Liver Histopathology Study On Chronic Hepatitis B Patients With Mild Elevated In Transaminases

Object To study the pathological differences of chronic hepatitis B patients among mild elevated in transaminases (ALT 1-2×ULN), chronic asymptomatic HBV carrier (ASC) and moderate elevated in transaminases (ALT 2-10×ULN).To explore the relationships between immunohistochemical and in situ hybridizational changes in liver tissues and serum HBVDNA.Methods To collect ALT≤10×ULN chronic hepatitis B patients, and divide into three groups,group A:mild elevated in transaminases (ALT 1-2×ULN);group B:chronic asymptomatic HBV carrier (ASC) and group C moderate elevated in transaminases (ALT 2-10×ULN).Patients'transaminases were detected by automatic biochemistry analyzer, HB virus maker was detected by ELISA, and HBVDNA was detected by real-time fluorescent quantitative PCR.All these patients undergone percutaneous liver biopsy by echo.All liver biopsy specimens were stained with HE stain, reticular fiber staining, and immunohistochemical and in situ hybridizational staining. All liver biopsy specimens were assessed by the same experienced liver pathologist blinded to the liver biochemistry and scored according to standard criteria.Immunohistochemical staining was graded into five grade, and in situ hybridizational staining was graded into four grades.To compare the hepatic necrosis inflammation grade and hepatic fibrosis stage among the three groups. To explore the relationships between immunohistochemical and in situ hybridizational changes in liver tissues and serum HBVDNA.Results1. The average age of the patients in group A and group C was older than that of the patients in group B, showing a significant difference (P<0.01), but the average age of the patients in group A and group C was of no significant difference (P>0.05).The serum HBVDNA also showed significant difference among the three groups (P<0.05),the serum HBVDNA level in the patients in group B was high than that of the patients in group A and group C (P<0.05),but the serum HBVDNA level in the patients in group A and group C was of no significant difference (P>0.05).2. There were significant difference among the three groups in the hepatic necrosis inflammation grade in liver tissues (P<0.01).The hepatic necrosis inflammation grade were group C > group A > group B (P<0.01). The hepatic necrosis inflammation grade had positive correlation with ALT and AST (rs=0.706, P<0.01 and rs=0.664, P<0.01, respectively), negative correlation with serum HBVDNA (rs=-0.352, P<0.01).3. There were significant difference among the three groups in the hepatic fibrosis stage in liver tissues (P<0.01). The hepatic fibrosis stage were group C > group A > group B (P<0.01). The hepatic fibrosis stage also had positive correlation with ALT and AST(rs=0.565,P<0.01 and rs=0.594,P<0.01,respectively), negative correlation with serum HBVDNA(rs=-0.237,P<0.01).4. The HBsAg level in liver tissues were no significant difference among the three groups (P=0.197>0.05). The HBcAg and HBVDNA level in liver tissues were significant difference among the three groups (both P<0.01). There were significant difference between group A and group B, group B and group C in the HBcAg and HBVDNA level in liver tissues, but the difference between group A and group C were insignificant.Conclusion The chronic hepatitis B patients'age, the serum HBVDNA level, and the HBcAg and HBVDNA level in liver tissues, who with mild elevated in transaminases was similar with those of the patients with moderate elevated in transaminases.The hepatic necrosis inflammation grade and fibrosis stage in liver tissues of the patients with mild elevated in transaminases was slighter than those of the patients with moderate elevated in transaminases, but severer than ASC. Significant hepatic pathology was found in chronic hepatitis B patients with mild elevated in transaminases.Liver biopsy in cases of chronic hepatitis B patients with mild elevated in transaminases is helpful to assess accurately both the activity of the disease and the degree of fibrosis and to estimate if antiviral therapy shoud be conducted.The serum HBVDNA level was consistent with the HBcAg and HBVDNA level in liver tissues, but inconsistent with the HBsAg level in liver tissues.