Liver inflammation and fibrosis in HBV-infected patients with a low viral load

Manlei JIANG; Fei XU; Lunli ZHANG

doi:10.3969/j.issn.1001-5256.2023.06.008

Volume 39 Issue 6

Jun. 2023

Turn off MathJax

Article Contents

Article Navigation > Journal of Clinical Hepatology > 2023 > 39(6): 1304-1307

PDF( 1724 KB)

Liver inflammation and fibrosis in HBV-infected patients with a low viral load

DOI: 10.3969/j.issn.1001-5256.2023.06.008

Manlei JIANG^{1
,
,
,},
Fei XU¹,
Lunli ZHANG²

1.
Department of Difficult Hepatology, Ganzhou Fifth People's Hospital, Ganzhou, Jiangxi 341000, China
2.
Department of Infectious Diseases, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China

Research funding:

Science and Technology Fund Project of Jiangxi Provincial Health Commission (202212322);

Ganzhou Science and Technology Bureau Fund Project (GZ2020ZSF294)

More Information

Corresponding author: JIANG Manlei, lffjml@163.com (ORCID: 0000-0003-0971-6219)
Received Date: 2022-10-27
Accepted Date: 2022-12-12
Published Date: 2023-06-20

Abstract

Abstract

Objective To investigate liver inflammation and fibrosis in patients with chronic HBV infection with a low viral load. Methods Among the HBsAg-positive patients who attended Ganzhou Fifth People's Hospital from April 2019 to June 2022, 41 patients with 20 IU/mL < HBV DNA < 2 000 IU/mL were selected and underwent the examinations of blood biochemistry, liver stiffness measurement (LSM), and liver biopsy to clarify liver inflammation and fibrosis. Liver inflammation was analyzed according to HBV DNA, alanine aminotransferase (ALT), LSM, and age. The chi-square test was used for comparison of categorical data between groups. Results Among the 41 patients, 15 (36.59%) had liver inflammation grade ≥G2 and/or liver fibrosis stage ≥S2. Among these 15 patients, 11 (73.33%) had an HBV DNA level of > 200-2 000 IU/mL and 4 (26.67%) had an HBV DNA level of 20-200 IU/mL; the patients with G2 liver inflammation accounted for 73.33% (11/15), and those with S2 liver fibrosis accounted for 46.67% (7/15); the patients with ALT ≤30 U/L accounted for 46.67% (7/15); the patients aged ≥30 years accounted for 86.66% (13/15); the patients with LSM > 17 kPa accounted for 6.67% (1/15), those with an LSM value of 12.4-17 kPa accounted for 46.67% (7/15), and those with an LSM value of 9.4-12.4 kPa accounted for 33.33% (5/15). Conclusion Patients with chronic HBV infection and low-level viremia have a relatively high risk of progression of inflammation and fibrosis. ALT level cannot be used as a basis for antiviral therapy in HBV-infected people with a low viral load. LSM based on transient elastography can be used as a noninvasive test to screen for CHB patients with a low viral load, and antiviral therapy should be considered when HBV-infected patients with a low viral load have an age of > 30 years and an LSM value of > 9.4 kPa persistently.
- Hepatitis B, Chronic,
- Viral Load,
- Hepatic Fibrosis

FullText(HTML)

References(16)

References

[1]	SETO WK, LO YR, PAWLOTSKY JM, et al. Chronic hepatitis B virus infection[J]. Lancet, 2018, 392(10161): 2313-2324. DOI: 10.1016/S0140-6736(18)31865-8.
[2]	HUTIN Y, NASRULLAH M, EASTERBROOK P, et al. Access to treatment for hepatitis B virus infection - worldwide, 2016[J]. MMWR Morb Mortal Wkly Rep, 2018, 67(28): 773-777. DOI: 10.15585/mmwr.mm6728a2.
[3]	ZHANG R, TANG YY, YU Q, et al. Analysis on ten-year data of individualized programs to prevent mother-to-child transmission of hepatitis B virus[J/CD]. Chin J Exp Clin Infect Dis(Electronic Edition), 2021, 15(5): 303-310. DOI: 10.3877/cma.j.issn.1674-1358.2021.05.003. 张荣, 唐雍艳, 喻茜, 等. 个体化方案阻断乙型肝炎病毒母婴传播十年数据分析[J/CD]. 中华实验和临床感染病杂志(电子版), 2021, 15(5): 303-310. DOI: 10.3877/cma.j.issn.1674-1358.2021.05.003.
[4]	CAO XZ, YI W, LIU XM, et al. The immune response and influencing factor of hepatitis B virus vaccine on 3-year-old children born to mothers infected with HBV[J/OL]. Chin J Liver Dis (Electronic Version), 2022, 14(2): 57-62. DOI: 10.3969/j.issn.1674-7380.2022.02.009. 曹秀贞, 易为, 刘雪梅, 等. HBV感染母亲所生儿童3岁时乙肝疫苗免疫应答情况及影响因素[J/OL]. 中国肝脏病杂志(电子版), 2022, 14(2): 57-62. DOI: 10.3969/j.issn.1674-7380.2022.02.009.
[5]	LIU J, LIANG W, JING W, et al. Countdown to 2030: eliminating hepatitis B disease, China[J]. Bull World Health Organ, 2019, 97(3): 230-238. DOI: 10.2471/BLT.18.219469.
[6]	Chinese Society of Infectious Diseases, Chinese Medical Association; Chinese Society of Hepatology, Chinese Medical Association. Guidelines for the prevention and treatment of chronic hepatitis B (version 2019)[J]. J Clin Hepatol, 2019, 35(12): 2648-2669. DOI: 10.3969/j.issn.1001-5256.2019.12.007. 中华医学会感染病学分会, 中华医学会肝病学分会. 慢性乙型肝炎防治指南(2019年版)[J]. 临床肝胆病杂志, 2019, 35(12): 2648-2669. DOI: 10.3969/j.issn.1001-5256.2019.12.007.
[7]	China Hepatitis Prevention and Control Foundation, Infectious Diseases Branch of Chinese Medical Association, Hepatology Branch of Chinese Medical Association and Hepatology Professional Committee of Chinese Research Hospital Association. Expert consensus on transient elastography for the diagnosis of liver fibrosis (2018 updated edition)[J]. Chin J Hepatol, 2019, 27(3): 182-191. DOI: 10.3760/cma.j.issn.1007-3418.2019.03.004. 中国肝炎防治基金会, 中华医学会感染病学分会, 中华医学会肝病学分会和中国研究型医院学会肝病专业委员会. 瞬时弹性成像技术诊断肝纤维化专家共识(2018年更新版)[J]. 中华肝脏病杂志, 2019, 27(3): 182-191. DOI: 10.3760/cma.j.issn.1007-3418.2019.03.004.
[8]	LOK AS, MCMAHON BJ. Chronic hepatitis B[J]. Hepatology, 2007, 45(2): 507-539. DOI: 10.1002/hep.21513.
[9]	LIAW YF. Natural history of chronic hepatitis B virus infection and long-term outcome under treatment[J]. Liver Int, 2009, 29(Suppl 1): 100-107. DOI: 10.1111/j.1478-3231.2008.01941.x.
[10]	FANNING GC, ZOULIM F, HOU J, et al. Therapeutic strategies for hepatitis B virus infection: towards a cure[J]. Nat Rev Drug Discov, 2019, 18(11): 827-844. DOI: 10.1038/s41573-019-0037-0.
[11]	HUI CK, LEUNG N, YUEN ST, et al. Natural history and disease progression in Chinese chronic hepatitis B patients in immune-tolerant phase[J]. Hepatology, 2007, 46(2): 395-401. DOI: 10.1002/hep.21724.
[12]	MA JW, ZHAI YZ. Progress on treatment of immune tolerance phase of hepatitis B virus infection[J/OL]. Chin J Liver Dis(Electronic Version), 2022, 14(2): 32-36. DOI: 10.3969/j.issn.1674-7380.2022.02.005. 马俊雯, 翟永贞. 乙型肝炎病毒感染免疫耐受期治疗进展[J/OL]. 中国肝脏病杂志(电子版), 2022, 14(2): 32-36. DOI: 10.3969/j.issn.1674-7380.2022.02.005.
[13]	Hepatology Branch of Chinese Medical Association. Expert opinion on expanding antiviral therapy for chronic hepatitis B[J]. Chin J Hepatol, 2022, 30(2): 131-136. DOI: 10.3760/cma.j.cn501113-20220209-00060. 中华医学会肝病学分会. 扩大慢性乙型肝炎抗病毒治疗的专家意见[J]. 中华肝脏病杂志, 2022, 30(2): 131-136. DOI: 10.3760/cma.j.cn501113-20220209-00060.
[14]	WANG C, WANG C, DEUBNER H, et al. High prevalence of significant fibrosis in patients with immunotolerance to chronic hepatitis B infection[J]. Hepatology, 2005, 42(Suppl 1): A573.
[15]	ZHUANG H. Should chronic hepatitis B be treated in the uncertain phase?[J]. J Clin Hepatol, 2021, 37(9): 2033-2036. DOI: 10.3969/j.issn.1001-5256.2021.09.007. 庄辉. 不确定期慢性乙型肝炎应否治疗?[J]. 临床肝胆病杂志, 2021, 37(9): 2033-2036. DOI: 10.3969/j.issn.1001-5256.2021.09.007.
[16]	SUN Y, CHANG J, LIU X, et al. Mortality trends of liver diseases in mainland China over three decades: an age-period-cohort analysis[J]. BMJ Open, 2019, 9(11): e029793. DOI: 10.1136/bmjopen-2019-029793.

Relative Articles

[1]	Lulu ZHOU, Bing DONG, Jiejing XIN, Guanghua XU, Na LIU. Liver histopathological features of HBeAg-negative patients in the indeterminate phase of low-viral-load chronic hepatitis B virus infection[J]. Journal of Clinical Hepatology, 2025, 41(1): 52-56. doi: 10.12449/JCH250108
[2]	Meijie SHI, Huanming XIAO, Yubao XIE, Sheng LI, Folai ZENG, Xiaoling CHI. Role of traditional Chinese Medicine in prevention and treatment of chronic hepatitis B liver fibrosis: Current status, challenges, and thoughts[J]. Journal of Clinical Hepatology, 2023, 39(6): 1280-1286. doi: 10.3969/j.issn.1001-5256.2023.06.004
[3]	Zhaofang BAI, Xiaoyan ZHAN, Guiji LYU, Yongping YANG. Blocking and reversing liver fibrosis with traditional Chinese medicine compound prescriptions: Beyond the known frontiers[J]. Journal of Clinical Hepatology, 2023, 39(2): 273-277. doi: 10.3969/j.issn.1001-5256.2023.02.004
[4]	Huanming XIAO, Meijie SHI, Yubao XIE, Xiaoling CHI. Advances and thoughts in traditional Chinese medicine diagnosis and treatment of chronic hepatitis B-related liver fibrosis[J]. Journal of Clinical Hepatology, 2023, 39(2): 260-266. doi: 10.3969/j.issn.1001-5256.2023.02.002
[5]	Hailin CHENG, Xudong HU, Bing XIA, Tao BAI, Sixia LU. Clinical effect of tenofovir alafenamide fumarate on chronic hepatitis B patients with low viral load after entecavir treatment[J]. Journal of Clinical Hepatology, 2022, 38(3): 537-540. doi: 10.3969/j.issn.1001-5256.2022.03.009
[6]	Huikun ZHOU, Jianning JIANG, Minghua SU, Rongming WANG, Bobin HU, Deli DENG, Huilan WEI, Xianshuai LIANG, Wenming HE, Rongsheng GUO. Efficacy of entecavir versus tenofovir disoproxil fumarate in treatment of chronic hepatitis B patients with high viral load[J]. Journal of Clinical Hepatology, 2022, 38(3): 532-536. doi: 10.3969/j.issn.1001-5256.2022.03.008
[7]	Ye HaiWen, Deng Yong, Zhang LingQiang, Wang HaiJiu, Zhou Ying, Xu XiaoLei, Fan HaiNing. Influence of HBV DNA load on surgical outcome of hepatitis B-associated liver cancer[J]. Journal of Clinical Hepatology, 2018, 34(9): 1995-1998. doi: 10.3969/j.issn.1001-5256.2018.09.035
[8]	Gu JiuLian, Liu ShouSheng, Li ChangFei, Xiao JianHan, Xin YongNing, Xuan ShiYing. Value of highly sensitive serum virological markers in hepatitis B patients with a low viral load[J]. Journal of Clinical Hepatology, 2018, 34(6): 1302-1307. doi: 10.3969/j.issn.1001-5256.2018.06.037
[9]	Qin XiaoMei, Fan ChenYing, Li ShuangJie, Peng HuiYun. Correlation of HBV DNA load with liver pathology,liver function,and serological markers of liver fibrosis in children with chronic hepatitis B[J]. Journal of Clinical Hepatology, 2016, 32(3): 472-475. doi: 10.3969/j.issn.1001-5256.2016.03.014
[10]	Li Qiang, Huang YuXian, Chen Liang. Independent predictive factors for significant liver histological changes in patients with HBe Ag-positive high-viral-load chronic HBV infection and a normal alanine aminotransferase level[J]. Journal of Clinical Hepatology, 2016, 32(7): 1310-1314. doi: 10.3969/j.issn.1001-5256.2016.07.019
[11]	Sun JianMin. Efficacy of thymosin α1 in chronic HBV infection patients with low viral load in immune-clearance or low-replication phase[J]. Journal of Clinical Hepatology, 2015, 31(2): 202-204. doi: 10.3969/j.issn.1001-5256.2015.02.014
[12]	Liu HaoGang, Xin YongNing, Jiang Man, Zhang DingDing, Jiang XiangJun, Xuan ShiYing. Correlation between expression of PI4KA in serum and HVB DNA load in patients with chronic hepatitis B[J]. Journal of Clinical Hepatology, 2014, 30(2): 132-135. doi: 10.3969/j.issn.1001-5256.2014.02.009
[13]	Ding Chen, Pan Fan, Hu HaiZhang, Xiong RiHui, Li Song, Jiang Yi, Pan Chen. Efficacy of antiviral therapy in hepatocellular carcinoma patients with high HBV DNA levels after radical resection[J]. Journal of Clinical Hepatology, 2014, 30(7): 656-659. doi: 10.3969/j.issn.1001-5256.2014.07.021
[14]	Zhang HengBing. Effects of marine in the treatment of chronic hepatitis B patients with low viral load[J]. Journal of Clinical Hepatology, 2012, 28(3): 176-178.
[15]	Niu ChunYan, Gao BaoHua, Zheng JianYun, Wu FangXiong, Wang Wen, Luo JianMei, Zheng NaiQing. The correlations between HBV quantity in the liver tissue and the severity of liver tissue injury in chronic hepatitis B and hepatic cirrhosis[J]. Journal of Clinical Hepatology, 2011, 27(3): 277-279.
[16]	Jiang WeiPing, Lai LiYing, Li XinHua, Chen DongPing. Study on the linkage between variation of YMDD in hepatitis B virus and hepatic fibrosis serum markers[J]. Journal of Clinical Hepatology, 2004, 20(6): 345-346.
[17]	Yin ChiBiao, Zhang FuChun, Xian JianZhong, Cao Yang, Tang XiaoPing. Study of relationship between the serum viral load and ALT level and response to interferon therapy.[J]. Journal of Clinical Hepatology, 2004, 20(2): 97-98.
[18]	Zhang Min, Zhang LingXia, Xin ShaoJie, Zhao JingMin, Wang SongShan, Wang LinJie. The relationship between transforming growth factor β1 and liver fibrosis[J]. Journal of Clinical Hepatology, 2000, 16(1): 32-33.
[19]	Zhang ChunLan, Shi YaLing. The Relation of Hepatic Fibrosis Indexes to HBVDNA Title and Pathological Change[J]. Journal of Clinical Hepatology, 2000, 16(4): 220-221.

Supplements(0)

Cited By

Cited by

Periodical cited type(6)

1.	黄海艳. 前S1抗原乙型肝炎病毒DNA联合乙型肝炎5项检验用于乙型肝炎肝纤维化诊断的价值. 实用医技杂志. 2025(02): 134-138 .
2.	邱功钦，谢丹，陈姿任，欧阳石. 高敏PCR在HBV极低病毒载量的慢性乙型肝炎患者中检测的临床意义. 临床肝胆病杂志. 2024(03): 483-488 . 本站查看
3.	蔡晓娟，汪美华，毛莉萍，缪幼菡，姚超，朱晓红. 恩替卡韦序贯联合聚乙二醇干扰素α-2b治疗低水平HBsAg阳性CHB患者疗效观察. 中西医结合肝病杂志. 2024(07): 587-591 .
4.	安国兴. 慢性乙型肝炎经恩替卡韦治疗后发生低病毒血症的影响因素分析. 医药前沿. 2024(21): 25-27 .
5.	胡兄. 乙型肝炎病毒载量对慢性乙型肝炎患者血清免疫学指标及肝纤维化指标的影响. 慢性病学杂志. 2024(10): 1494-1496+1500 .
6.	熊敏，郭道宁，刘红佶，冯齐齐. 超声弹性成像参数联合血清学指标对不同Child-Pugh分期肝病的诊断价值分析. 现代消化及介入诊疗. 2023(09): 1161-1165 .

Other cited types(0)

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Get Citation

PDF

XML

Article Metrics

Article views (588) PDF downloads(80)

Liver inflammation and fibrosis in HBV-infected patients with a low viral load

DOI: 10.3969/j.issn.1001-5256.2023.06.008