Association between liver pathology and clinical features in patients with chronic HBV infection and slightly elevated alanine aminotransferase

Objective To investigate the association between liver pathological changes and clinical features in patients with chronic HBV infection and alanine aminotransferase (ALT) 1-2 × upper limits of normal (ULN) .Methods A total of 80 patients with chronic HBV infection and ALT 1-2×ULN who were hospitalized in The First Affiliated Hospital of Bengbu Medical College from July 2015 to December 2016 were enrolled.All patients underwent liver biopsy, and according to positive or negative HBe Ag, these patients were divided into two groups, and the association of liver pathological changes with age, sex, and HBV DNA load was analyzed.The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups.Results The HBe Ag-negative group had significantly higher age and serum ALT level than the HBe Ag-positive group (t=12.35 and 7.18, both P<0.01) .Compared with the HBe Ag-positive group, the HBe Ag-negative group had a significantly higher proportion of patients with liver inflammation ≥G2 (54.8% vs 76.3%, χ2=53.68, P<0.01) or fibrosis degree ≥S2 (57.1% vs 73.7%, χ2=46.67, P<0.01) .Immunohistochemical staining was performed for 35 patients to measure the expression of HBsAg and HBcAg in the liver, and there were no significant differences in the staining scores of HBsAg and HBcAg between the two groups (both P>0.05) .Conclusion Among patients with chronic HBV infection and slightly elevated ALT, HBe Ag-negative patients have significantly worse conditions of liver lesions than HBe Ag-positive patients.Liver biopsy is recommended for older patients with a long course of disease, in order to provide guidance for antiviral therapy.