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Influence factors of liver inflammation activity and fibrosis of patients with chronic hepatitis B

Objective 
To analyze the influence factors of liver inflammation activity and fibrosis of patients with chronic hepatitis B (CHB) infection. 
 
 
Methods 
A total of 971 patients with chronic hapatitis B virus (HBV) infection, who underwent liver biopsy and routine laboratory testing, such as biochemical tests, blood routine examination, HBV DNA and serum hepatitis markers, were recruited. Categorical data were analyzed by Chi-square test. Quantitative data among three groups were compared by one-way analysis of variance. Quantitative data between two groups were compared by Student-t test, Spearman correlation analysis and multiple regression analysis. 
 
 
Results 
Nine hundred and seventy-one patients were divided into three groups including group A (more than three continuous normal alanine aminotransferase [ALT] within a year, n=332), group B (first elevated ALT, n=341) and group C (more than two or more elevated ALT within six months, n=298). The male patients in three groups were 47.9%, 74.2% and 73.8%, respectively, with statistical significance (χ2=64.778, P<0.01). Hepatitis B e antigen (HBeAg)-positive patients in groups A, B and C were 161(48.5%), 234(69.0%) and 176(59.1%), respectively. The difference was statistically significant in three groups (χ2=28.325, P<0.01). The proportions of patients with G≥2 in three groups were 36.4%, 56.9% and 51.3%, respectively (χ2=29.868, P<0.01); and those of S≥2 were 25.3%, 35.5% and 35.9%, respectively (χ2=10.807, P=0.005). The proportions of patients with G≥2 and (or) S≥2 in three groups were 137(41.3%), 208(61.0%) and 164(55.0%), respectively. The differences were significant among three groups (χ2=22.235, P<0.01). Group A was divided into subgroup A1 (ALT<30 U/L) with 229 cases and subgroup A2 (ALT≥30 U/L) with 103 cases. Differences of proportions of male, patients with HBeAg positivity and G≥2 and (or) S≥2 were statistically significant between sub groups A1 and A2 (all P<0.05). The Spearman correlation analysis and Logistic regression analysis of group A showed that age older than 35 years, ALT≥30 U/L, aspartate aminotransferase (AST)≥25 U/L, HBeAg-positive and platelet counts were associated with significant pathological changes (all P<0.05). Age (OR=2.012, 95%CI: 1.196-3.383), HBeAg-positive (OR=2.188, 95%CI: 1.339-3.584) and AST (OR=2.312, 95%CI: 1.390-3.846) were independent predictors for significant liver pathological changes. 
 
 
Conclusions 
The proportion of significant liver pathological changes in the patients with first elevated ALT is similar with that in patients with repeatedly ALT elevated. Thus, early antiviral treatment is recommended in those patients with first elevated ALT. Age≥35 years, HBeAg-positive and AST≥25 U/L are independent predictors for significant liver pathological changes of chronic HBV infected patients with ALT persistently normal. Therefore, for patients who meet the above conditions, early antiviral treatment should be initiated. 
 
 
Key words: 
Alanine transaminase; Hepatitis B; Pathology