Changes Of Hepatic Histology From Patients With Chronic Hepatitis B With HBeAg Positive And Normal Or Minimally Raised Alanine Aminotransferase

BACKGROUND:Based on the presence of HBeAg or not,CHB is divided into HBeAg-positive chronic HBV infection and HBeAg-negative chronic HBV infection.The characters of HBeAg-positive patients include,patients have subclinical hepatitis,very high HBV-DNA and normal alanine aminotransferase concentrations,and minimum inflammation and fibrosis on histology;In our country,HBV infection is acquired during infancy or early childhood,patients are mostly asymptomatic, but have increased risk of liver cirrhosis,especially who have normol or mild alanine aminotransferase concentrations.OBJECTIVE:To Analysis the changes of hepatic histology from patients with chronic hepatitis B with HBeAg positive and normal or minimally raised alanine aminotransferase.METHODS:A prospective study was conducted the patients with chronic hepatitis B with HBeAg positive and normal or minimally raised alanine aminotransferase, who were admitted to the Lanzhou University Second Hospital for a liver biopsy.RESULTS:CHB patients (n=117)who were admitted to the Lanzhou University Second Hospital for a liver biopsy were enrolled.(1)Gender distribution:68.4%(80/117)of whom were male,31.6%(37/117)of whom were female,Male:female=2.16:1;Male had twice as many female who infected HBV;(2)Age distribution:The age beween 30-40 have highest proportion, which accounting for 32.5%(38/117); (3)Serum ALT level distribution:The serum ALT lever less than ULN accounted for 57.3%(67/117);The serum ALT lever less than twice ULN accounted for 42.7%(50/117);(4) Serum hepatitis B virus (HBV)-DNA level;The serum HBV-DNA level less than 5.0E+2copies/ml accounted for 11.1%(13/117);The serum HBV-DNA level less than E+5copies/ml accounted for 20.5%(24/117);The serum HBV-DNA level more than E+5copies/ml accounted for 68.4%(80/117);More than 50% patients have high viral loads;(5)The liver tissue HBV-DNA level:HBeAg-positive patients(n=13)whose serum HBV-DNA level less than 5.0E+2copies/ml have 76.9% HBV-DNA in liver tissue, and 46.2% have high viral loads in these patients;(6)HBsAg concentration:Patients with HBsAg concentrations less than 2500IU/ml accounted for 25.5%(12/47),and HBsAg concentrations between 2500IU/ml and 10000 IU/ml accounted for 25.5%(12/47),and HBsAg concentrations more than 10000 IU/ml accounted for 48.9%(23/47);The last group take highest proportion;(7)Fibroscan distribution:Liver stiffness measurement(LSM)by Fibroscan less than 5kPa accounted for 20.6%(22/107),and more than 5kPa accounted for 79.4%(85/107).The last group take highest proportion;(8)The characteristic of hepatic histopathology and correlation between inflammaiton grade and fibrosis stage score:Significant hepatic inflammation was found in 47.9%(56/117)of these patients,and significant hepatic fibrosis was found in 45.3%(53/117);There was a positive correlation between inflammaiton grade and fibrosis stage score(r=0.803,P<0.01);(9)The correlation between gender and METAVIR scoring≥G2S2:There was no statistically significant difference in sex raito bewteen the two groups(.P>0.05);(10)The correlation between age and METAVIR scoring≥G2 S2:Inflammaiton grade was significantly higher in the>40 years age group than in the<40 years age group(.P<0.05),and there was no statistically significant difference in the fibrosis stage score(P>0.05);(11)The correlation between serum ALT lever and METAVIR scoring≥G2S2:There was no association between ALT≤ULN and 1×ULN<ALT<2×ULN in hepatic histopathology G2-4 and S2-4(both P>0.05);(12)The correlation between HBV-DNA and METAVIR scoring≥G2 S2:There was no significant differences between serum HBV-DNA/liver tissue HBV-DNA and METAVIR scoring (both P>0.05);(13)The correlation between HBsAg concentrations and METAVIR scoring≥G2S2:Inflammaiton grade was significantly higher in the HBsAg concentrations less than 2500IU/ml group than in the more than 2500IU/ml group(P<0.05),and there was no statistically significant difference in the fibrosis stage score(P>0.05);(14)The correlation between FS and METAVIR scoring≥G2S2:Liver stiffness measurement were positively correlated with inflammation grade and fibrosis stage score(r=0.3410.394,bothP<0.01).CONCIUSION:1.The characters of HBeAg-positive patients include,Male had twice as many female who infected HBV,relatively younger,very high HBV-DNA and high HBsAg concentration;2.More than 50% patients have METAVIR scoring≥G2S2;3.Inflammation grade was significantly higher in the low HBsAg concentrations and Age>40,but it can’t reflect the fibrosis stage score,so we advice the middle-aged patients should accept liver biopsy;4.The patients whose serum HBV-DNA level less than 5.0E+2copies/ml have more than 50% patients with liver HBV-DNA replication,and most of them have high viral loads;5.Serum HBV-DNA/Liver tissue HBV-DNA may not directly influence METAVIR scoring;6.Fibroscan can illustrate the liver fibrosis in HBeAg(+)CHB patients;7.Liver biopsy is important in patients with slightly raised of alanine aminotransferase concentrations to establish whether antiviral therapy is indicated.