Liver inflammatory activity in chronic hepatitis B patients with a low HBV DNA level and related factors

Objective To investigate the association between liver inflammatory activity and clinical features in chronic hepatitis B (CHB) patients with a low HBV DNA level, and to provide a basis for judging the condition of such patients.Methods A total of 137 patients with an HBV DNA level of 20-2000 IU/ml who were treated in The Third People's Hospital of Kunming from January 2014 to December 2017were enrolled, and according to the grade of liver inflammatory activity, they were divided into G1 group with 44 patients, G2 group with 84patients, and G3 group with 9 patients.Liver biopsy and immunohistochemistry were performed for all patients, and the association of the grade of liver inflammatory activity with age, sex, HBV infection time, liver function, HBsAg level, HBV DNA load, genotype, diameter of the portal vein, diameter of the splenic vein, and spleen thickness was analyzed.The Kruskal-Wallis H test was used for comparison of nonparametric ranked data between multiple groups.Results Of all 137 patients, 126 had negative HBeAg, among whom 42 (33.33%) had G1 inflammation, 77 (61.11%) had G2 inflammation, and 7 (5.56%) had G3 inflammation;11 had positive HBeAg, among whom 2 (18.18%) had G1 inflammation, 7 (63.64%) had G2 inflammation, and 2 (18.18%) had G3 inflammation.There were significant differences in globulin, HBV DNA load, platelet count (PLT) , diameter of the splenic vein, and spleen thickness between the 126 HBeAg-negative patients with different inflammation grades (H=6.189, 7.168, 8.624, 8.170, and 8.522, all P<0.05) .Conclusion The majority of patients with a low HBV DNA level have≥G2 liver inflammation and the indication for antiviral therapy, and the grade of inflammation is closely associated with globulin, HBV DNA load, PLT, diameter of the splenic vein, and spleen thickness.