Jiang ML, Xu F, Li JL, Luo JY, Hu JL, Zeng XQ. Clinical features of abnormal α-fetoprotein in 15 patients with chronic viral hepatitis B after treatment with antiviral drugs. World J Hepatol 2025; 17(1): 100392 [DOI: 10.4254/wjh.v17.i1.100392]
Corresponding Author of This Article
Man-Lei Jiang, Chief Doctor, Ganzhou Institute of Liver Disease, Department of hepatology, Ganzhou Fifth People's Hospital, No. 666 Dongjiangyuan Avenue, Shuixi Town, Ganzhou 341000, Jiangxi Province, China. lffjml@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Man-Lei Jiang, Fei Xu, Jin-Long Li, Jia-Yu Luo, Jiang-Ling Hu, Xian-Qiang Zeng, Ganzhou Institute of Liver Disease, Department of Hepatology, Ganzhou Fifth People's Hospital, Ganzhou 341000, Jiangxi Province, China
Author contributions: Jiang ML designed and conducted the study and wrote the paper; Li JL contributed to the analysis and wrote the paper; Luo JY, Hu JL, Zeng XQ provided clinical advice; and Xu F provided clinical advice and supervised the study.
Institutional review board statement: This study was reviewed and approved by the Ganzhou Fifth People's Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author lffjml@163.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Man-Lei Jiang, Chief Doctor, Ganzhou Institute of Liver Disease, Department of hepatology, Ganzhou Fifth People's Hospital, No. 666 Dongjiangyuan Avenue, Shuixi Town, Ganzhou 341000, Jiangxi Province, China. lffjml@163.com
Received: August 15, 2024 Revised: November 29, 2024 Accepted: December 17, 2024 Published online: January 27, 2025 Processing time: 143 Days and 23.3 Hours
Abstract
BACKGROUND
Liver function of chronic hepatitis B (CHB) patients is essentially normal after treatment with antiviral drugs. In rare cases, persistently abnormally elevated α-fetoprotein (AFP) is seen in CHB patients following long-term antiviral treatment. However, in the absence of imaging evidence of liver cancer, a reasonable explanation for this phenomenon is still lacking.
AIM
To explore the causes of abnormal AFP in patients with CHB who were not diagnosed with liver cancer.
METHODS
From November 2019 to May 2023, 15 patients with CHB after antiviral treatment and elevated AFP were selected. Clinical data and quality indicators related to laboratory testing, imaging data, and pathological data were obtained through inpatient medical records.
RESULTS
All patients had increased AFP and significantly elevated IgG. Cancer was excluded by imaging examination. Only four patients had elevated alanine aminotransferase, 10 had elevated aspartate aminotransferase, nine had elevated total bilirubin, and two had antinuclear antibodies. The liver biopsy and histopathological examination indicated that 14 patients had rosette, moderate, or higher interfacial inflammation, lymphocyte infiltration, and severe hepatic fibers (11 cases), which was consistent with the pathological features of autoimmune hepatitis (AIH). After 8-12 week of hormone therapy, the levels of AFP and IgG, and liver function returned to normal (P < 0.05).
CONCLUSION
For patients with CHB and elevated AFP after antiviral treatment, autoimmune hepatitis should be considered. CHB with AIH is clinically insidious and difficult to detect, and prone to progression to cirrhosis. Liver puncture pathological examination should be performed when necessary to confirm diagnosis.
Core Tip: There is no reasonable explanation for the continuous abnormal increase of α-fetoprotein (AFP) in patients with chronic hepatitis B (CHB) after long-term antiviral therapy and the lack of imaging evidence of liver tumor. We observed 15 patients with CHB treated with antiviral therapy without imaging evidence of liver cancer, and explored the cause of elevated AFP by liver biopsy. Pathological examination suggested that autoimmune hepatitis (AIH) might be complicated, but the diagnosis could not be confirmed by a comprehensive and a simplified diagnostic scoring system for AIH.
