Changes of liver pathology and its influencing factors in patients with chronic hepatitis B viral infection and low level of serum alanine aminotransferase: an analysis of 135 cases

Objective To investigate the changes of liver pathology and its influencing factors in patients with chronic hepatitis B viral (HBV) infection and low level of serum alanine aminotransferase (ALT). Methods The clinical data of 135 with chronic HBV infection patients, in whom the serum ALT levels were less than two times of the upper limit of normal (ULN), were collected from the Affiliated Hospital of Medical School of Ningbo University and the First Affiliated Hospital, Zhejiang University School of Medicine during July 2017 and July 2019. The result of hepatic histological examination was reviewed, and the risk factors of obvious liver inflammation (G≥2) or fibrosis (S≥2) in patients were analyzed with Logistic regression analysis. Results The pathological examination of liver tissue revealed G≥2 or S≥2 in 52 cases (38.5%). The univariate analysis showed that age, family history of HBV infection, ALT 1-<2×ULN, aspartate aminotransferase(AST)≥1×ULN, low platelet count(PLT)and prolongation of prothrombin time(PT)were associated with G≥2 or S≥2 in chronic HBV infection patients with low level ALT (P<0.05 or <0.01). Multivariate Logistic regression analysis showed that age(OR=1.052, 95%CI 1.007-1.100), family history of HBV infection(OR=5.448, 95%CI 2.191-13.548)and AST(OR=1.042, 95%CI 1.005-1.081)were independent risk factors of G≥2 or S≥2 in chronic HBV infection patients with low level ALT (P<0.05 or <0.01). Conclusion Age, family history of HBV infection and AST level can be used to judge the severity of liver pathological changes and necessity of antiviral treatment for patients with chronic HBV infection having ALT<2×ULN. Key words: Hepatitis B, chronic; Liver histopathology; Alanine aminotransferase