| Objective:1.To explore the liver histopathological and clinical characteristics of patients with chronic hepatitis b with ALT<2ULN level,and to evaluate the significance of liver biopsy for their antiviral treatment decision.2.The ratio of liver biopsy to diagnosis of liver fibrosis and the ratio of nuclear magnetic resonance imaging to early cirrhosis were compared.Methods:108 patients with chronic hepatitis B infection with ALT<2ULN level underwent ultrasound-guided liver biopsy from January 2016 to January 2019 in the Department of Hepatology,XXXHospital.The general conditions including gender,age,HBV DNA and HBsAg were recorded.Age,HBeAg,ALT,AST,GGT,TBA,TBIL,PCIII,LN,HA,FN,TG,CHOL,AFP and other related laboratory indicators,as well as patient abdominal magnetic resonance imaging results.Compare livers in groups with different ALT groupings,age grouping,gender grouping,HBeAg-positive,negative grouping,HBV DNA replication(low-to-low replication(<10~5 IU/L),high replication(≥10~5 IU/L))Inflammatory activity staging and liver fibrosis grading.The results of nuclear magnetic resonance imaging of patients were collected and analyzed.The positive rate of liver fibrosis and early cirrhosis was compared between liver biopsy and MRI.Results:1.Among the 108 cases,histopathological examination of liver biopsy showed 29cases of liver inflammation(26.9%),43 cases of G2(39.8%),33 cases of G3(30.6%),and 3 cases of G4(2.7%);9 cases(8.3%)in S0 stage,52 cases(48.1%)in S1 stage,28 cases(25.9%)in S2 stage,16 cases(14.8%)in S3 stage,and 3 cases(2.9%)in S4stage;Among them,79 patients(73.1%)had G2 and above inflammation,47(43.5%)had fibrosis graded S2 and above,and 47(43.5%)had≥G2S2.2.The clinical features of different liver inflammation stages(<G2,≥G2)and different liver fibrosis grades(<S2,≥S2)were compared between ALT<2ULN patients.Male liver inflammation stage≥G2 was more than female(x~2=4.62,P=0.032);TBA levels were abnormally elevated when the liver inflammation stage was≥G2 (mean 10.2±11.6),and there was a difference between the groups(t=-2.609,P=0.01).HBV DNA levels were different between different liver fibrosis grades(t=-2.06, P=0.044),and the average level of HBV DNA was higher in<S2 group.There were no significant differences in HBeAg(positive,negative),age,ALT,AST,GGT,and TBIL between the various groups of inflammation and fibrosis(P>0.05).There was no significant difference in liver inflammation activity stage and liver fibrosis grade between ALT<50U/L and 50≥ALT<100U/L groups(P<0.05).There was no significant difference in the stage of liver inflammation activity between the patients<35 years old and age≥35 years old(P<0.05),and the liver fibrosis grade was statistically different(P<0.05).There was a statistically significant difference in liver inflammation between different genders(P<0.05),and there was no statistical difference between liver fibrosis grades(P>0.05).There were significant differences in liver inflammation stage and liver fibrosis grade between HBeAg positive and negative group(P<0.05).In patients with HBV DNA levels≥10~5 IU/L and<10~5 IU/L,there was a statistically significant difference in liver inflammation stage(P<0.05),and there was no significant difference in liver fibrosis grade(P>0.05).In patients with GGT<45U/L and GGT≥45U/L group,there was a statistically significant difference in liver inflammation stage(P<0.05),and there was no statistical difference between liver fibrosis grades(P>0.05).TBA value was statistically significant in liver inflammation stage(P<0.005),and there was no statistical significance in liver fibrosis grade(P>0.05).Logistic regression was used to analyze gender(OR=0.294,95%CI:0.098,0.879),HBeAg positive(OR=2.956,95%CI:0.978,8.935),TBA(OR=2.752,95%CI:0.836,9.065).there are risk factors for liver inflammation≥G2.HBeAg-positive(OR=2.956,95%CI:0.978,8.935)is a risk factor for liver inflammation≥S2.3.This group of MRI showed that the rate of early cirrhosis was 59.3%(64/108),and the liver biopsy showed that the liver fibrosis rate was 73.1%(79/108).Conclusion:1.Among patients with active hepatitis B virus replication and ALT<2 ULN,patients with liver histopathology≥G2 and≥S2 accounted for 73.1%and 43.5%,respectively.Reaching G2S2 and above accounted for 43.5%,of which 2 patients had G4S4.It is indicated that a higher proportion of patients with low-level ALT in this group are moderately active in liver inflammation or(and)liver fibrosis and cirrhosis.2.Women with chronic HBeAg-positive and abnormally elevated TBA have higher inflammatory activity.Follow-up and positive liver biopsy should be used to confirm the diagnosis and avoid omission.3.HBeAg-positive patients are more likely to have progression of liver fibrosis.4.In this group of patients with low ALT level chronic hepatitis B,abdominal NMR examination showed a higher rate of early cirrhosis(59.3%),and liver fibrosis rate was 73.1%.5.To combined with liver biopsy improves the detection rate of occult liver fibrosis and/or cirrhosis. |
