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Clinical significance of blood biochemical liver function tests in asymptomatic chronic HBs Ag carriers
Insights
This study observed 31 chronic Hepatitis B carriers. Liver function tests often appeared normal despite significant liver damage, highlighting a disconnect between biochemical markers and histological findings in Hepatitis B virus infection.
Area of Science:
- Hepatology
- Virology
- Gastroenterology
Background:
- Chronic Hepatitis B virus (HBV) infection affects millions globally.
- Asymptomatic carriers often present with persistent Hepatitis B surface antigen (HBs Ag).
- Assessing liver damage in chronic HBV carriers requires careful evaluation of multiple parameters.
Purpose of the Study:
- To investigate the relationship between biochemical liver function tests and histological findings in asymptomatic chronic HBs Ag carriers.
- To explore the dissociation between blood biochemistry and liver morphology in chronic HBV infection.
Main Methods:
- Longitudinal study of 31 asymptomatic chronic HBs Ag carriers.
- Hepatitis B virus (HBV) infection assumed, with HBs Ag persistence for ≥6 months.
- Laparoscopy with liver biopsy performed 6-21 months post-infection.
- Blood biochemical liver function tests monitored every 4 weeks for 6 months to 5 years.
Main Results:
- 16 of 31 carriers showed consistently normal liver function tests.
- 15 of 31 carriers had transient, sometimes pathological, fluctuations in liver function tests.
- Histological examination revealed significant inflammatory processes, including chronic aggressive hepatitis and liver cirrhosis, in both groups.
- A notable dissociation was observed between normal or transiently abnormal blood biochemistries and severe histological liver damage.
Conclusions:
- Biochemical liver function tests may not accurately reflect the severity of liver damage in all asymptomatic chronic Hepatitis B carriers.
- The discrepancy between biochemical and morphological findings in chronic HBV infection warrants further investigation.
- Rethinking diagnostic approaches for chronic Hepatitis B is necessary, considering the limitations of standard liver function tests.
Abstract:
To date we have had 31 asymptomatic chronic HBs Ag carriers in whom the time of HBV infection can be assumed, HBs Ag in sera persisted for at least 6 months, laparoscopy with liver biopsy was performed within 6 to 21 months after the assumed HBV infection, and the clinical course after performance of laparoscopy with liver biopsy ranged from 6 months to 5 years has been observed, while with the lapse of time, blood biochemical liver function tests were examined once every 4 weeks. In 16 out of 31 cases, the results of blood biochemical liver function tests remained always in the normal range and in the remaining 15 cases, blood biochemistries fluctuated sometimes pathologically, but transiently. In the former group, the results of blood biochemical liver function tests showed no pathologic findings, although the histologic inflammatory processes were outstanding in cases of chronic aggressive hepatitis and liver cirrhosis. In the remaining 15 cases, blood biochemistries fluctuated transiently and slightly, although morphological findings corresponded to chronic aggressive hepatitis and liver cirrhosis. The dissociation between blood biochemistries and morphologic findings needs to be further clarified.