title: [Histological changes in the livers of chronic hepatitis B patients with persistently normal serum alanine transaminase levels].
abstract: OBJECTIVE
  To study the histological changes in livers of chronic hepatitis B (CHB) patients with persistently normal serum ALT levels (PNAL).
  
  
  METHODS
  274 CHB patients who had percutaneous liver biopsies and had a detectable viral load (lower limit of detection is 10(3) copies/ml) in our department between October 2003 and February 2007 were included in this study. Among these patients, 139 had PNAL, group A, (with at least 3 normal serum ALT levels, with intervals of more than two months over a period of 12 or more months before the biopsy). The other 135 patients, group B, had abnormal serum ALT levels during the same period. The histological changes in the livers of the two groups of patients were compared.
  
  
  RESULTS
  Sixty-six (47.5%) patients with PNAL had normal liver histology, but significant pathohistological changes such as significant necroinflammation, fibrosis and/or cirrhosis were found in 33 (23.7%) patients. Thirteen (9.4%) had established cirrhosis. When compared to patients within (0-0.75)x upper limit of normal (ULN) ALT, patients within (0.76-1.00)x ULN ALT had higher scores of histological changes (43.5% vs. 19.8%, P < 0.05). In the PNAL group, scores of histological changes increased sharply in parallel with an age increase of older than 40 yrs. However neither viral loads nor HBeAg statuses of the PNAL patients had any predictive meaning to the scores of the histological findings.
  
  
  CONCLUSIONS
  23.7% of our CHB patients with PNAL, regardless of what their HBeAg statuses or viral load levels were, had significant liver pathohistological changes. Liver biopsies should be considered in CHB patients with PNAL, especially those older than 40 yrs and with a higher ALT within (0.76-1) x ULN.
authors.affiliation: Department of Infectious Diseases, Affiliated Ruijin Hospital to Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Hong-Lian
authors.initials: HL
authors.lastname: Gui
authors.forename: Qing
authors.initials: Q
authors.lastname: Xie
authors.forename: Hui
authors.initials: H
authors.lastname: Wang
authors.forename: Wei
authors.initials: W
authors.lastname: Cai
authors.forename: Zhi-Mei
authors.initials: ZM
authors.lastname: Lin
authors.forename: Shan
authors.initials: S
authors.lastname: Jiang
authors.forename: Pei
authors.initials: P
authors.lastname: Xu
authors.forename: Xia-Qiu
authors.initials: XQ
authors.lastname: Zhou
authors.forename: Qing
authors.initials: Q
authors.lastname: Guo
authors.forename: Hong
authors.initials: H
authors.lastname: Yu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D005260:Female; D006513:Hepatitis B e Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000097:blood / Q000473:pathology* / Q000503:physiopathology*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D006513:Hepatitis B e Antigens; D000410:Alanine Transaminase