Independent predictive factors for significant liver histological changes in patients with HBe Ag-positive high-viral-load chronic HBV infection and a normal alanine aminotransferase level

Objective To investigate the independent predictive factors for significant liver histological changes( SLHCs) in patients with HBe Ag- positive high- viral- load chronic hepatitis B virus( HBV) infection and a normal alanine aminotransferase( ALT) level. Methods A retrospective analysis was performed on the clinical data of 116 previously untreated patients with HBe Ag- positive high- viral-load( HBV DNA≥105copies / ml) chronic HBV infection and a normal ALT level( < 50 U/L) who were hospitalized in Shanghai Public Health Clinical Center Affiliated to Fudan University from June 2013 to August 2015. The definition of SLHCs was inflammation ≥G2 and /or fibrosis≥S2. The t- test or Mann- Whitney U rank sum test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups. Univariate and multivariate regression analyses were used to determine independent predictive factors for SLHCs. Results Of all the 116 patients,47( 40. 5%) had SLHCs. The multivariate analysis showed that age( OR = 2. 828,P < 0. 05),ALT( OR = 1. 011,P < 0. 05),and gamma- glutamyl transpeptidase( GGT)( OR = 1. 089,P< 0. 05) were independent predictors for SLHCs in patients with HBe Ag- positive high- viral- load chronic HBV infection and a normal ALT level. The patients aged ≤30 years had a significantly lower incidence rate of SLHCs than those aged > 30 years( 21. 6% vs 49. 4%,χ2= 6. 42,P = 0. 015),the patients with ALT ≤30 U/L had a significantly lower incidence rate of SLHCs than those with 30 U/L < ALT≤50 U/L( 17. 6% vs 50. 0%,χ2= 19. 86,P < 0. 001),and the patients with GGT≤40 U/L had a significantly lower incidence rate of SLHCs than those with GGT > 40 U/L( 28. 8% vs 66. 7%,χ2= 28. 63,P < 0. 001). Conclusion In patients with HBe Ag- positive high-viral- load chronic HBV infection and a normal ALT level,those with an age of > 30 years,ALT > 30 U/L,and GGT > 40 U/L tend to develop SLHCs and need liver biopsy.