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The clinical significance of persistently normal ALT in chronic hepatitis B infection.

Abstract：

BACKGROUND/AIMS:Chronic hepatitis B virus (HBV) disease is caused by both necroinflammation and active viral replication. The role of ALT levels as a predictor of liver injury has recently been questioned. The aim of the study was to determine whether normal ALT is associated with liver injury in a cohort of HBV patients undergoing liver biopsy. METHODS:This is a retrospective review of chronic HBV patients divided into 3 groups; (1) persistently normal ALT (PNALT); (2) ALT 1-1.5X ULN and (3) ALT>1.5X ULN. Multiple clinical, biochemical, virological variables were evaluated. RESULTS:One hundred and ninety-two patients met the inclusion criteria, 59 with PNALT, 26 with ALT 1-1.5X ULN, and 107 with ALT>1.5X ULN. Increasing age, higher ALT, higher grade of inflammation on biopsy, and HBeAg positivity predicted fibrosis. 18% of patients with PNALT had stage 2+ fibrosis and 34% had grade 2 or 3 inflammation. Overall 37% of patients with PNALT had significant fibrosis or inflammation. Subgroup analysis showed the majority with fibrosis belonged to the high normal ALT group and that only a minority who were young and immune tolerant had significant findings on biopsy. CONCLUSIONS:There is significant fibrosis and inflammation in 37% of patients with PNALT and a liver biopsy should be considered in patients older than 40 with high normal ALT.

journal_name

J Hepatol

journal_title

Journal of hepatology

authors

Lai M,Hyatt BJ,Nasser I,Curry M,Afdhal NH

doi

10.1016/j.jhep.2007.07.022

subject

Has Abstract

pub_date

2007-12-01 00:00:00

pages

760-7

issue

6

eissn

0168-8278

issn

1600-0641

pii

S0168-8278(07)00476-X

journal_volume

47

pub_type

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