 77,P < 0. 05). The chronic HBV-infected patients older than30 years of age had significantly higher Knodell and Ishak scores than those younger than 30 years of age( both P < 0. 05). Moreover,the degree of liver injury was significantly higher in the infected patients with an ALT level of( 0. 5-1) × upper limit of normal( ULN) than in those with an ALT level of( 0-0. 49) × ULN( P < 0. 05). Patients with undetectable HBV DNA replication had a significantly lower degree of liver injury than those with detectable HBV DNA replication( P < 0. 05). However,there was no significant correlation between liver injury and hepatic expression of HBs Ag and HBc Ag( both P > 0. 05). Conclusion Liver biopsy should be considered for the chronic HBV-infected patients with detectable viral load and sustainable normal ALT,particularly those older than 40 years of age.