Clinical and histopathological features of chronic hepatitis B virus infected patients with high HBV-DNA viral load and normal alanine aminotransferase level: A multicentre-based study in China

Yu Feng Xing; Da Qiao Zhou; Jing Song He; Chun Shan Wei; Wei Chao Zhong; Zhi Yi Han; De Ti Peng; Mu Min Shao; Tung Ting Sham; Daniel Kam Wah Mok; Chi On Chan; Guang Dong Tong

doi:10.1371/journal.pone.0203220

Clinical and histopathological features of chronic hepatitis B virus infected patients with high HBV-DNA viral load and normal alanine aminotransferase level: A multicentre-based study in China

Yu Feng Xing, Da Qiao Zhou, Jing Song He, Chun Shan Wei, Wei Chao Zhong, Zhi Yi Han, De Ti Peng, Mu Min Shao, Tung Ting Sham, Daniel Kam Wah Mok, Chi On Chan, Guang Dong Tong

Research output: Journal article publication › Journal article › Academic research › peer-review

27 Citations (Scopus)

Abstract

Background The aim of this study is to reveal the clinical and histopathological features of HBsAg-positive and HBeAg-positive chronic hepatitis B infected patients with high level of HBV DNA, from 17 hospitals and medical centres in China, with alanine aminotransferase levels within the lower region of normal range versus those with levels within the upper region of normal range and to investigate the clinical risk factors for the requirement of treatment through the examination of liver biopsy. Methods Liver biopsy was performed on high level of HBV DNA of 455 patients with HBsAg-positive and HBeAg-positive chronic hepatitis B infection and persistently normal alanine aminotransferase level. Liver necroinflammation and fibrosis were graded per the Knodell histological activity index and Ishak’s fibrosis score, respectively. Univariate analysis of the clinical parameters versus necroinflammation and fibrosis was carried out. Results Of the subjects in this multicentre-based study, 5.49% and 10.11% had significant necroinflammation with Knodell histological activity index 9 and hepatic fibrosis stages with Ishak scores 3, respectively. The subjects were stratified into three age groups (30–39, 40–49 and 50 years), and our data clearly suggested that age, particularly in the age group over 50, was an independent predictor of liver necroinflammation and fibrosis. Lower HBV-DNA viral levels were found in patients with Knodell histological activity index 9 or advanced fibrosis (Ishak scores 3). Conclusion Our results showed that histological changes in liver tissues were observed in a significant proportion of patients with persistently normal alanine aminotransferase level. According to the data evaluation results, liver biopsy is advisable for HBeAg-positive chronic hepatitis B infected patients aged older than 40 and high HBV-DNA viral load in China.

Original language	English
Article number	e0203220
Journal	PLoS ONE
Volume	13
Issue number	9
DOIs	https://doi.org/10.1371/journal.pone.0203220
Publication status	Published - Sept 2018

ASJC Scopus subject areas

General Biochemistry,Genetics and Molecular Biology
General Agricultural and Biological Sciences
General

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This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1371/journal.pone.0203220

http://hdl.handle.net/10397/80000

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Xing, Y. F., Zhou, D. Q., He, J. S., Wei, C. S., Zhong, W. C., Han, Z. Y., Peng, D. T., Shao, M. M., Sham, T. T., Mok, D. K. W., Chan, C. O., & Tong, G. D. (2018). Clinical and histopathological features of chronic hepatitis B virus infected patients with high HBV-DNA viral load and normal alanine aminotransferase level: A multicentre-based study in China. PLoS ONE, 13(9), Article e0203220. https://doi.org/10.1371/journal.pone.0203220

@article{314a408423444ce0abcf45facb5d0853,

title = "Clinical and histopathological features of chronic hepatitis B virus infected patients with high HBV-DNA viral load and normal alanine aminotransferase level: A multicentre-based study in China",

abstract = "Background The aim of this study is to reveal the clinical and histopathological features of HBsAg-positive and HBeAg-positive chronic hepatitis B infected patients with high level of HBV DNA, from 17 hospitals and medical centres in China, with alanine aminotransferase levels within the lower region of normal range versus those with levels within the upper region of normal range and to investigate the clinical risk factors for the requirement of treatment through the examination of liver biopsy. Methods Liver biopsy was performed on high level of HBV DNA of 455 patients with HBsAg-positive and HBeAg-positive chronic hepatitis B infection and persistently normal alanine aminotransferase level. Liver necroinflammation and fibrosis were graded per the Knodell histological activity index and Ishak{\textquoteright}s fibrosis score, respectively. Univariate analysis of the clinical parameters versus necroinflammation and fibrosis was carried out. Results Of the subjects in this multicentre-based study, 5.49% and 10.11% had significant necroinflammation with Knodell histological activity index 9 and hepatic fibrosis stages with Ishak scores 3, respectively. The subjects were stratified into three age groups (30–39, 40–49 and 50 years), and our data clearly suggested that age, particularly in the age group over 50, was an independent predictor of liver necroinflammation and fibrosis. Lower HBV-DNA viral levels were found in patients with Knodell histological activity index 9 or advanced fibrosis (Ishak scores 3). Conclusion Our results showed that histological changes in liver tissues were observed in a significant proportion of patients with persistently normal alanine aminotransferase level. According to the data evaluation results, liver biopsy is advisable for HBeAg-positive chronic hepatitis B infected patients aged older than 40 and high HBV-DNA viral load in China.",

author = "Xing, {Yu Feng} and Zhou, {Da Qiao} and He, {Jing Song} and Wei, {Chun Shan} and Zhong, {Wei Chao} and Han, {Zhi Yi} and Peng, {De Ti} and Shao, {Mu Min} and Sham, {Tung Ting} and Mok, {Daniel Kam Wah} and Chan, {Chi On} and Tong, {Guang Dong}",

note = "Funding Information: This study was supported by the National Science and Technology Major Project (2008ZX10005008; 2012ZX10005006 to GDT) and Guangdong Province Science and Technology Project (2017A020213016 to YFX) and Shenzhen Basic Research Program (JCYJ20160229173844278 to COC). The funders Publisher Copyright: {\textcopyright} 2018 Xing et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

year = "2018",

month = sep,

doi = "10.1371/journal.pone.0203220",

language = "English",

volume = "13",

journal = "PLoS ONE",

issn = "1932-6203",

publisher = "Public Library of Science",

number = "9",

}

Xing, YF, Zhou, DQ, He, JS, Wei, CS, Zhong, WC, Han, ZY, Peng, DT, Shao, MM, Sham, TT, Mok, DKW, Chan, CO & Tong, GD 2018, 'Clinical and histopathological features of chronic hepatitis B virus infected patients with high HBV-DNA viral load and normal alanine aminotransferase level: A multicentre-based study in China', PLoS ONE, vol. 13, no. 9, e0203220. https://doi.org/10.1371/journal.pone.0203220

Clinical and histopathological features of chronic hepatitis B virus infected patients with high HBV-DNA viral load and normal alanine aminotransferase level: A multicentre-based study in China. / Xing, Yu Feng; Zhou, Da Qiao; He, Jing Song et al.
In: PLoS ONE, Vol. 13, No. 9, e0203220, 09.2018.

Research output: Journal article publication › Journal article › Academic research › peer-review

TY - JOUR

T1 - Clinical and histopathological features of chronic hepatitis B virus infected patients with high HBV-DNA viral load and normal alanine aminotransferase level

T2 - A multicentre-based study in China

AU - Xing, Yu Feng

AU - Zhou, Da Qiao

AU - He, Jing Song

AU - Wei, Chun Shan

AU - Zhong, Wei Chao

AU - Han, Zhi Yi

AU - Peng, De Ti

AU - Shao, Mu Min

AU - Sham, Tung Ting

AU - Mok, Daniel Kam Wah

AU - Chan, Chi On

AU - Tong, Guang Dong

N1 - Funding Information: This study was supported by the National Science and Technology Major Project (2008ZX10005008; 2012ZX10005006 to GDT) and Guangdong Province Science and Technology Project (2017A020213016 to YFX) and Shenzhen Basic Research Program (JCYJ20160229173844278 to COC). The funders Publisher Copyright: © 2018 Xing et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2018/9

Y1 - 2018/9

N2 - Background The aim of this study is to reveal the clinical and histopathological features of HBsAg-positive and HBeAg-positive chronic hepatitis B infected patients with high level of HBV DNA, from 17 hospitals and medical centres in China, with alanine aminotransferase levels within the lower region of normal range versus those with levels within the upper region of normal range and to investigate the clinical risk factors for the requirement of treatment through the examination of liver biopsy. Methods Liver biopsy was performed on high level of HBV DNA of 455 patients with HBsAg-positive and HBeAg-positive chronic hepatitis B infection and persistently normal alanine aminotransferase level. Liver necroinflammation and fibrosis were graded per the Knodell histological activity index and Ishak’s fibrosis score, respectively. Univariate analysis of the clinical parameters versus necroinflammation and fibrosis was carried out. Results Of the subjects in this multicentre-based study, 5.49% and 10.11% had significant necroinflammation with Knodell histological activity index 9 and hepatic fibrosis stages with Ishak scores 3, respectively. The subjects were stratified into three age groups (30–39, 40–49 and 50 years), and our data clearly suggested that age, particularly in the age group over 50, was an independent predictor of liver necroinflammation and fibrosis. Lower HBV-DNA viral levels were found in patients with Knodell histological activity index 9 or advanced fibrosis (Ishak scores 3). Conclusion Our results showed that histological changes in liver tissues were observed in a significant proportion of patients with persistently normal alanine aminotransferase level. According to the data evaluation results, liver biopsy is advisable for HBeAg-positive chronic hepatitis B infected patients aged older than 40 and high HBV-DNA viral load in China.

AB - Background The aim of this study is to reveal the clinical and histopathological features of HBsAg-positive and HBeAg-positive chronic hepatitis B infected patients with high level of HBV DNA, from 17 hospitals and medical centres in China, with alanine aminotransferase levels within the lower region of normal range versus those with levels within the upper region of normal range and to investigate the clinical risk factors for the requirement of treatment through the examination of liver biopsy. Methods Liver biopsy was performed on high level of HBV DNA of 455 patients with HBsAg-positive and HBeAg-positive chronic hepatitis B infection and persistently normal alanine aminotransferase level. Liver necroinflammation and fibrosis were graded per the Knodell histological activity index and Ishak’s fibrosis score, respectively. Univariate analysis of the clinical parameters versus necroinflammation and fibrosis was carried out. Results Of the subjects in this multicentre-based study, 5.49% and 10.11% had significant necroinflammation with Knodell histological activity index 9 and hepatic fibrosis stages with Ishak scores 3, respectively. The subjects were stratified into three age groups (30–39, 40–49 and 50 years), and our data clearly suggested that age, particularly in the age group over 50, was an independent predictor of liver necroinflammation and fibrosis. Lower HBV-DNA viral levels were found in patients with Knodell histological activity index 9 or advanced fibrosis (Ishak scores 3). Conclusion Our results showed that histological changes in liver tissues were observed in a significant proportion of patients with persistently normal alanine aminotransferase level. According to the data evaluation results, liver biopsy is advisable for HBeAg-positive chronic hepatitis B infected patients aged older than 40 and high HBV-DNA viral load in China.

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U2 - 10.1371/journal.pone.0203220

DO - 10.1371/journal.pone.0203220

M3 - Journal article

C2 - 30180183

AN - SCOPUS:85053035538

SN - 1932-6203

VL - 13

JO - PLoS ONE

JF - PLoS ONE

IS - 9

M1 - e0203220

ER -

Clinical and histopathological features of chronic hepatitis B virus infected patients with high HBV-DNA viral load and normal alanine aminotransferase level: A multicentre-based study in China

Abstract

ASJC Scopus subject areas

UN SDGs

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