What is the reason of elevated alanine aminotransferase level in HBeAg negative patients with low viremia: NAFLD or chronic hepatitis?
OBJECTIVE
Increased alanine aminotransferase (ALT) levels with negative hepatitis B virus (HBV) DNA by hybridization is a common problem in Turkey where is a mild endemic region. We aimed to evaluate the causes of elevated ALT levels in patients who are negative for hepatitis B e antigen (HBeAg) and HBV DNA (by hybridization) for at least 6 months.


METHODS
Forty-nine patients were enrolled in this study. Histological changes [histological activity index (HAI), and the extent of fibrosis] were assessed according to the Knodell scoring system and steatosis were graded by Brunt's classification for NAFLD in all patients.


RESULTS
A mean age of the patients was 34.9 +/- 12.1 years (16-70). 43 (87.8%) of them were male. Mean ALT level was 95 +/- 39.7 IU/L (50- 258). Hyperglycemia (>100 mg/dL) and hyperlipidemia were found in 12 and 24 patients, respectively. Hepatic steatosis (7 patients grade 1; 5 patients grade 2; and 7 patients grade 3), ground-glass hepatocyte, chronic hepatitis, and Wilson disease were found in liver biopsy in 38.8%, 32.6%, 26.6%, 2%, respectively. Mean HAI was 6.5 +/- 3.6 (4-12) in chronic hepatitis. Seven patients (53.9%) were in stage 1 and 2 while 6 patients (46.1%) were in stage 3 and 4.


CONCLUSIONS
Nonalcoholic fatty liver disease is the most common cause of elevated ALT levels in HBeAg negative/HBV DNA negative patients. Chronic hepatitis B was found in 26.6% of these patients.
Demir
Kadir
K
Department of Gastroenterohepatology, Istanbul University, Turkey. kadirdr@hotmail.com
Akyuz
Filiz
F
Ozdil
Sadakat
S
Aksoy
Nevzat
N
Kaymakoglu
Sabahattin
S
Poturoglu
Sule
S
Akyüz
Umit
U
Besisik
Fatih
F
Boztas
Gungor
G
Mungan
Zeynel
Z
Cevikbas
Ugur
U
Cakaloglu
Yýlmaz
Y
Okten
Atilla
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood / Q000378:metabolism*; D004279:DNA, Viral / Q000097:blood; D005234:Fatty Liver / Q000201:enzymology* / Q000473:pathology; D005260:Female; D006513:Hepatitis B e Antigens / Q000097:blood*; D006515:Hepatitis B virus / Q000302:isolation & purification; D019694:Hepatitis B, Chronic / Q000201:enzymology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015854:Up-Regulation; D014766:Viremia
D004279:DNA, Viral; D006513:Hepatitis B e Antigens; D000410:Alanine Transaminase