Lowering the cut-off value of ALT may contribute to identify chronic HBV infection patients with significant liver histological changes / 中华临床感染病杂志

ABSTRACT

Objective:To explore the necessity of lowering the cut-off value of alanine aminotransferase (ALT) in identifying chronic HBV infection patients with significant liver histological changes.Methods:The clinical data of 123 chronic HBV infection patients with normal ALT according to domestic criteria who underwent liver biopsy in the Department of Hepatology of Taizhou People’s Hospital from June 2016 to March 2021 were analyzed retrospectively. According to the cut-off ALT values recommended by 2018 version of AASLD guidelines (male 35 U/L, female 25 U/L), the patients were divided into two groups high normal value group (HNALT, ALT≥AASLD and<domestic standard) and normal low value group (LNALT, ALT<AASLD value). The cases with significant liver histological changes (G/S≥2) were compared between the two groups. Univariate and multivariate Logistic regression analysis were used to explore the risk factors of G/S≥2.Results:There were 68(68/123, 55.3%) cases with significant liver histological changes (G/S≥2) in this series. Among 83 patients in the LNALT group, there were 35 case of G≥2 (42.2%), 26 cases of S≥2 (31.3%) and 39 cases of G/S≥2 (47.0%); while among 40 patients in the HNALT group, there were 27 cases of G≥2 (67.5%), 21 cases of S≥2 (52.5%), and 29 cases of G/S≥2 (72.5%), respectively. There were significant differences between the two groups ( χ2=6.928, 5.126 and 7.107, all P values <0.05). Univariate analysis showed that ALT at high normal values ( χ2=7.107), albumin levels ( t=2.248), glutamyltransferase ( Z=-2.885) and international normalized ratio (INR) ( t=-3.152) were significantly associated with liver histological changes in patients ( P<0.05 ro <0.01). Multivariate Logistic regression analysis showed that ALT at high normal value ( OR=3.492, 95% CI 1.369-8.907) and INR ( OR=1.529, 95% CI 1.054-2.218) were independent risk factors of significant liver histological changes. Conclusion:Lowering the cut-off value of ALT may contribute to identify patients who potentially need antiviral treatment. It is recommended that patients with high normal value of ALT according to domestic criteria should undergo liver biopsy or non-invasive liver fibrosis examination to evaluate the histological changes of the liver and treat them if necessary.