Analysis Of Liver Histopathological Characteristics And Influencing Factors In Chronic HBV-infected Patients With Normal ALT

Objective We analyzed the correlation between significant liver histological characteristics and clinical variables in HBe Ag-positive and HBe Agnegative patients and provided recommendations on treatment decisions for patients age younger than 30-year-old.Patients and Methods Liver biopsy was performed on 161 chronic HBVinfected patients with ALT≤40U/L from July,2000 – November,2019.Median age was 39(18-70)years.Histologic assessment was based on the Scheuer scoring system.All these patients had ALT within ULN at least six months prior to the baseline liver biopsy.Results Significant necroinflammation and fibrosis were observed in 65.2%(105/161)and 52.2%(84/161)patients of all cases,59.4%(41/69)and 44.9%(31/69)in the HBe Ag-positive,69.6%(64/92)and 57.6%(53/92)in the HBe Ag-negative.The histopathological abnormality was significantly negatively correlated with viral level(r=-0.3,p<0.05)in HBe Ag-positive subjects.Based on ROC curve analysis,6.7 log10 IU/m L of HBV-DNA was the level with the optimum sensitivity and specificity for the prediction of obvious inflammation or fibrosis.Threshold value of ALT(25 U/L)based on the distribution of ALT and virus loads.Patients younger than 30 years,almost all had significant pathological alteration with HBV-DNA < 6.7log10IU/ml;The ratio of insignificant liver’s inflammation and fibrosis were65% and 70% combined with HBV-DNA levels ≥ 6.7 log10IU/ml,on that basis,it could have a further rising,reaching 67.5% and 75% if ALT lower than 25 U/L.There were no obvious correlations between Histologic changes and clinical factors.Conclusions For Chronic HBV-infected patients younger than 30 years old who with HBe Ag-positive and persistently normal ALT,liver histopathological abnormalities increased with lower viral load,especially HBV-DNA lower than 6.7 log10IU/ml.Severe liver histopathological damage occurred in HBe Ag-negative.Early pharmacological interventions are recommended for these patients.