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

Background:According to HBeAg positive or negative,the chronic hepatitis B are divided into HBeAg(+) and HBeAg(-);In the HBeAg-negative phases,the most of patients remain in an inactive,low-replicative state(inactive HBV carrier state).Inactive carriers have persistently normal ALT(PNALT),low or below cut-off monitoring serum HBV-DNA levels,minimal or no necro-inflammation and generally minimal to mild fibrosis on liver biopsy,but more and more findings show Patients with HBeAg-negative chronic hepatitis B virus infection are older and higher risk to progress of liver disease to cirrhosis and hepatocellular carcinoma.Liver biopsy can be early found a hidden dangers of progress.Objective:To analyse changes of Hepatic histology METAVIR scoring of HBeAg-negative chronic hepatitis B virus infection with alanine aminotransferase(ALT)normal or minimally raised(less than two-time Upper Limit of Normal,<2ULN).Methods:Retrospective analysis of the data from Hospitalized patients,accepted liver biopsy of HBeAg-negative chronic hepatitis B virus infection with alanine aminotransferase(ALT) normal or minimally raised(less than two-time Upper Limit of Normal,<2ULN).Results:134 patients met our inclusion criteria.(1)Gender distribution:63.4%(85/134) male patients were male and 36.6%(49/134)were female.The ratio of male and female incidence was 1.7:1,Male infection rate slightly higher than the female;(2)Age distribution:The majority age of patients was range from 40 to 49 years,They accounted for 40.3%(54/134);(3)Serum ALT level distribution:Serum ALT normal patients were accounted for 79.1%(106/134),20.9%(28/134) patients were serum ALT≤2ULN;(4)Serum HBV-DNA load distribution:47%(63/134) patients are serum HBV-DNA level below cut-off monitoring,41.8%(56/134)patients of serum HBV-DNA <E+5copies/ml,11.2%(15/134) patients serum HBV-DNA≥E+5copies/m1.More than 80% of patients with low viral loads;(5)Liver tissue HBV-DNA load distribution:63patients are serum HBV-DNA level below cut-off monitoring,But there are still more than 84.1%(53/63) of patients liver tissue with HBV-DNA replication,64.2%(34/53) of the patients with higher viral loads (≥E+5copies/ml);(6)Serum HBsAg quantification level distribution:They accounted for 53.8% (21/39)(HBsAg<2500IU/ml),patients were 38.5%(15/39X2500IU/ml≤HBsAg<10000IU/ml), They accounted for 7.7%(3/39)(≥10000IU/ml).Patients of HBsAg quantification low and medium level(<10000IU/ml) had a higher prevalence with accounting for 92.3%(36/39);(7)FS value distribution:FS≤5.0kPa:19.4%(20/103),FS≥5.0kPa:77.7%(80/103);(8)Hepatic histology METAVIR scoring:134 patients exist different degree of liver tissue damage,54.5%(73/134) patients of METAVIR scoring≥G2,50.7%(68/134) patients who METAVIR score≥S2;(9)The FS and METAVIR scoring≥G2S2 correlation:FS≥5.0Kpa,More than 50% of the patients is METAVIR scoring≥G2S2,With the increase of the FS value,the liver tissue have serious tendency.(10)The Serum ALT level and METAVIR scoring>G2S2 correlation:There were obvious differences on METAVIR scoring≥G2 between ALT normal and ALT<2ULN(P=0.038),patients are higher risk in METAVIR scoring≥G2 with ALT normal,There were no obvious differences on METAVIR scoring≥S2(P=0.122);(11)Serum HBV-DNA load and METAVIR scoring≥G2S2 correlation:There are obvious differences on METAVIR scoring≥G2 between serum HBV-DNA low and higher load level,The degree of liver inflammation is aggravating with higher virus load level,But it can’t prove serum HBV-DNA is the direct factors influencing patients METAVIR scoring,it is not in the fibrosis stage;(12)Liver tissue HBV-DNA load and METAVIR scoring≥G2S2 correlation:There are no differences on METAVIR scorings;(13)The Serum HBsAg quantification level and METAVIR scoring≥G2S2 correlation:There are no differences on METAVIR scoring≥G2S2 between serum HBsAg quantification low and medium level(P>0.05),The relationship between the higher serum HBsAg quantification level and METAVIR scoring is not clear,because of lacking of enough data;(14)The age and METAVIR scoring≥G2S2 correlation;Higher age group(≥30y) is more obvious damage than lower age group(<30y) in the degree of inflammatory,it is not in the fibrosis stage.(15)The gender and METAVIR scoring≥G2S2 correlationrThere are no obvious differences of gender in the incidence of METAVIR scoring≥G2S2(P>0.05).Conclusions:1.Male infection rate slightly higher than the female,The majority age of patients was range from 40 to 49 years;2.Patients are higher risk in METAVIR scoring≥G2 with ALT normal;3.More than 40% patients are serum HBV-DNA with low viral loads;4.Alough patients are serum HBV-DNA level below cut-off monitoring,but there are still more than 80% of patients liver tissue with HBV-DNA replication,More than 40% of the patients with liver tissue higher viral loads(≥E+5copies/ml);5.The main of HBsAg quantification level distribution between low and medium level(<10000IU/ml);6.More than 50% of the patients is Hepatic histology METAVIR scoring≥G2S2,Especially the risk is higher in the age≥30,ALT normal;7.Liver tissue HBV-DNA is the direct factors influencing patients METAVIR scoring;8.There are obvious differences on METAVIR scoring≥G2 between serum HBV-DNA low and (?) The degree of liver inflammation is aggravating with higher virus load level,But can’t (?)m HBV-DNA load is the direct factors influencing patients METAVIR scoring;9.FS>5.0Kp,More than 80% of the patients is METAVIR scoring≥G2S2,With the increase of the FS value,the liver tissue have serious tendency; 10.Serum ALT level,HBV-DNA load,serum HBsAg quantification Can’t truthfully reflect the liver damage,To treatment in such patients the liver biopsy should be taken into the liver tissue have serious tendency.