title: The independent predictors of significant liver histological changes in chronic hepatitis B virus infection patients with persistently high-normal or low-normal alanine transaminase levels.
abstract: To determine the independent predictors of significant liver histological changes (SLHC) defined as inflammatory grade ≥A2 and/or fibrosis stage ≥F2 using the METAVIR scoring system in chronic hepatitis B virus (HBV) infection patients with persistently normal ALT (PNALT) levels.
  
  
  
  We enrolled 392 chronic HBV infection patients with PNALT defined as normal ALT (≤40 IU/L) measured on at least three occasions at intervals of more than 2 months apart over a period of 12 or more months. Univariate and multiple analyses were performed to identify the independent predictors of SLHC in high-normal ALT (HNALT) (20<ALT≤40 IU/L) and low-normal ALT (LNALT) (ALT≤20 IU/L) groups, respectively.
  
  
  
  Of 392 PNALT patients, 291 (74.2%) had HNALT and 101 (25.8%) had LNALT. The prevalence of SLHC in HNALT group is higher than that in LNALT group (36.4% vs. 19.8%, p=0.002). Of 291 HNALT patients, 106 (36.4%) had SLHC, and multivariate analysis showed that age (OR=1.059, 95%CI, 1.027-1.093, p<0.001), ALT (OR=1.018, 95%CI, 1.052-1.167, p<0.001), and gamma-glutamyl transpeptidase (GGT) (OR=1.012, 95%CI, 1.002-1.022, p=0.016) were independent predictors of SLHC. Of 101 LNALT patients, 20 (19.8%) had SLHC, and multivariate analysis showed that age (OR=1.121, 95%CI, 1.044-1.204, p=0.002) was the only independent predictor of SLHC.
  
  
  
  Age, ALT, and GGT were independent predictors of SLHC in HNALT patients, and age was the only independent predictor of SLHC in LNALT patients. These predictors might be used to screen SLHC, select candidates for liver biopsies, and guide proper antiviral therapy.
authors.affiliation: Department of Hepatitis, Shanghai Public Health Clinical Center, Fudan University, Shanghai 200032, China.|These authors contributed equally to this article.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Li
authors.affiliation: Department of Hepatitis, Shanghai Public Health Clinical Center, Fudan University, Shanghai 200032, China.|These authors contributed equally to this article.
authors.forename: Chuan
authors.initials: C
authors.lastname: Lu
authors.affiliation: Department of Hepatitis, Shanghai Public Health Clinical Center, Fudan University, Shanghai 200032, China.
authors.forename: Weixia
authors.initials: W
authors.lastname: Li
authors.affiliation: Department of Hepatitis, Shanghai Public Health Clinical Center, Fudan University, Shanghai 200032, China.
authors.forename: Yuxian
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Hepatitis, Shanghai Public Health Clinical Center, Fudan University, Shanghai 200032, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Chen
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000235:genetics / Q000378:metabolism*; D005260:Female; D006515:Hepatitis B virus / Q000472:pathogenicity; D019694:Hepatitis B, Chronic / Q000201:enzymology* / Q000235:genetics / Q000378:metabolism*; D006801:Humans; D008099:Liver / Q000201:enzymology* / Q000378:metabolism*; D008297:Male; D005723:gamma-Glutamyltransferase / Q000235:genetics / Q000378:metabolism
chemical_list: D005723:gamma-Glutamyltransferase; D000410:Alanine Transaminase