Liver Histological Abnormalities Were Better Reflected by Virus Level in Chronic Hbv Infected Patients Aged ≤ 30 Years, Hbeag-Positive and Persistently Normal Alt

Background: We analyzed correlations between significant liver histological characteristics and clinical variables in HBV-infected patients and provided recommendations on treatment decisions for patients age younger than 30-year-old.Methods: Liver biopsy was performed on 161 chronic HBV-infected patients with ALT ≤ 40 U/L from July, 2000 – November, 2019. Median age was 39(18-70) years old. Histologic assessment was based on the Scheuer scoring system. Results: Significant necroinflammation and fibrosis were observed in 65.2% (105/161) and 52.2% (84/161) patients of all cases. The pathological abnormality was significantly negatively correlated with viral level in HBeAg-positive subjects, and based on ROC curve analysis, the viral level to predict obvious liver pathological changes was 6.7 log10 IU/ml in those patients. Threshold value of ALT (25 U/L) based on the distribution of ALT and virus levels. Patients younger than 30 years old, almost all had significant pathological alteration with HBV-DNA < 6.7 log10 IU/ml; However, the ratio of insignificant liver’s inflammation and fibrosis were 65% and 70% with HBV-DNA levels ≥ 6.7 log10 IU/ml respectively, on that basis, it could have a further rising, reaching 67.5% and 75% combining with ALT ≤ 25 U/L. Conclusion: Viral load was a better factor to reflect hepatic histological abnormality in Chronic HBV-infected patients with HBeAg-positive and persistently normal ALT whose age ≤ 30 years, 5000000 IU/ml was a suitable threshold.

Comparison and Validation of APRI and FIB-4 for Evaluating Liver Fibrosis in Chinese Hepatitis B Virus-infected Patients with Persistently Normal ALT, Mildly and Significantly Elevated ALT

Background: Many noninvasive models based on serum markers composition are used for the assessment of liver fibrosis, reducing the need for liver biopsy. However, most of the models have rarely been validated in Chinese hepatitis B patients. We aim to evaluate and validate chronic hepatitis B(CHB) patients with normal ALT, mildly and significantly elevated ALT levels.Methods: This single-center retrospective study enrolled 285 patients with CHB who underwent liver biopsy. There were 156 patients in normal ALT group, 85 patients in mildly elevated ALT group, and 44 patients in significantly elevated ALT group. The diagnostic accuracy of APRI and FIB-4 was evaluated by areas under the characteristic curves (AUROC) using the histological assessment of the fibrosis stages of the biopsy specimens as the standards.Results: Among 285 patients with CHB, 156 patients had normal ALT level, of which 65 (41.7%) had significant fibrosis(S2-4). The evaluation of significant fibrosis, AUROC in APRI and FIB-4 were 0.608, 0.634, 0.708 and 0.638, 0.679, 0.734 in normal ALT, mildly and significantly elevated ALT, respectively. The assessment of advanced fibrosis, AUROC in APRI and FIB-4 were 0.636, 0.751, 0.708 and 0.652, 0.763, 0.734 in normal ALT, mildly and significantly elevated ALT groups, respectively. Conclusions: APRI and FIB-4 may not be ideal noninvasive markers for evaluating liver fibrosis in Chinese HBV-infected patients with normal ALT levels. Compared with HBV-infected patients with normal ALT, APRI and FIB-4 had high accuracies in diagnosing liver fibrosis in patients with mildly and significantly elevated ALT.

Antiviral Therapy for Chronic HBV Infection With Persistently Normal Alanine Aminotransferase: Controversy and Consensus

ALT is one of the most sensitive biochemical indexes to reflect liver injury. It is generally believed that hepatitis B virus (HBV) infected patients with normal ALT levels are in either immune tolerance or low replication stage of the natural history of hepatitis B, and there is no or only mild inflammation in liver tissue, so antiviral therapy is not recommended. However, chronic HBV-infected patients with normal ALT levels are not always in a stable state. A considerable number of patients will develop active hepatitis or occult progress to liver fibrosis, cirrhosis, and hepatocellular carcinoma. Therefore, whether antiviral therapy should be recommended for chronic HBV infection with normal ALT level has been a hot topic in clinical practice. In this paper, the definition of immune tolerance, the relationship between ALT and liver inflammation, and the benefits of antiviral therapy were reviewed, and we hope it will be helpful for clinicians to have a deeper understanding of whether antiviral therapy should be considered for chronic HBV infection with normal ALT.

Exploring the efficacy and safety of polyene phosphatidylcholine for treatment of drug-induced liver injury using the Roussel Uclaf causality assessment method: a propensity score matching comparison

Objective In China, polyene phosphatidylcholine (PPC) is widely used to treat alanine aminotransferase (ALT) elevation associated with various liver diseases. Here, we assessed the efficacy and safety of PPC in treating drug-induced liver injury (DILI). Methods Data from a multicenter retrospective cohort study (DILI-R) were analyzed to compare PPC and magnesium isoglycyrrhizinate (MgIG) for treatment of DILI. We used the Roussel Uclaf causality assessment method (RUCAM) to evaluate patients with DILI. Patients with RUCAM scores ≥6 were included in the study, while those with RUCAM scores <6 were further evaluated by a panel of hepatologists. The primary outcome was the proportion of patients with ALT normalization at discharge. Propensity score matching was used to identify 183 matched pairs of patients (366 patients in total) from 25,927 patients with DILI. Results Among the DILI patients, 64 of 183 (34.97%) achieved normal ALT levels after treatment in both the PPC and the MgIG groups. Conclusion There were no significant differences in safety biomarkers including serum creatinine, blood urea nitrogen, white blood cells, platelets, hemoglobin, and albumin between patients treated with PPC or MgIG. The safety and efficacy of these two agents for treatment of DILI were comparable.

The Diagnostic Value of Adenosine Deaminase in Children With Infectious Mononucleosis by EBV

Background Infectious mononucleosis (IM) which was a common disease in children was often accompanied by elevated transaminase and occasionally liver failure. This study aimed to explore the diagnostic value of adenosine deaminase in IM and its concurrent elevated alanine aminotransferase (ALT). Methods 104 children with IM and 50 controls with acute infection, of whom main symptoms were fever, tonsillitis or lymphadenitis, from Children’s Hospital of Soochow University were enrolled in this study. Among 104 children with IM, 54 had normal ALT (IM1 group) and 50 had elevated ALT (IM2 group). Then the clinical and laboratory data of the children were collected to explore the diagnostic value of ADA in the three groups. Results ADA in the IM group was significantly higher compared with it in the control group (P < 0.001). ADA had a high correlation with lymphocyte count, CD3 + CD8 + T cell (%), CD4+/CD8 + and CD3-CD19+(%) (|r| >0.7, p < 0.01). ADA had great diagnostic value in pediatric patients with IM. The sensitivity and specificity of ADA in predicting pediatric IM patients were 97.1% and 94.0%, respectively. Furthermore, multivariate regression analysis indicated that ADA was risk factor for elevated ALT in children with IM. Conclusions ADA may be a novel diagnostic indicator for pediatric IM and indirectly predict elevated ALT.

A Non-invasive Model for Predicting Liver Inflammation in Chronic Hepatitis B Patients With Normal Serum Alanine Aminotransferase Levels

Background and Aims: Chronic hepatitis B (CHB) patients with normal alanine aminotransferase (ALT) levels are at risk of disease progression. Currently, liver biopsy is suggested to identify this population. We aimed to establish a non-invasive diagnostic model to identify patients with significant liver inflammation.Method: A total of 504 CHB patients who had undergone liver biopsy with normal ALT levels were randomized into a training set (n = 310) and a validation set (n = 194). Independent variables were analyzed by stepwise logistic regression analysis. After the predictive model for diagnosing significant inflammation (Scheuer's system, G ≥ 2) was established, a nomogram was generated. Discrimination and calibration aspects of the model were measured using the area under the receiver operating characteristic curve (AUC) and assessment of a calibration curve. Clinical significance was evaluated by decision curve analysis (DCA).Result: The model was composed of 4 variables: aspartate aminotransferase (AST) levels, γ-glutamyl transpeptidase (GGT) levels, hepatitis B surface antigen (HBsAg) levels, and platelet (PLT) counts. Good discrimination and calibration of the model were observed in the training and validation sets (AUC = 0.87 and 0.86, respectively). The best cutoff point for the model was 0.12, where the specificity was 83.43%, the sensitivity was 77.42%, and the positive likelihood and negative likelihood ratios were 4.67 and 0.27, respectively. The model's predictive capability was superior to that of each single indicator.Conclusion: This study provides a non-invasive approach for predicting significant liver inflammation in CHB patients with normal ALT. Nomograms may help to identify target patients to allow timely initiation of antiviral treatment.

The frequency of non-alcoholic fatty liver disease in non-obese young medical professionals

This cross-sectional study was conducted in Mayo Hospital, Lahore, from July 16, 2018 to January 15, 2019 to observe the frequency of occurrence of non-alcoholic fatty liver disease in non-obese young medical professionals. One hundred and fifty-three subjects were selected using Simple Random Sampling Technique. SPSS version 25.0 was used to analyse the data. Out of a total of 153 medical professionals, 67 (43.8%) were males and 86 (56.2%) were females, median age was 23 years (inter-quartile range of 5 years), mean BMI was 22.79 + 1.57 kg/m2, 122 (79.7%) subjects had normal texture of liver on ultrasonography and normal ALT levels, 21 (13.7%) had fatty liver with normal ALT levels, and 10 (6.5%) had fatty liver and elevated ALT levels (NASH). NAFLD and NASH are common ultrasonographic findings in seemingly healthy young adults with normal BMI. Awareness programmes should be carried out at the national level to educate the general public about the prevention and treatment of this disease through lifestyle and dietary modifications. Continuous...