1770. Analysis of liver histological findings of HBeAg negative chronic hepatitis B patients with high viral replication and normal ALT levels
Session: Poster Abstract Session: Viral Infections; Pathogenesis and Epidemiology
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
ID-Week-Dr.Rahmet-Guner.pdf (308.9 kB)
Background: To investigate liver damage and correlation between serum HBV DNA and quantitative HBsAg in HBeAg negative chronic Hepatitis B patients whose serum ALT levels are persistantly normal and HBV DNA levels are higher than 10.000 copies/mL.
Methods: The patients who are HBsAg positive, HBeAg negative, older than 35 years old and whose HBV DNA levels are higher than 104 copies/mL while ALT level is normal at least one year before liver biopsy were included in the study. Liver needle biopsy was performed at all of the patients. Liver histopathologic findings were assessed by same pathologist according to the Ishak scoring system. Furhermore, HBV DNA and quantitative HBsAg were investigated from the patient's blood sample that are taken in the day of the liver biopsy. Chronic hepatitis B treatment indication was confirmed if necroinflamation score was >7 or fibrosis score was ≥2 according to the Ishak scoring system. SPSS 16.0 version was used for analysis of data.
Results: Thirty patients were included in this study. Male and female patients were distrubuted equally. Mean age was 47,2 years (35-73 years). Moderate or over inflamation were detected in 6,7% of the patients. As seen in table 1, 30% of the patients' fibrosis score was ≥2 and these patients were decided to be treated and treatment was started for these patients (Table 1). Necroinflamation and fibrosis score were different between the groups with low-normal and high-normal ALT. There was a good association between HBsAg and HBV DNA levels and between fibrosis score and HBV DNA levels.
Conclusion: HBV infections have a different course in HBeAg negative patients. Liver biopsy should be done irrespective from serum ALT levels to the patients who are older than 35 years old in this group. HBsAg quantitation is a good marker as an alternative to HBV DNA in staging of chronic HBV infection.
Table 1: Results of liver biopsies.
Number (%)
Histologic Activity Index (Ishak Scoring System)
Mild (0-6) 28 (93,3)
Moderate (7-9) 2 (6,7)
Severe (>9) 0
Fibrosis Score
0-1 21 (70)
2-6 9 (30)
Siran Keske, MD1, Rahmet Guner, Prof. Dr.2, Mehmet A. Tasyaran, Prof. Dr.2, Gul Ruhsar Yilmaz, Ass. Prof.3 and Serdar Balci, MD4, (1)Infectious Diseases and Clinical Microbiology, Polatli Duatepe State Hospital, Ankara, Turkey, (2)Infectious Diseases and Clinical Microbiology, Yildirim Beyazit University, Faculty of Medicine, Ankara, Turkey, (3)Infectious Diseases and Clinical Microbiology, Ataturk Education and Research Hospital, Ankara, Turkey, (4)Pathology, Yildirim Beyazit University, Faculty of Medicine, Ankara, Turkey
结论：乙肝病毒感染在HBeAg阴性患者中有一条不同的路线。应做肝活检，不论谁是年龄超过35岁，在这组患者血清ALT水平。乙肝表面抗原定量是一个很好的标志物作为替代分期慢性HBV感染HBV DNA 。
表1：肝活检的结果。
数目（％）
组织学活动指数（伊沙克评分系统）
温和的 (0-6 ） 28 （ 93,3 ）
中度（7-9） 2 （6,7 ）
重度（ > 9 ） 0
纤维化评分
0-1 21 （70 ）
2-6 9 （30 ）作者: 咬牙硬挺 时间: 2013-10-7 10:54
感谢分享作者: jinpaimanman 时间: 2013-12-30 21:35
意思是小三阳DNA>5次方，ALT正常的，70%纤维化S0~S2，30% S2~S4吗，，，最后那句看不明白：结论：乙肝病毒感染在HBeAg阴性患者中有一条不同的路线。应做肝活检，不论谁是年龄超过35岁，在这组患者血清ALT水平。乙肝表面抗原定量是一个很好的标志物作为替代分期慢性HBV感染HBV DNA 。
意思是小三阳DNA>5次方，ALT正常的，70%纤维化S0~S2，30% S2~S4吗，，，最后那句看不明白：结论：乙肝病毒感染在HBeAg阴性患者中有一条不同的路线。应做肝活检，不论谁是年龄超过35岁，在这组患者血清ALT水平。乙肝表面抗原定量是一个很好的标志物作为替代分期慢性HBV感染HBV DNA 。