Liver histopathological lesions is severe in patients with normal alanine transaminase and low to moderate hepatitis B virus DNA replication

doi:10.3748/wjg.v29.i16.2479

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World Journal of Gastroenterology

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Retrospective Cohort Study

World J Gastroenterol. Apr 28, 2023; 29(16): 2479-2494
Published online Apr 28, 2023. doi: 10.3748/wjg.v29.i16.2479

Liver histopathological lesions is severe in patients with normal alanine transaminase and low to moderate hepatitis B virus DNA replication

Su-Wen Jiang, Xiang Lian, Ai-Rong Hu, Jia-Lin Lu, Zhe-Yun He, Xiao-Jun Shi, De-Dong Zhu, Zong-Yi Wang, Guan-Cheng Huang

Su-Wen Jiang, Ai-Rong Hu, Zhe-Yun He, Xiao-Jun Shi, De-Dong Zhu, Ningbo Institute of Liver Diseases, Ningbo No. 2 Hospital, Ningbo 315020, Zhejiang Province, China

Xiang Lian, Department of Infectious Diseases, Xiangshan Hospital Affiliated to Wenzhou Medical University, Ningbo 315020, Zhejiang Province, China

Jia-Lin Lu, Zong-Yi Wang, Department of Infectious Diseases, The First Hospital of Ninghai County, Ningbo 315000, Zhejiang Province, China

Guan-Cheng Huang, Department of Infectious Diseases, The Affiliated Yang-Ming Hospital of Ningbo University, Ningbo 315400, Zhejiang Province, China

Author contributions: Hu AR contributed to the conception, design and administrative support; Jiang SW, Hu AR, Lian X, Shi XJ, Zhu DD, Wang ZY, Huang GC contributed to the provision of study materials or patients; Jiang SW, Lu JL, He ZY contributed to the collection and assembly of data; Jiang SW, Hu AR contributed to the data analysis and interpretation; and all authors final approval of manuscript.

Supported by Zhejiang Provincial Basic and Public Welfare Foundation, No. LGF22H030002; Ningbo Science and Technology Program, No.2021S182; Major Medical Scientific Research Foundation of National Health Commission of the People's Republic of China-Zhejiang Province, No. WKJ-ZJ-2341; and Zhejiang Province and Ningbo City Co-constructed Project of Leading Medical & Health Discipline, No. 2016-S04.

Institutional review board statement: The study was approved by institutional ethics/committee of Ningbo No. 2 Hospital (No: PJ-NBEY-KY-2017-069-01, PJ-NBEY-KY-2021-037-02, and PJ-NBEY-KY-2022-138-01).

Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

Conflict-of-interest statement: We have no financial relationships to disclose.

Data sharing statement: No additional data are available.

Corresponding author: Ai-Rong Hu, MD, Doctor, Ningbo Institute of Liver Diseases, Ningbo No. 2 Hospital, No. 41 Xibei Street, Haishu District, Ningbo 315020, Zhejiang Province, China. huairong@ucas.edu.cn

Received: January 31, 2023
Peer-review started: January 31, 2023
First decision: February 23, 2023
Revised: March 5, 2023
Accepted: April 7, 2023
Article in press: April 7, 2023
Published online: April 28, 2023
Processing time: 82 Days and 21.5 Hours

Core Tip

Core Tip: According to the guidelines, for patients with normal alanine transaminase (ALT), hepatitis B virus (HBV) DNA levels were defined as ≥ 10⁷/2 × 10⁷ and < 2 × 10³ IU/mL in the ‘immune-tolerant’ and the ‘inactive-carrier’ phase, respectively. However, it is still controversial. In this study, we analyzed the liver histopathology and the risk factors in 634 cases with positive HBV DNA and normal ALT. We found that patients with low or moderate HBV DNA level had more severe liver diseases. HBV DNA level (negative correlation) was an independent risk factor for liver histopathological severity. Therefore, we consider that the phase definition of chronic hepatitis B may be revised based on whether the level of HBV DNA exceeds the detection low limit value.