Risk factors and antiviral treatment indications for chronic hepatitis B based on liver pathology
Objective To analyze the risk factors for liver inflammation and fibrosis progression in patients with chronic hepatitis B(CHB),and to provide the basis for initiating antiviral treatment for patients with CHB aged<30 years.Methods A total of 285 patients with CHB who were admitted to Shulan(Hangzhou)Hospital Affiliated to Shulan International Medical College of Zhejiang Shuren University and did not receive antiviral therapy were collected from February 2017 to October 2021.Liver biopsy pathology,hematological indexes and clinical information were recorded.According to the degree of inflammation(G)and fibrosis staging(S),the patients with G ≤1 and S ≤1 were divided into group A(123 cases),and those with G>1 and(or)S>1 were divided into group B(162 cases).The hematological indexes and clinical information of the two groups were compared.The risk factors for inflammation and fibrosis progression in patients with CHB were analyzed by binary logistic regression,and the diagnostic efficacy of related risk factors on liver GS stage of patients with CHB was evaluated by ROC curve.Results The sensitivity of the diagnosis of hepatic GS progression was significantly increased after lowering the ALT threshold,while the specificity was decreased.There were significant differences between the two groups in age,WBC,PLT,albumin,ALT,AST,ALP,γ-glutamyl transpeptidase(γ-GT),DBil,PT,international standardized ratio,hyaluronic acid(HA),type Ⅳ collagen(ⅣC),and the FIB-4 index based on ALT,AST,PLT and age(all P<0.05).Binary logistic regression analysis showed that albumin,DBil,HA and Ⅳ C were risk factors for liver GS progression in patients with CHB(all P<0.05);ROC curve showed that the AUCs of HA and ⅣC in diagnosing liver GS progression were 0.616 and 0.655,respectively,while the AUC of albumin and DBil showed no statistical significance in diagnosing liver GS progression.Conclusion Lowering ALT threshold can improve the sensitivity of diagnosis of liver GS progression.Regularly monitoring liver function,liver fibrosis index,coagulation function and other hematological indicators of patients with CHB younger than 30 years old can effectively evaluate the progression of liver GS,which is helpful to timely start antiviral treatment.
Chronic hepatitis BLiver biopsyLiver PathologyRisk factorIndication