Thai Journal of Gastroenterology

Article :
Histologic Activity Index in Chronic Hepatitis B Patients, Comparison Between Patients with Mild Elevation of Serum ALT and ALT Values Over 2 Times the Upper Limit of Normal

Author :
Kijkunasathian W, M.D.
Tankijvanich P, M.D.
Visetopas N, M.D.
SuwannaKul P, M.D.
Komolmit P, M.D.

Abstract :

Background: Several practice guidelines have been proposed to assist physicians in management of chronic hepatitis B patients. Most of them recommend that liver biopsy and treatment should be performed in
patients with ALT levels >2x ULN.  However, such management in patients with ALT levels of 1-2x ULN is still
controversial.

Objective: To compare the liver histology in term of the degree of necroinflammation and fibrosis in the patients with elevated ALT levels of 1-2x ULN and levels >2x ULN according to the Knodell histologic activity index and to determine whether there were any predictors of  hepatic necroinflammatory activity and fibrosis.

Patients and Methods: Liver biochemistry and liver histology of chronic hepatits B patients were
assessed to characterize the histologic features of the chronic hepatitis B patients with elevated ALT levels of 1-2x ULN and levels >2x ULN according to the Knodell histologic activity index.
Results: Of 104 patients, 35 patients had ALT levels of 1-2x ULN (mean ALT 1.5x ULN). 69 patients
had ALT levels >2x ULN (mean ALT 4.4x ULN).  Mean necroinflammatory scores and fibrotic scores in the first
group were 4.26 (+/- 2.17) and 1.71 (+/- 1.38), respectively and the latter group were 4.58 (+/- 2.26) and 1.51 (+/- 1.16), respectively.  Fourteen patients (40.0%) in the first group had necroinflammatory scores >3 and 13 patients (38.2%) in the first group had fibrotic scores ?3. There were no statistically significant associations among age, sex and all biochemical parameters predictive of necroinflammatory activity.  Alpha-fetoprotein levels was only independent predictor of moderate to severe fibrosis (odd ratio 1.18, 95%CI 1.04-1.34, p = 0.013).

Conclusion: There was no difference in liver histology between patients with ALT levels of 1-2x ULN
and levels >2x ULN and there was no statistically significant associations among characteristic of patients and biochemistry to predict necroinflammatory activity.  Alpha-fetoprotein levels was only independent predictor of moderate to severe fibrosis.  ALT levels alone can not be used to predict necroinflammatory and fibrotic indices in chronic hepatitis B patients.

[Thai J Gastroenterol 2005; 6(1): 15-20]

Keyword :
chronic hepatitis B; histologic activity index scores

PDF Download :
file/Thai-Journal-of-gastroenterology-vol-6-no-1-3089301.pdf