Document Detail


Histologic evidence of active liver injury in chronic hepatitis B patients with normal range or minimally elevated alanine aminotransferase levels.
MedLine Citation:
PMID:  20179614     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
GOALS: To evaluate the proportion of patients with histologic evidence of active liver disease (HEALD) who have chronic hepatitis B (CHB) and normal/minimally elevated serum alanine aminotransferase (ALT). Sub-analysis was performed to determine whether HEALD based upon liver biopsy better correlates with ALT using modified ALT (30 men/19 women) upper limit of normal (ULN) criteria compared with local conventional laboratory. BACKGROUND: There are limited data on CHB with normal range ALT (NRALT). We designed a study to evaluate histologic damage in this cohort of patients. STUDY: A retrospective, multicenter study evaluated CHB patients with normal/minimally elevated ALT [< or = 1.2 x ULN (hepatitis B e antigen positive) or < or = 1.5 x ULN (hepatitis B e antigen negative)]. Liver biopsy specimens were reviewed by an independent histopathologist. HEALD was defined as Knodell necroinflammatory score greater than 5 and Ishak fibrosis stage greater than 1. RESULTS: Forty-five patients met criteria: median age of 40 years; 51% males; 73% Asian; and 67% hepatitis B e antigen negative. Median hepatitis B virus DNA was 6.04 log10 copies/mL, aspartate aminotransferase (AST) 30 IU/L, and ALT 42 IU/L; and 40% of the patients had ALT greater than ULN. Overall, 20% had HEALD and among patients with NRALT, 4 of 27 (15%) and 0 of 5 (0%) had HEALD through conventional or modified ALT ULN, respectively. CONCLUSIONS: One fifth of patients with CHB and normal/minimally elevated ALT had HEALD. Among the subset of patients with NRALT, 15% (4 of 27) had HEALD when using conventional laboratory compared with 0% (0 of 5) patients by modified ALT ULN criteria. Use of the modified ALT ULN will likely improve accuracy in identifying patients who may have HEALD compared with conventional laboratory ULN.
Authors:
Ke-Qin Hu; Eugene R Schiff; Kris V Kowdley; Albert D Min; Mitchell L Shiffman; William M Lee; Zachary D Goodman; Lauren O Dau; Kenneth J Peschell; Elizabeth A Fagan; John F Flaherty
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of clinical gastroenterology     Volume:  44     ISSN:  1539-2031     ISO Abbreviation:  J. Clin. Gastroenterol.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-16     Completed Date:  2010-10-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7910017     Medline TA:  J Clin Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  510-6     Citation Subset:  IM    
Affiliation:
Division of GI/Hepatology, University of California Irvine School of Medicine, Orange, CA 92868, USA. kqhu@uci.edu
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00263614
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MeSH Terms
Descriptor/Qualifier:
Adult
Alanine Transaminase / blood*
Aspartate Aminotransferases / blood
Biopsy
Clinical Trials as Topic
DNA, Viral / analysis
Female
Hepatitis B e Antigens / analysis*
Hepatitis B, Chronic / physiopathology*
Humans
Liver / physiopathology*
Male
Middle Aged
Retrospective Studies
Chemical
Reg. No./Substance:
0/DNA, Viral; 0/Hepatitis B e Antigens; EC 2.6.1.1/Aspartate Aminotransferases; EC 2.6.1.2/Alanine Transaminase

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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