Noninvasive Markers Of Liver Inflammation And Fibrosis In Chronic Hepatitis B Patients

Aim:To find non-invasive markers for assessing liver histological abnormalities in treatment-naive chronic hepatitis B(CHB)patients with normal or 1-2xupper limit of normal(ULN)alanine aminotransferase(ALT).Methods:We retrospectively reviewed 1731 patients who had taken liver biopsy tests in the first affiliated hospital,Zhejiang University from October 2010 to October 2015.Among them 522 patients with chronic hepatitis B were included.Patients with ALT<2xULN(normal or 1-2×ULN)and ALT>2xULN were 432 and 90 respectively.Liver histology was assessed according to the Metavir scoring system.Laboratory tests such as ALT,aspartate aminotransferase(AST)and HBV DNA were analyzed.Results:33.6%of cases with significant inflammation and 21.3%of cases with significant fibrosis were observed in CHB patients with ALT<2xULN.There were significant differences in age,platelet count(PLT),ALT,AST,AST/ALT ratio(AAR),AST to PLT ratio index(APRI),and fibrosis index based on the 4 factors(FIB-4)between patients with mild and significant necroinflammation.AST was the independent factor in predicting significant necroinflammation.The area under receiver operating characteristic(ROC)curve was 0.701.The optimal cut-off value,sensitivity and specificity were 29.5 U/L,0.621 and 0.690 respectively.The differences of age(?40 years),PLT,ALT,AST,HBsAg,APRI,FIB-4 and HBV DNA were statistically significant between patients with mild and significant fibrosis.PLT was an independent factor in assessing the fibrosis stage.The area under ROC curve,optimal cut-off value,sensitivity and specificity were 0.648,165.5×109/L,0.565 and 0.676 respectively.Conclusion:33.6%of cases with significant inflammation and 21.3%of cases with significant fibrosis were observed in treatment-naive CHB patients with ALT normal and 1-2×ULN.AST<29.5U/L and PLT>165.5×10~9/L may have eliminating value for predicting significant inflammation and fibrosis respectively.