Serum liver fibrosis markers discriminate significant liver inflammation in chronic hepatitis B patients with normal or near‐normal alanine aminotransferase

Abstract

Chronic liver inflammation caused by chronic hepatitis B virus (CHB) infection leads to liver cirrhosis and hepatocellular carcinoma. Recently, the role of alanine aminotransferase (ALT) as a predictor of liver inflammation has been questioned. The aim of this study was to investigate the utility of noninvasive fibrosis markers including hyaluronic acid (HA), collagen type IV (CIV), N‐terminal propeptide of type III procollagen (PIIINP), and laminin (LN) in identifying significant liver inflammation in patients with CHB, especially in patients with normal or near‐normal ALT. A total of 242 CHB patients who underwent liver biopsy were enrolled. The serum levels of ALT, aspartate aminotransferase, HA, CIV, PIIINP, and LN were quantified and the relationship between histological staging and serum markers was systematically analyzed. Serum CIV, PIIINP, HA, and LN levels increased significantly along with the increasing severity of liver inflammation. Multivariate analysis showed that CIV and LN were independently associated with significant inflammation. CIV, PIIINP, HA, and LN levels were found to have high diagnostic values for predicting significant inflammation in patients with CHB (area under the curve, AUC = 0.807, 0.795, 0.767, and 0.703, respectively). The combined index for the identification of significant inflammation, including CIV, PIIINP, HA, and LN levels, significantly improved diagnostic performance (AUC = 0.851). Moreover, the combined index also achieved excellent diagnostic accuracy (AUC = 0.861) in patients with CHB with normal or near‐normal ALT. In conclusion, the combined index may be a strong indicator for discriminating significant liver inflammation, especially in patients with CHB with normal or near‐normal ALT.

Glaucocalyxin A attenuates carbon tetrachloride‐induced liver fibrosis and improves the associated gut microbiota imbalance

“…The level of HA, LN, IV‐C and PIIINP is usually increased in patients with hepatic fibrosis. Serum HA, LN, IV‐C and PIIINP levels significantly increased along with the escalating severity of liver inflammation (Liao et al, 2019). The results of the study showed that levels of HA, LN, Col‐IV and PIIINP in the model group increased significantly, compared to the control group.…”

Serum qAnti‐HBc combined with ALT and HBsAg predicts significant hepatic inflammation in HBeAg‐positive immune active patients

“…Anti‐HBc has been known as a biomarker to indicate antiviral treatment response 16 . Recently, some studies found that qAnti‐HBc levels were positively correlated with hepatic inflammation and fibrosis in treatment naïve CHB patients 18,19,23,24 . However, there is a lack of evidence of the correlation of qAnti‐HBc with liver inflammation before and after antiviral treatment in HBeAg‐positive immune active patients.…”

Sickle cell hepatopathy: An underrecognized and undertreated cause of chronic liver disease

“…Additionally, although abnormal liver biochemistries are common in SCD, there is little guidance on further diagnostic workup in asymptomatic patients. There is consistent evidence in the literature that in asymptomatic cohorts with CLD resulting from varying etiologies (viral hepatitis, cystic fibrosis, and NAFLD), normal/near normal liver biochemistries can occur in the setting histopathological and sonographic findings consistent with fibrosis 17–19 . Noninvasive techniques including serum biomarkers and advanced imaging have emerged as promising alternatives in assessing for hepatic fibrosis across a spectrum of diffuse liver disorders.…”

“…There is consistent evidence in the literature that in asymptomatic cohorts with CLD resulting from varying etiologies (viral hepatitis, cystic fibrosis, and NAFLD), normal/near normal liver biochemistries can occur in the setting histopathological and sonographic findings consistent with fibrosis. [17][18][19] Noninvasive techniques including serum biomarkers and advanced imaging have emerged as promising alternatives in assessing for hepatic fibrosis across a spectrum of diffuse liver disorders. Models combining noninvasive biochemical, serological, and elastographic tests can provide complementary information on underlying hepatic dysfunction and improve the diagnostic accuracy in predicting progressive fibrosis (Table 1); these can, in turn, provide guidance on workup for SCH (Figure 1).…”