Document Detail


A large population histology study showing the lack of association between ALT elevation and significant fibrosis in chronic hepatitis B.
MedLine Citation:
PMID:  22389715     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: We determined the association between various clinical parameters and significant liver injury in both hepatitis B e antigen (HBeAg)-positive and HBeAg-negative patients.
METHODS: From 1994 to 2008, liver biopsy was performed on 319 treatment-naïve CHB patients. Histologic assessment was based on the Knodell histologic activity index for necroinflammation and the Ishak fibrosis staging for fibrosis.
RESULTS: 211 HBeAg-positive and 108 HBeAg-negative patients were recruited, with a median age of 31 and 46 years respectively. 9 out of 40 (22.5%) HBeAg-positive patients with normal ALT had significant histologic abnormalities (necroinflammation grading ≥ 7 or fibrosis score ≥ 3). There was a significant difference in fibrosis scores among HBeAg-positive patients with an ALT level within the Prati criteria (30 U/L for men, 19 U/L for women) and patients with a normal ALT but exceeding the Prati criteria (p = 0.024). Age, aspartate aminotransferase and platelet count were independent predictors of significant fibrosis in HBeAg-positive patients with an elevated ALT by multivariate analysis (p = 0.007, 0.047 and 0.045 respectively). HBV DNA and platelet count were predictors of significant fibrosis in HBeAg-negative disease (p = 0.020 and 0.015 respectively). An elevated ALT was not predictive of significant fibrosis for HBeAg-positive (p = 0.345) and -negative (p = 0.544) disease. There was no significant difference in fibrosis staging among ALT 1-2 × upper limit of normal (ULN) and > × 2 ULN for both HBeAg-positive (p = 0.098) and -negative (p = 0.838) disease.
CONCLUSION: An elevated ALT does not accurately predict significant liver injury. Decisions on commencing antiviral therapy should not be heavily based on a particular ALT threshold.
Authors:
Wai-Kay Seto; Ching-Lung Lai; Philip P C Ip; James Fung; Danny Ka-Ho Wong; John Chi-Hang Yuen; Ivan Fan-Ngai Hung; Man-Fung Yuen
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Publication Detail:
Type:  Journal Article     Date:  2012-02-28
Journal Detail:
Title:  PloS one     Volume:  7     ISSN:  1932-6203     ISO Abbreviation:  PLoS ONE     Publication Date:  2012  
Date Detail:
Created Date:  2012-03-05     Completed Date:  2012-07-05     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  101285081     Medline TA:  PLoS One     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e32622     Citation Subset:  IM    
Affiliation:
Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Alanine Transaminase / metabolism*
Female
Hepatitis B e Antigens / metabolism*
Hepatitis B, Chronic / enzymology*,  pathology*
Humans
Liver Cirrhosis / enzymology*,  pathology*
Male
Middle Aged
Young Adult
Chemical
Reg. No./Substance:
0/Hepatitis B e Antigens; EC 2.6.1.2/Alanine Transaminase
Comments/Corrections

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


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