ArticleAlimentary pharmacology & therapeutics2020
Very low probability of significant liver inflammation in chronic hepatitis B patients with low ALT levels in the absence of liver fibrosis.
Article in Alimentary pharmacology & therapeutics, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers.
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Who cites it
26 citing papers in PubMed, 35 citations in OpenAlex.
- A large cohort analysis of metabolic signatures underlying the liver-eye axis.Communications medicine · 2026Article
- Predictive tool for evident histological liver injury in chronic hepatitis B patients: Development and validation.World journal of hepatology · 2026Article
- Downregulated Expression of Serum Exosome-Derived miR-375-3p Alleviates Interface Hepatitis and Promotes Fibrosis Regression in Patients With Chronic Hepatitis B.Clinical and translational gastroenterology · 2025Article
- Patients with chronic hepatitis B exhibiting significant inflammation and fibrosis should pay particular attention to the status of hepatic steatosis during antiviral therapy.Virology journal · 2025Article
- [Comparison of the population covered by the 2024 version of the WHO's hepatitis B prevention and treatment guidelines and the Chinese antiviral treatment guidelines].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2024Article
- Liver inflammation activity in patients with autoimmune hepatitis with normal alanine aminotransferase and immunoglobulin G levels.Journal of translational autoimmunity · 2024Article
- Antiviral treatment standards for hepatitis B: An urgent need for expansion.World journal of gastroenterology · 2024Article
- Histological features of chronic hepatitis B patients with normal alanine aminotransferase according to different criteria.Hepatology communications · 2024Article
- High immunocompetence in chronic hepatitis patients with normal alanine transaminase levels and and negative hepatitis B e-antigen for the progression of liver fibrosis.Immunity, inflammation and disease · 2024Article
- Fatty liver is associated with significant liver inflammation and increases the burden of advanced fibrosis in chronic HBV infection.BMC infectious diseases · 2023Article
- Lowering the threshold of alanine aminotransferase for enhanced identification of significant hepatic injury in chronic hepatitis B patients.World journal of gastroenterology · 2023Article
- [Hepatic pathological characteristics and factors influencing alanine transaminase value below twice the upper limit of normal in patients with chronic hepatitis B].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2023Article
- M1 macrophages may be effective adjuvants for promoting Th‑17 differentiation in HBeAg positive hepatitis patients with ALT ≤2ULN.Molecular medicine reports · 2023Article
- Establishment and validation of a diagnostic nomogram for significant histopathologic changes of hepatic injury in HBV-infected patients.Annals of translational medicine · 2023Article
- The urgency to expand the antiviral indications of general chronic hepatitis B patients.Frontiers in medicine · 2023Review
- Levels of Antibodies to Hepatitis B Core Antigen Are Associated With Liver Inflammation and Response to Peginterferon in Patients With Chronic Hepatitis B.The Journal of infectious diseases · 2022Article
- Interleukin-2 promotes pegylated interferon alpha for hepatitis B surface antigen loss: A retrospective pragmatic clinical study at the Fourth Affiliated Hospital of Zhejiang University Medical College.Health science reports · 2022Article
- Definition and classification of acute-on-chronic liver diseases.World journal of clinical cases · 2022Review
- Presence of Liver Inflammation in Asian Patients With Chronic Hepatitis B With Normal ALT and Detectable HBV DNA in Absence of Liver Fibrosis.Hepatology communications · 2022Article
- [Expert opinion on expanding anti-HBV treatment for chronic hepatitis B].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2022Article
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Authors and funding
18 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundGuidelines recommend liver biopsy to rule out significant inflammatory activity in chronic hepatitis B (CHB) patients with elevated hepatitis B virus (HBV) DNA but without other indications for treatment.
aimTo study rates and determinants of clinically significant liver inflammation.
methodsWe selected patients with HBV DNA > 2000 IU/mL from the SONIC-B database. The presence of significant inflammation (METAVIR ≥ A2 or HAI ≥ 9) was assessed by liver biopsy and correlated with alanine aminotransferase (ALT) levels (according to AASLD upper limits of normal [ULN]) and stratified by the presence of significant liver fibrosis (Ishak ≥ 3 or METAVIR ≥ F2).
resultsThe cohort included 2991 patients; 1672 were HBeAg-positive. ALT was < ULN in 270 (9%), 1-2 times ULN in 852 (29%) and > 2 times ULN in 1869 (63%). Significant fibrosis was found in 1419 (47%) and significant inflammatory activity in 630 (21%). Significant inflammatory activity was found in 34% of patients with liver fibrosis, compared to 9.5% of those without (P < 0.001). Among patients without fibrosis, significant inflammatory activity was detected in 3.6% of those with normal ALT, 5.0% of those with ALT 1-2 times ULN and in 13% of those with ALT > 2 times ULN (P < 0.001). ALT < 2 times ULN had a negative predictive value of 95% for ruling out significant inflammatory activity among patients without liver fibrosis.
conclusionsAmong patients without significant fibrosis, an ALT level < 2 times ULN is associated with < 5% probability of significant inflammatory activity. If fibrosis can be ruled out using non-invasive methods, liver biopsy solely to assess inflammatory activity should be discouraged.
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