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Author Spotlight: Advancements and Challenges in Hepatitis B Virus Detection
Published on: December 15, 2023
Clinical Distribution Characteristics and Identification for Significant Liver Inflammation of Patients in Chronic
Shanshan Chen1, Xuan Dai2, Yueyue Zhao2
1Emergency and Critical Care Center, Department of Emergency Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Zhejiang, Hangzhou 310014, China.
Insights
A significant portion of chronic hepatitis B patients fall into an indeterminate phase. These patients frequently experience severe liver inflammation, with key biomarkers indicating prognosis.
Area of Science:
- Hepatology
- Virology
- Clinical Medicine
Background:
- Chronic hepatitis B (CHB) is a global health concern.
- A subset of CHB patients present with an "indeterminate phase" lacking clear immune status classification.
- Understanding this phase is crucial for accurate diagnosis and management.
Purpose of the Study:
- To investigate the clinical distribution of CHB patients in the indeterminate phase.
- To identify characteristics associated with significant liver inflammation in this patient group.
Main Methods:
- Retrospective analysis of clinical data from 1226 CHB patients across two medical centers.
- Classification of CHB phases according to AASLD 2018 guidelines.
- Evaluation of liver inflammation using the Scheuer scoring system (G ≥ 2 defined as significant inflammation).
Main Results:
- Approximately 36.0% of CHB patients were categorized into the indeterminate phase.
- Significant liver inflammation was prevalent in 54.1% of patients within the indeterminate phase.
- Prothrombin time (PT), platelet count (PLT), alanine aminotransferase (ALT), and HBV-DNA levels were associated with significant inflammation.
Conclusions:
- The indeterminate phase represents a substantial proportion of CHB patients.
- Liver inflammation severity in the indeterminate phase correlates with fibrosis stage.
- Biomarkers like PT, PLT, ALT, and HBV-DNA may predict severe inflammation and prognosis in CHB.
Aim:
In clinical practice, a considerable proportion of patients with chronic hepatitis B (CHB) who do not conform to any immune status are considered to be in the "indeterminate phase". In this study, we aim to study the clinical distribution characteristics and identification of significant liver inflammation in patients in indeterminate phase.
Methods:
This study retrospectively analyze clinical data of 1226 patients with CHB at two medical centers in Zhejiang province. According to American Association for the Study of Liver Diseases (AASLD) 2018 hepatitis B guidance, CHB can be divided into four phases: immune-tolerant phase, HBeAg-positive immune active phase, inactive phase, and HBeAg-negative immune active phase. Liver inflammation grade was evaluated using the Scheuer scoring system, and significant liver inflammation was defined as G ≥ 2.
Results:
The distribution of different immune status was as follows: 259 (21.1%) patients in immune-tolerant phase, 365 (29.8%) patients in HBeAg-positive immune active phase, 128 (10.4%) patients in inactive phase, and 33 (2.7%) patients in HBeAg-negative immune active phase. However, 441 (36.0%) patients did not meet any of the above immune phases, which were defined as indeterminate phase. Significant liver inflammation (54.1%) was common in CHB patients with indeterminate phase. Prothrombin time (PT), platelet count (PLT), alanine aminotransferase (ALT), and hepatitis B virus (HBV)-DNA were associated with significant inflammation.
Conclusions:
The results of this study showed that about 36.0% of patients were divided into indeterminate phase. The proportion of patients with significant inflammation in indeterminate phase and liver inflammation becomes more severe with aggravation of fibrosis stage. PT, PLT, ALT, and HBV-DNA may have a significant correlation with severe inflammation and prognosis of CHB.
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