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A Large Population Histology Study Showing the Lack of Association between ALT Elevation and Significant Fibrosis in Chronic Hepatitis B

OBJECTIVE: We determined the association between various clinical parameters and significant liver injury in both hepatitis B e antigen (HBeAg)-positive and HBeAg-negative patients. METHODS: From 1994 to 2008, liver biopsy was performed on 319 treatment-naïve CHB patients. Histologic assessment was...

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Autores principales: Seto, Wai-Kay, Lai, Ching-Lung, Ip, Philip P. C., Fung, James, Wong, Danny Ka-Ho, Yuen, John Chi-Hang, Hung, Ivan Fan-Ngai, Yuen, Man-Fung
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3289659/
https://www.ncbi.nlm.nih.gov/pubmed/22389715
http://dx.doi.org/10.1371/journal.pone.0032622
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author Seto, Wai-Kay
Lai, Ching-Lung
Ip, Philip P. C.
Fung, James
Wong, Danny Ka-Ho
Yuen, John Chi-Hang
Hung, Ivan Fan-Ngai
Yuen, Man-Fung
author_facet Seto, Wai-Kay
Lai, Ching-Lung
Ip, Philip P. C.
Fung, James
Wong, Danny Ka-Ho
Yuen, John Chi-Hang
Hung, Ivan Fan-Ngai
Yuen, Man-Fung
author_sort Seto, Wai-Kay
collection PubMed
description OBJECTIVE: We determined the association between various clinical parameters and significant liver injury in both hepatitis B e antigen (HBeAg)-positive and HBeAg-negative patients. METHODS: From 1994 to 2008, liver biopsy was performed on 319 treatment-naïve CHB patients. Histologic assessment was based on the Knodell histologic activity index for necroinflammation and the Ishak fibrosis staging for fibrosis. RESULTS: 211 HBeAg-positive and 108 HBeAg-negative patients were recruited, with a median age of 31 and 46 years respectively. 9 out of 40 (22.5%) HBeAg-positive patients with normal ALT had significant histologic abnormalities (necroinflammation grading ≥7 or fibrosis score ≥3). There was a significant difference in fibrosis scores among HBeAg-positive patients with an ALT level within the Prati criteria (30 U/L for men, 19 U/L for women) and patients with a normal ALT but exceeding the Prati criteria (p = 0.024). Age, aspartate aminotransferase and platelet count were independent predictors of significant fibrosis in HBeAg-positive patients with an elevated ALT by multivariate analysis (p = 0.007, 0.047 and 0.045 respectively). HBV DNA and platelet count were predictors of significant fibrosis in HBeAg-negative disease (p = 0.020 and 0.015 respectively). An elevated ALT was not predictive of significant fibrosis for HBeAg-positive (p = 0.345) and -negative (p = 0.544) disease. There was no significant difference in fibrosis staging among ALT 1–2×upper limit of normal (ULN) and >×2 ULN for both HBeAg-positive (p = 0.098) and -negative (p = 0.838) disease. CONCLUSION: An elevated ALT does not accurately predict significant liver injury. Decisions on commencing antiviral therapy should not be heavily based on a particular ALT threshold.
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spelling pubmed-32896592012-03-02 A Large Population Histology Study Showing the Lack of Association between ALT Elevation and Significant Fibrosis in Chronic Hepatitis B Seto, Wai-Kay Lai, Ching-Lung Ip, Philip P. C. Fung, James Wong, Danny Ka-Ho Yuen, John Chi-Hang Hung, Ivan Fan-Ngai Yuen, Man-Fung PLoS One Research Article OBJECTIVE: We determined the association between various clinical parameters and significant liver injury in both hepatitis B e antigen (HBeAg)-positive and HBeAg-negative patients. METHODS: From 1994 to 2008, liver biopsy was performed on 319 treatment-naïve CHB patients. Histologic assessment was based on the Knodell histologic activity index for necroinflammation and the Ishak fibrosis staging for fibrosis. RESULTS: 211 HBeAg-positive and 108 HBeAg-negative patients were recruited, with a median age of 31 and 46 years respectively. 9 out of 40 (22.5%) HBeAg-positive patients with normal ALT had significant histologic abnormalities (necroinflammation grading ≥7 or fibrosis score ≥3). There was a significant difference in fibrosis scores among HBeAg-positive patients with an ALT level within the Prati criteria (30 U/L for men, 19 U/L for women) and patients with a normal ALT but exceeding the Prati criteria (p = 0.024). Age, aspartate aminotransferase and platelet count were independent predictors of significant fibrosis in HBeAg-positive patients with an elevated ALT by multivariate analysis (p = 0.007, 0.047 and 0.045 respectively). HBV DNA and platelet count were predictors of significant fibrosis in HBeAg-negative disease (p = 0.020 and 0.015 respectively). An elevated ALT was not predictive of significant fibrosis for HBeAg-positive (p = 0.345) and -negative (p = 0.544) disease. There was no significant difference in fibrosis staging among ALT 1–2×upper limit of normal (ULN) and >×2 ULN for both HBeAg-positive (p = 0.098) and -negative (p = 0.838) disease. CONCLUSION: An elevated ALT does not accurately predict significant liver injury. Decisions on commencing antiviral therapy should not be heavily based on a particular ALT threshold. Public Library of Science 2012-02-28 /pmc/articles/PMC3289659/ /pubmed/22389715 http://dx.doi.org/10.1371/journal.pone.0032622 Text en Seto et al. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Seto, Wai-Kay
Lai, Ching-Lung
Ip, Philip P. C.
Fung, James
Wong, Danny Ka-Ho
Yuen, John Chi-Hang
Hung, Ivan Fan-Ngai
Yuen, Man-Fung
A Large Population Histology Study Showing the Lack of Association between ALT Elevation and Significant Fibrosis in Chronic Hepatitis B
title A Large Population Histology Study Showing the Lack of Association between ALT Elevation and Significant Fibrosis in Chronic Hepatitis B
title_full A Large Population Histology Study Showing the Lack of Association between ALT Elevation and Significant Fibrosis in Chronic Hepatitis B
title_fullStr A Large Population Histology Study Showing the Lack of Association between ALT Elevation and Significant Fibrosis in Chronic Hepatitis B
title_full_unstemmed A Large Population Histology Study Showing the Lack of Association between ALT Elevation and Significant Fibrosis in Chronic Hepatitis B
title_short A Large Population Histology Study Showing the Lack of Association between ALT Elevation and Significant Fibrosis in Chronic Hepatitis B
title_sort large population histology study showing the lack of association between alt elevation and significant fibrosis in chronic hepatitis b
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3289659/
https://www.ncbi.nlm.nih.gov/pubmed/22389715
http://dx.doi.org/10.1371/journal.pone.0032622
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