The timing of antiviral therapy for chronic hepatitis B (CHB) patients with normal alanine transaminase (ALT) or aged < 30 years is still undetermined. We aimed to elucidate the correlation between liver histology, age, and ALT level in CHB patients and analyze the histological characteristics of the liver among patients with persistently normal ALT or aged < 30 years. A retrospective analysis was conducted on 697 treatment-naive CHB patients. Liver biopsies were performed, and significant histological damage was defined as the grade of liver inflammation ≥ G2 and/or fibrosis ≥ S2 based on the Scheuer scoring system. The liver inflammation grades and fibrosis stages correlated positively with age, ALT, AST, GGT levels and negatively with the counts of PLT (all p < 0.050) in HBeAg-positive patients. Higher ALT levels and lower PLT counts were independently associated with significant liver inflammation and fibrosis in both HBeAg-positive and HBeAg-negative patients. Furthermore, among those with persistently normal ALT levels, the incidence of significant liver inflammation and fibrosis were 66.1% and 53.7% in HBeAg-positive groups, and 63.0% and 55.5% in HBeAg-negative groups. Moreover, there was no significant difference in the prevalence of significant liver damage between patients aged < 30 years and those aged ≥ 30 years, in both HBeAg-positive (≥ G2 or ≥ S2: 63.8% vs. 75.8%, p = 0.276) and HBeAg-negative (≥ G2 or ≥ S2: 65.9% vs. 72.5%, p = 0.504) groups, among patients with persistently normal ALT levels. A considerable proportion of CHB patients with persistently normal ALT, including those below the age of 30 years, exhibited significant histological damage. This highlights the importance of initiating early antiviral therapy for HBV-infected individuals, even in the absence of elevated ALT levels.

中文翻译：

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丙氨酸氨基转移酶持续正常或年龄 < 30 岁的慢性乙型肝炎患者可能表现出明显的组织学损伤

丙氨酸转氨酶 (ALT) 正常或年龄 < 30 岁的慢性乙型肝炎 (CHB) 患者的抗病毒治疗时机尚未确定。我们的目的是阐明慢性乙型肝炎患者肝脏组织学、年龄和 ALT 水平之间的相关性，并分析 ALT 持续正常或年龄 < 30 岁患者的肝脏组织学特征。对 697 名初治慢性乙型肝炎患者进行了回顾性分析。进行肝活检，根据 Scheuer 评分系统，显着的组织学损伤定义为肝脏炎症等级≥G2 和/或纤维化≥S2。 HBeAg 阳性患者的肝脏炎症等级和纤维化阶段与年龄、ALT、AST、GGT 水平呈正相关，与 PLT 计数呈负相关（均 p < 0.050）。在 HBeAg 阳性和 HBeAg 阴性患者中，较高的 ALT 水平和较低的 PLT 计数与显着的肝脏炎症和纤维化独立相关。此外，在ALT水平持续正常的人群中，HBeAg阳性组中显着肝脏炎症和纤维化的发生率分别为66.1%和53.7%，HBeAg阴性组中分别为63.0%和55.5%。此外，对于 HBeAg 阳性的患者，年龄 < 30 岁和年龄 ≥ 30 岁的患者的严重肝损伤发生率没有显着差异（≥ G2 或 ≥ S2：63.8% vs. 75.8%，p = 0.276） ALT 水平持续正常的患者中，HBeAg 阴性（≥ G2 或 ≥ S2：65.9% 与 72.5%，p = 0.504）组。相当一部分 ALT 持续正常的 CHB 患者，包括 30 岁以下的患者，表现出明显的组织学损伤。这凸显了即使在 ALT 水平没有升高的情况下，对 HBV 感染者开始早期抗病毒治疗的重要性。