Comparison Of METAVIR Scores From Patients With Chronic Hepatitis B With HbeAg Positive / Negative And Normal Or Mildly Raised Alanine Aminotransferase

Background:Hepatitis B virus infection is the main cause of chronic liver disease in our country.Chronic hepatitis B disease progression occult,easy to progress to liver cirrhosis or liver cancer and threatend the patients life. Now,We dicide if a patient need to antiviral therapy mainly according to the alanine transaminase level in blood.According to the level of Hepatitis B e Antigen(HBe Ag) in serum of patients,they will be divided into two groups,which one is called HBe Ag-positive CHB,and the other is HBe Ag-negative CHB.In theory,the HBe Ag-positive CHB is staying immune tolerant phase,so it hasn’t obviously clinical symptoms,and liver function is mildly abnormal,and progress of liver tissue slightly.In HBe Ag-negative CHB,because of the antibody against hepatitis B virus means disease appeared immune activation and liver tissue due to inflammatory injury appear different degree of progress.However,there were different levels of liver tissue progression from patients with chronic hepatitis B with HBe Ag positive/negative and normal or mildly raised alanine aminotransferase in recent years.Objective:To analyze the general characteristics from patients with chronic hepatitis B with HBe Ag positive/negative and normal or mildly raised alanine aminotransferase and the difference of liver tissue METAVIR score between the two groups.Merhods:Collected and retrospectively analyzed the general characteristics from patients who come to Hepatic Department of the Second Hospital of Lanzhou University during 2011.6~2014.6,with chronic hepatitis B with HBe Ag positive/negative and normal or mildly raised alanine aminotransferase,and the patients were taken liver biopsy.Results:Referring to the inclusion criteria, a total of 140 patients with HBeAg-positive CHB and191 patients with HBe Ag-negative CHB were included in the study.(1) gender characteristics: in140 cases of HBe Ag-positive CHB patients, male 96, female 44, male and female ratio was 2.2:1;in 191 HBe Ag-negative CHB patients, male 132, female 59, male and female ratio 2.2:1.(2) age characteristics:in HBe Ag-positive CHB patients,mean age(mean + standard deviation) 33.6 +10.8 years old,with 20-29 as the main. In HBe Ag-negative CHB patients,mean age(mean + standard deviation) was 38 + 9.7 years old,with 30-39 as the main.(3) in HBe Ag-positive/negative CHB patients, respectively,57.1% and 72.8% of the patients with normal ALT levels;42.9% and27.2% patients with mild ALT levels.And there’s no statistically significant(P>0.05) in the two groups.(4) The distribution of blood DNA HBV: there is high level of the serum HBVDNA as the main in HBe Ag-positive CHB and a mild level of the serum HBV DNA as the main in HBe Ag negative CHB.And there’s no significant statistical difference between the two groups(P > 0.05).(5) although the peripheral serum HBV DNA below the line test but liver tissue HBV DNA remain can be test.and its existence the possibility is more than 90%,among them about 50% in liver tissues of patients with existing high HBV viral load.And there’s no significant statistical difference between the two groups(P >0.05).(6)There is high level of the serum Hepatitis B s Antigen as the main in HBe Ag-positive CHB and a low to moderate level of the serum Hepatitis B s Antigen as the main in HBe Ag-negative CHB.(7) More than 70%HBe Ag positive/HBe Ag negative CHB patients’ Fibroscan > 5(k Pa).(8)There’s no significant statistical difference of METAVIR score in HBe Ag-positive/HBe Ag-negative;but HBe Ag-positive/HBe Ag negative in patients with CHB METAVIR score greater than or equal to G2S2 nearly and greater than 50%.(9)There’s no significant statistical difference in HBe Ag-positive/negative CHB two groups,while the liver tissue of DNA were replication.(10)The liver histological progression found in about 50%of patients while the ALT is normal,and there’s no significant statistical difference in two groups(P=0.611>0.05).There’s significant statistical difference in two group in the inflammatory process while the ALT mildly elevated.(11)There’s significant statistical difference in HBe Ag negative/positive CHB patients while the age >30years old and ALT <2ULN(P<0.05).(12)There was no significant difference of progression of liver histology between HBe Ag positive And negative patients in different HBs Ag titers.(13)when FS>5.0Kpa,close to 50%HBe Ag-positive/HBe Ag negative patients with METAVIR score greater than or equal to G2S2 and there’s no significant statistical difference between the two groups(P>0.05).Conclusion:1.METAVIR score greater than or equal to G2S2: HBeAg-positive CHB patients is more than or equal to 40%,HBe Ag-negative CHB patients is more than or equal to 50%.ALT normal HBe Ag-negative patients occur higher risk,while METAVIR is more than or equal to G2S2, especially over the age of 30 and mildly elevated ALT.3.The serum HBV DNA was lower than the detection line but the liver tissue HBV DNA were replicated: the patients of both groups were above 90%, and more than half of the patients(>50%) in thigh load of liver tissue DNA HBV.4.The load of HBV DNA in serum or liver tissues may not directly influence factors in patients with METAVIR more than or equal to G2S2.5.There’s a similar trend of the METAVIR score more than or equal to G2S2 between HBe Ag-positive/HBe Ag-negative,while FS is greater than 5.0Kpa.