title: Significant fibrosis is not rare in Chinese chronic hepatitis B patients with persistent normal ALT.
abstract: BACKGROUND
  Limited studies have been done on chronic hepatitis B (CHB) patients defined according to the latest Asian-Pacific Association for the Study of the Liver guideline with liver histology by a large sample size.
  
  
  METHODS
  We retrospectively evaluated liver histological characteristics on a cohort of consecutive treatment-naive CHB patients with persistent normal alanine aminotransferase (PNALT) or elevated ALT from May 2005 to October 2011. Histological assessment was based on the Metavir scoring system, significant abnormality was defined as necroinflammation grade ≥A2 and/or fibrosis stage ≥F2.
  
  
  RESULTS
  A total of 675 CHB patients were recruited, including 516 HBeAg-positive and 159 HBeAg-negative patients. In HBeAg-positive patients, significant fibrosis was found 49.4% (42/85) in PNALT, 69.8% (88/126) in ALT 1-2×upper limit normal (ULN) and 81.6% (249/305) in ALT>2×ULN group, respectively. In HBeAg-negative patients, significant fibrosis was found 30.9% (17/55) in PNALT, 73.3% (33/45) in ALT 1-2×ULN and 94.9% (56/59) in ALT>2×ULN group, respectively. HBeAg-positive patients with PNALT over 30 years old had a higher frequency of significant fibrosis than those under 30 years old (87.5% vs. 45.5%, P = 0.058). Multivariate logistic regression analysis indicated increasing age (P = 0.012), higher aspartate aminotransferase (AST) (P < 0.001) and lower HBV DNA (P < 0.001) were associated with significant necroinflammation, while higher AST (P < 0.001), lower albumin (P = 0.027) and HBV DNA (P = 0.004) were associated with significant fibrosis in HBeAg-positive patients with elevated ALT. Higher AST was associated with significant necroinflammation in HBeAg-negative patients with elevated ALT (P = 0.009).
  
  
  CONCLUSIONS
  Significant fibrosis is not rare in Chinese CHB patients with PNALT, especially HBeAg-positive patients over 30 years old.
authors.affiliation: Hepatology Unit and Key Lab for Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China ; Department of Hepatology, Guangzhou No.8 People's Hospital, Guangzhou Medical University, Guangzhou, China.
authors.forename: Baolin
authors.initials: B
authors.lastname: Liao
authors.forename: Zhanhui
authors.initials: Z
authors.lastname: Wang
authors.forename: Siwei
authors.initials: S
authors.lastname: Lin
authors.forename: Ying
authors.initials: Y
authors.lastname: Xu
authors.forename: Junqing
authors.initials: J
authors.lastname: Yi
authors.forename: Min
authors.initials: M
authors.lastname: Xu
authors.forename: Zuxiong
authors.initials: Z
authors.lastname: Huang
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhou
authors.forename: Fuchun
authors.initials: F
authors.lastname: Zhang
authors.forename: Jinlin
authors.initials: J
authors.lastname: Hou
mesh_terms: D000328:Adult; D001219:Aspartate Aminotransferases / Q000097:blood*; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005355:Fibrosis; D006513:Hepatitis B e Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000097:blood / Q000201:enzymology* / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000201:enzymology* / Q000473:pathology*; D008297:Male; D055815:Young Adult
chemical_list: D006513:Hepatitis B e Antigens; D001219:Aspartate Aminotransferases