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KMID : 1103920080140010116
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Korean Journal of Hepatology
2008 Volume.14 No. 1 p.116 ~ p.121
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Normal range of serum ALT level in patients with chronic hepatitis
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Seo Yeon Seok
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Abstract
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The clinical significance of persistently normal ALT in chronic hepatitis B infection Lai M, Hyatt BJ, Nasser I, Curry M, Afdhal NH
Background : Chronic hepatitis B virus (HBV) disease is caused by both necroinflammation and active viral replication. The role of ALT levels as a predictor of liver injury has recently been questioned. The aim of the study was to determine whether normal ALT is associated with liver injury in a cohort of HBV patients undergoing liver biopsy.
Methods : This is a retrospective review of chronic HBV patients divided into 3 groups; (1) persistently normal ALT (PNALT); (2) ALT 1~1.5× ULN and (3) ALT > 1.5× ULN. Multiple clinical, biochemical, virological variables were evaluated.
Results : One hundred and ninety-two patients met the inclusion criteria, 59 with PNALT, 26 with ALT 1~1.5× ULN, and 107 with ALT > 1.5× ULN. Increasing age, higher ALT, higher grade of inflammation on biopsy, and HBeAg positivity predicted fibrosis. 18% of patients with PNALT had stage 2+ fibrosis and 34% had grade 2 or 3 inflammation. Overall 37% of patients with PNALT had significant fibrosis or inflammation. Subgroup analysis showed the majority with fibrosis belonged to the high normal ALT group and that only a minority who were young and immune tolerant had significant findings on biopsy.
Conclusion : There is significant fibrosis and inflammation in 37% of patients with PNALT and a liver biopsy should be considered in patients older than 40 with high normal ALT. [J Hepatol 2007;47:760-767
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KEYWORD
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Hepatitis B, Chronic, Necroinflammation, Fibrosis, Progression
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