Clinical significance of liver biopsy for chronic hepatitis B with persistently normal transaminases

Objective The histological features of chronic hepatitis B virus (HBV) infection with persistently normal serum transaminases has not been will studied. The aim of this study was to investigate clinical significance of liver biopsy for these patients. Methods A total of 452 HBsAg positive patients and clinical course of more than six months undergone percutaneous liver biopsy. All liver biopsy specimens were assessed by experienced liver pathologists blinded to the liver biochemistry and scored according to standard criteria. Results None of patients had normal liver pathology. Patients with elevated serum transaminases had significant higher degree of hepatic necrosis inflammation grade (G) and fibrosis stage (S) compared with pateitns with normal transaminase ( P 0.05). In the latter group, G3 were seen in 10 cases (5.5%) and 13 cases (9.1%), S3 in 7(3.8%) and 16(11.1%), and S4 in 3 (1.6%) and 7(4.9%) in HbeAg positive and negative groups, respectively. Moreover, in patients with normal transaminases, HbeAg negative group had higher degree of fibrosis stage than that of HbeAg positive group ( P 0.05). Conclusion Although severe pathology was more frequent in patients with abnormal transaminase, significant hepatic pathology was found in cases with repeatedly normal trasaminases. Liver biopsy in cases of chronic HBV infection is helpful to assess accurately both the current activity of the disease and the degree of fibrosis and to estimate if antiviral therapy should be conducted. It seems necessary to treat chronic hepatitis B patients with normal transaminases but with severe hepatic necrosis inflammation and fibrosis.