Serum alkaline phosphatase levels as a simple and useful test in screening for significant fibrosis in treatment-naive patients with hepatitis B e-antigen negative chronic hepatitis B

BACKGROUND: Staging of liver fibrosis is critical in guiding the treatment of chronic hepatitis B (CHB) virus. Many efforts have been made toward the research of noninvasive techniques, mostly focusing on hepatitis B e-antigen (HBeAg)-positive [HBeAg(+)] CHB patients, whereas HBeAg(+) and HBeA-negative [HBeAg(−)] represent different stages of hepatitis B virus infection. Thus, in this study, we aimed to search for routinely available clinical noninvasive liver fibrosis markers and separately analysed the markers in HBeAg(+) and HBeAg(−) CHB patients. METHODS: Patients with CHB who were treatment naive and who underwent a liver biopsy at our hospital from 1 January 2016 to 31 April 2017 were enrolled. Liver histology was scored using the Scheuer classification system. The area under the receiver operator curve was used to determine the diagnostic accuracy. RESULTS: A total of 191 patients, including 104 HBeAg(+) and 87 HBeAg(−) treatment-naive CHB patients, were enrolled in this study. Serum alkaline phosphatase (ALP) levels increased gradually in all patients and separately in HBeAg(−) CHB patients, but not in HBeAg(+) CHB patients. ALP was an independent factors predicting significant fibrosis (S≥2) in all of the patients and separately in HBeAg(−) patients, with area under the receiver operator curves of 0.651 and 0.717, respectively. Further, the optimal cut-off value of ALP (>69.5 IU/l) for distinguishing HBeAg(−) CHB patients with significant fibrosis was determined (S≥2). CONCLUSION: Serum ALP levels can identify significant fibrosis (S≥2) in treatment-naive HBeAg(−) CHB patients and could potentially reduce the need for liver biopsies and help to guide the clinical treatment of CHB.