Liver histological changes and clinical features in chronic hepatitis B with normal or mildly elevated alanine aminotransferase

Objective To investigate the association between liver histological changes and clinical indices in chronic hepatitis B( CHB)patients with normal or mildly elevated alanine aminotransferase( ALT),and to provide a basis for guiding antiviral therapy. Methods A retrospective analysis was performed for the clinical data of 903 CHB patients who underwent liver biopsy in Sichuan Provincial People's Hospital from October 2011 to August 2018. The association of sex,age,serum HBeAg status,serum ALT,and HBV DNA level with liver inflammation activity and fibrosis degree was analyzed in CHB patients with an ALT level of < 2 × upper limit of normal( ULN). The chi-square test was used for comparison of categorical data between two groups. Results The liver inflammatory activity ranged from G1 to G4 in 903 CHB patients,among whom 67. 6% had G2 inflammation and 831( 92. 0%) had G≥2 inflammation; the fibrosis stage ranged from S0 to S4 in all patients,among whom 78. 2% had S1 fibrosis and 159( 17. 6%) had S≥2 fibrosis. Male patients had significantly higher liver inflammatory activity and fibrosis stage than the female patients( χ2= 6. 120 and 15. 098,both P < 0. 05). Among the patients with ALT < 1 × ULN,1 × ULN≤ALT < 1. 5 × ULN,and ALT≥1. 5 × ULN,91. 2%,92. 1%,and 94. 8%,respectively,had marked( G≥2)liver inflammation and necrosis,which showed a significant difference between the three groups( χ2= 28. 125,P < 0. 05); among the three groups of patients,12. 7%,22. 9%,and 24. 4%,respectively,had marked( S≥2) liver fibrosis,which showed a significant difference between the three groups( χ2= 18. 004,P < 0. 05). Liver inflammatory activity and fibrosis degree aggravated with the increase in the age of CHB patients( χ2= 65. 768 and 56. 056,both P < 0. 05) and the reduction in serum HBV DNA level( χ2= 21. 712 and 29. 461,both P <0. 05). The HBeAg-negative patients had significantly higher liver inflammatory activity and fibrosis stage than the HBeAg-positive patients( χ2= 30. 798 and 26. 380,both P < 0. 05). Among the HBeAg-positive and HBeAg-negative patients with an age of ≥30 years and 1. 5 × ULN ≤ ALT < 2 × ULN,100%( 40/40) and 97. 8%( 45/46),respectively,had marked liver inflammation and necrosis.Conclusion Most CHB patients with normal or mildly elevated ALT have marked liver inflammation and varying degrees of liver fibrosis,especially male patients aged ≥30 years. It is recommended to perform liver histopathological examination to assess the indication for antiviral therapy and avoid delay in treatment.