Published online Apr 21, 2017. doi: 10.3748/wjg.v23.i15.2802
Peer-review started: November 12, 2016
First decision: December 29, 2016
Revised: January 12, 2017
Accepted: February 17, 2017
Article in press: February 17, 2017
Published online: April 21, 2017
Processing time: 159 Days and 21.3 Hours
To determine incidence and clinical biomarkers of marked necroinflammation and fibrosis characteristics among chronic hepatitis B (CHB) patients with persistently normal alanine aminotransferase (PNALT).
Liver biopsy was performed on 115 CHB patients with PNALT. Necroinflammation and fibrosis were graded by the Knodell histologic activity index and the Ishak fibrosis score, respectively. Correlations between the available clinical parameters and necroinflammation and fibrosis were analysed.
Marked necroinflammation (Knodell activity index ≥ 7) and fibrosis (Ishak fibrosis score ≥ 3) were found in 36.5% and 15.5% of CHB patients with PNALT, respectively. Following a univariate logistic regression analysis, multiple logistic regression analysis indicated that aspartate transaminase (AST) (AUROC = 0.852, cut-off value = 22.5 U/L) serves as an independent predictor of notable liver inflammation, while platelet (PLT) count (AUROC = 0.905, cut-off value = 171.5 ×109/mL) and gamma-glutamyl transpeptidase (GGT) (AUROC = 0.909, cut-off value = 21.5 U/L) level serve as independent predictors of notable liver fibrosis.
A considerable proportion of marked histological abnormalities existed in our cohort, who will benefit from optimal therapeutic strategies administered according to predictive indication by AST, PLT and GGT levels.
Core tip: Marked necroinflammation and fibrosis were present in the livers of chronic hepatitis B virus-infected Chinese patients with persistently normal alanine aminotransferase. Clinical parameters associated with liver injury were identified. The identified biomarkers can indicate patients with liver injury.