Simple serum markers for significant liver inflammation in chronic hepatitis B patients with an alanine aminotransferase level lower than 2 times upper limit of normal

Objective To investigate the simple serum markers for significant liver inflammation in chronic hepatitis B(CHB) patients with an alanine aminotransferase(ALT) level of < 2 times upper limit of normal(ULN).Methods The clinical data of 278 CHB patients with ALT < 2 × ULN(ULN = 40 U / L) were analyzed retrospectively.Significant liver inflammation was defined as a liver inflammatory activity grade(G) ≥2.The t- test was used for comparison of normally distributed continuous data between groups,and the Kruskal- Wallis rank sum test was used for non- normally distributed continuous data;the chi- square test was used for comparison of categorical data between groups.Multivariate logistic regression analysis was used to identify independent predictors for significant liver inflammation in CHB patients with ALT < 2 × ULN.The receiver operating characteristic(ROC) curve was used to evaluate the diagnostic value of serum markers in significant liver inflammation.Results Of the 278 CHB patients enrolled,175(62.9%) had no significant liver inflammation(G0- 1group) and 103(37.1%) had significant liver inflammation(G2- 4 group).There were significant differences in ALT,aspartate aminotransferase,alkaline phosphatase,gamma- glutamyl transpeptidase(GGT),albumin,globulin,prothrombin time(PT),platelet,absolute neutrophil count,hyaluronic acid(HA),glycocholic acid,precollagen Ⅲ,and collagen type Ⅳ(ⅣC) between the two groups(all P< 0.05).The multivariate regression analysis showed that GGT,PT,ⅣC,and HA were independent predictors for significant liver inflammation in CHB patients with ALT < 2 × ULN(OR = 1.015,1.600,1.151,and 1.014,P = 0.008,0.021,0.003,and 0.018).The areas under the ROC curve for GGT,PT,IVC,and HA to diagnose significant liver inflammation were 0.804,0.722,0.707,and 0.632,respectively.The cut- off value of 48.5 U / L for GGT to predict significant liver inflammation had a specificity of 90.3% and a negative predictive value of 74.6%.Conclusion GGT,PT,IVC,and HA are independent predictors for significant liver inflammation in CHB patients with ALT < 2 × ULN,among which GGT has the highest predictive value.