Characterization and evaluation of liver fibrosis grade in patients with chronic hepatitis B virus infection and normal transaminases
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Backgrounds/Aims: The objective of our study was to determine the epidemiological, laboratory, and serological characteristics of patients with chronic hepatitis B virus (HBV) infection and normal transaminases. The study also aimed to evaluate liver damage by measuring the liver fibrosis (LF) grade and to identify possible factors associated with the presence of fibrosis. Methods: A retrospective observational study was conducted in patients with chronic HBV infection and classified as inactive carriers or immune-tolerant. Epidemiological variables of age, sex, immigrant, alcohol consumption, and body mass index (BMI), as well as virological variables (HBV DNA) and transaminase level were collected throughout the follow-up. The LF grade was evaluated by transient elastography. The cutoff value for significant fibrosis (SF) was liver stiffness ≥7.9 kPa. Results: A total of 214 patients were included in the analysis, and 62% of them had a BMI ≥25 kg/m2. During follow-up, 4% of patients showed transaminase elevation (<1.5 times normal). Most patients had a viral DNA level <2,000 IU/mL (83%). Data on LF were available in 160 patients; of these, 14% had SF, 9% F3, and 6% F4. The variables associated with the presence of SF were transaminase alteration during follow-up, as 23% of patients with SF had elevated transaminases versus 3% of patients without SF (P<0.005), and BMI, as the vast majority of patients with SF (88%) had a BMI ≥25 kg/m2 versus 56% of patients without SF (P<0.05). Conclusions: In patients with chronic HBV infection and normal transaminases, liver damage does not seem to be related to DNA levels, alcohol consumption, or immigrant status. SF seems to be associated with transaminase alteration during follow-up and elevated BMI. It is therefore recommended to measure LF grade with validated non-invasive methods in such patients.
Abstract
Backgrounds/Aims: The objective of our study was to determine the epidemiological, laboratory, and serological characteristics of patients with chronic hepatitis B virus (HBV) infection and normal transaminases. The study also aimed to evaluate liver damage by measuring the liver fibrosis (LF) grade and to identify possible factors associated with the presence of fibrosis. Methods: A retrospective observational study was conducted in patients with chronic HBV infection and classified as inactive carriers or immune-tolerant. Epidemiological variables of age, sex, immigrant, alcohol consumption, and body mass index (BMI), as well as virological variables (HBV DNA) and transaminase level were collected throughout the follow-up. The LF grade was evaluated by transient elastography. The cutoff value for significant fibrosis (SF) was liver stiffness ≥7.9 kPa. Results: A total of 214 patients were included in the analysis, and 62% of them had a BMI ≥25 kg/m2. During follow-up, 4% of patients showed transaminase elevation (<1.5 times normal). Most patients had a viral DNA level <2,000 IU/mL (83%). Data on LF were available in 160 patients; of these, 14% had SF, 9% F3, and 6% F4. The variables associated with the presence of SF were transaminase alteration during follow-up, as 23% of patients with SF had elevated transaminases versus 3% of patients without SF (P<0.005), and BMI, as the vast majority of patients with SF (88%) had a BMI ≥25 kg/m2 versus 56% of patients without SF (P<0.05). Conclusions: In patients with chronic HBV infection and normal transaminases, liver damage does not seem to be related to DNA levels, alcohol consumption, or immigrant status. SF seems to be associated with transaminase alteration during follow-up and elevated BMI. It is therefore recommended to measure LF grade with validated non-invasive methods in such patients.
참고문헌 (41)
- Lai CL, "The natural history and treatment of chronic hepatitis B : a critical evaluation of standard treatment criteria and end points", Ann Intern Med, 147, pp.58~61 (2007)
- Guardiola Arévalo A, "Characteristics and course of chronic hepatitis B e antigen-negative infection", Gastroenterol Hepatol, 40, pp.59~69 (2017)
- Papatheodoridis GV, "Follow-up and indications for liver biopsy in HBeAg-negative chronic hepatitis B virus infection with persistently normal ALT : a systematic review", J Hepatol, 57, pp.196~202 (2002)
- Hadziyannis SJ, "Hepatitis B e antigen-negative chronic hepatitis B : natural history and treatment", Semin Liver Dis, 26, pp.130~141 (2006)
- European Association for the Study of the Liver, "EASL Clinical Practice Guidelines : management of chronic hepatitis B", J Hepatol, 50, pp.227~242 (2009)
- Hu KQ, "Hepatitis B virus (HBV) infection in Asian and Pacific Islander Americans (APIAs): how can we do better for this special population?", Am J Gastroenterol, 103, pp.1824~1833 (2008)
- Buti M, "Consensus document of the Spanish Association for the Study of the Liver on the treatment of Hepatitis B infection(2012)", Gastroenterol Hepatol, 35, pp.512~528 (2012)
- Perrillo R, "Hepatitis B virus replication x time equals trouble", Gastroenterology, 130, pp.989~991 (2006)
- Gómez Rodríguez R, "Characteristics of patients with chronic hepatitis B virus infection. Analysis of a series of 474 patients", Gastroenterol Hepatol, 36, pp.243~253 (2013)
- Martinot-Peignoux M, "Serum hepatitis B virus DNA levels and liver histology in inactive HBsAg carriers", J Hepatol, 36, pp.543~546 (2002)
- Invernizzi F, "The prognosis and management of inactive HBV carriers", Liver Int, (36 Suppl 1), pp.100~104 (2016)
- Lin CL, "Hepatitis B viral factors in HBeAg-negative carriers with persistently normal serum alanine aminotransferase levels", Hepatology, 45, pp.1193~1198 (2007)
- Kumar M, "Virologic and histologic features of chronic hepatitis B virus-infected asymptomatic patients with persistently normal ALT", Gastroenterology, 134, pp.1376~1384 (2008)
- Rockey DC, "Liver biopsy", Hepatology, 49, pp.1017~1044 (2009)
- Castellano G, "The value of FibroScan(R)in the followup of patients with chronic hepatitis B virus infection without indication for treatment", Gastroenterol Hepatol, (37 Suppl 2), pp.15~21 (2014)
- Bravo AA, "Liver biopsy", N Engl J Med, 344, pp.495~500 (2001)
- Wong VW, "Transient elastography", J Gastroenterol Hepatol, 25, pp.1726~1731 (2010)
- Castéra L, "Pain experienced during percutaneous liver biopsy", Hepatology, 30, pp.1529~1530 (1999)
- Castéra L, "Patient administered nitrous oxide", oxygen inhalation provides safe and effective analgesia for percutaneous liver biopsy : a randomized placebo-controlled trial, 2001, pp.96, 1553~1557
- Chan HL, "Alanine aminotransferase based algorithms of liver stiffness measurement by transient elastography(Fibroscan)for liver fibrosis in chronic hepatitis B", J Viral Hepat, 16, pp.36~44 (2009)
- Wong GL, "Evaluation of alanine transaminase and hepatitis B virus DNA to predict liver cirrhosis in hepatitis B e antigen negative chronic hepatitis B using transient elastography", Am J Gastroenterol, 103, pp.3071~3081 (2008)
- Wong GL, "Clinical factors associated with liver stiffness in hepatitis B e antigen-positive chronic hepatitis B patients", Clin Gastroenterol Hepatol, 7, pp.227~233 (2009)
- Wong GL, "On-treatment monitoring of liver fibrosis with transient elastography in chronic hepatitis B patients", Antivir Ther, 16, pp.165~172 (2011)
- Castéra L, "Transient elastography and biomarkers for liver fibrosis assessment and follow-up of inactive hepatitis B carriers", Aliment Pharmacol Ther, 33, pp.455~465 (2011)
- Chon YE, "Performance of transient elastography for the staging of liver fibrosis in patients with chronic hepatitis B: a meta-analysis", PLoS One, 7, pp.e44930~ (2012)
- Viganò M, "Dual cut-off transient elastography to assess liver fibrosis in chronic hepatitis B : a cohort study with internal validation", Aliment Pharmacol Ther, 34, pp.353~362 (2011)
- Fateen AA, "Assessment of hepatic fibrosis and necroinflammation among inactive HBsAg carriers in Egypt", Ann Hepatol, 11, pp.464~470 (2012)
- Mena Á, "Metabolic syndrome association with fibrosis development in chronic hepatitis B virus inactive carriers", J Gastroenterol Hepatol, 29, pp.173~178 (2014)
- Wong GL, "Liver fibrosis progression is uncommon in patients with inactive chronic hepatitis B : a prospective cohort study with paired transient elastography examination", J Gastroenterol Hepatol, 28, pp.1842~1848 (2013)
- Lin SY, "Why we should routinely screen Asian American adults for hepatitis B : a cross sectional study of Asians in California", Hepatology, 46, pp.1034~1040 (2007)
- Cadranel JF, "Epidemiology of chronic hepatitis B infection in France : risk factors for significant fibrosis--results of a nationwide survey", Aliment Pharmacol Ther, 26, pp.565~576 (2007)
- Poves-Martínez E, "Diagnostic incidence of the presence of positive HBsAg: epidemiologic, clinical, and virological characteristics.", Rev Esp Enferm Dig, 104, pp.10~15 (2012)
- Fabris P, "Changing epidemiology of HCV and HBV infections in Northern Italy : a survey in the general population", J Clin Gastroenterol, 42, pp.527~532 (2008)
- Weinbaum CM, "Recommendations for identification and public health management of persons with chronic hepatitis B virus infection", MMWR Recomm Rep, 57(RR-8), pp.1~20 (2008)
- Oliveri F, "Liver stiffness in the hepatitis B virus carrier : a non-invasive marker of liver disease influenced by the pattern of transaminases", World J Gastroenterol, 14, pp.6154~6162 (2008)
- Solá R, "Prevalence of hepatitis B and hepatitis C viruses in different counties of Catalonia, Spain: cross-sectional study", Med Clin(Barc), 22, pp.90~95 (2002)
- Papatheodoridis GV, "Is there a meaningful serum hepatitis B virus DNA cutoff level for therapeutic decisions in hepatitis B e antigen-negative chronic hepatitis B virus infection?", Hepatology, 48, pp.1451~1459 (2008)
- Papatheodoridis GV, "Longitudinal changes in serum HBV DNA levels and predictors of progression during the natural course of HBeAg-negative chronic hepatitis B virus infection", J Viral Hepat, 15, pp.434~441 (2008)
- Ikeda K, "Long-term outcome of HBV carriers with negative HBe antigen and normal aminotransferase", Am J Med, 119, pp.977~985 (2006)
- Wong GL, "Metabolic syndrome increases the risk of liver cirrhosis in chronic hepatitis B", Gut, 58, pp.111~117 (2009)
- Marcellin P, "Regression of cirrhosis during treatment with tenofovir disoproxil fumarate for chronic hepatitis B : a 5-year open-label follow-up study", Lancet, 381, pp.468~475 (2013)