High prevalence of significant liver fibrosis and cirrhosis in chronic hepatitis B patients with normal ALT in central Europe
Identifieur interne : 001679 ( Istex/Corpus ); précédent : 001678; suivant : 001680High prevalence of significant liver fibrosis and cirrhosis in chronic hepatitis B patients with normal ALT in central Europe
Auteurs : Thomas Göbel ; Andreas Erhardt ; Mathias Herwig ; Christopher Poremba ; Stephan Ernst Baldus ; Abdurrahman Sagir ; Ulrike Heinzel-Pleines ; Dieter H UssingerSource :
- Journal of Medical Virology [ 0146-6615 ] ; 2011-06.
English descriptors
- KwdEn :
Abstract
The indication for antiviral treatment of patients with chronic hepatitis B is based on serum HBV DNA levels, transaminases, and histological grade and stage. The relation of liver fibrosis and inflammation to ALT activity in chronic hepatitis B infection was investigated in a non‐endemic, European setting. A total of 253 patients with chronic hepatitis B who had undergone liver biopsy at the Clinic of Gastroenterology, Hepatology, and Infectious Diseases, Düsseldorf, Germany over the past 19 years (1990–2009) were evaluated. Thirty‐nine patients had persistently normal transaminases, 86 patients had ALT with 1–2 × ULN (upper limit of normal) and 128 patients had ALT >2 × ULN. Liver fibrosis or inflammation was defined as significant for stages or grades ≥ 2 according to the Desmet/Scheuer score. Significant liver fibrosis (F ≥ 2) was found in 36%, cirrhosis in 18%, and significant inflammation (G ≥ 2) in 27% of patients with normal transaminases. There was no difference in the stage of liver fibrosis and the frequency of cirrhosis between patients with normal and elevated transaminases. The most important factor associated with the presence of cirrhosis in multivariate analysis was age ≥40 years (P < 0.003). If concomitant factors like elevated GGT or male sex were furthermore present high prevalences of significant liver disease were found. The data indicate that, in a European setting, patients with chronic hepatitis B infection, and normal transaminases frequently have significant liver fibrosis or cirrhosis. Therefore, liver biopsy or liver stiffness measurement (LSM) should be performed in these patients to determine the stage of liver fibrosis. J. Med. Virol. 83:968–973, 2011. © 2011 Wiley‐Liss, Inc.
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DOI: 10.1002/jmv.22048
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ISTEX:AD3821449DD4205C1C44649D9A3CDCCCEDC7EC29Le document en format XML
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sortKey="Gobel, Thomas" sort="Gobel, Thomas" uniqKey="Gobel T" first="Thomas" last="Göbel">Thomas Göbel</name><affiliation><mods:affiliation>Clinic of Hepatology, Gastroenterology, and Infectious Diseases, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</mods:affiliation></affiliation></author><author><name sortKey="Erhardt, Andreas" sort="Erhardt, Andreas" uniqKey="Erhardt A" first="Andreas" last="Erhardt">Andreas Erhardt</name><affiliation><mods:affiliation>Clinic of Hepatology, Gastroenterology, and Infectious Diseases, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</mods:affiliation></affiliation><affiliation><mods:affiliation>Klinik für Gastroenterologie, Hepatologie und Infektiologie, Heinrich‐Heine‐Universität Düsseldorf, Moorenstr.5, D‐40225 Düsseldorf, Germany.===</mods:affiliation></affiliation></author><author><name sortKey="Herwig, Mathias" sort="Herwig, Mathias" uniqKey="Herwig M" first="Mathias" last="Herwig">Mathias Herwig</name><affiliation><mods:affiliation>Clinic of Hepatology, Gastroenterology, and Infectious Diseases, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</mods:affiliation></affiliation></author><author><name sortKey="Poremba, Christopher" sort="Poremba, Christopher" uniqKey="Poremba C" first="Christopher" last="Poremba">Christopher Poremba</name><affiliation><mods:affiliation>Institute of Pathology, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</mods:affiliation></affiliation><affiliation><mods:affiliation>Research Park Trier, Center of Histopathology, Cytology, and Molecular Diagnostics, Trier, Germany</mods:affiliation></affiliation></author><author><name sortKey="Baldus, Stephan Ernst" sort="Baldus, Stephan Ernst" uniqKey="Baldus S" first="Stephan Ernst" last="Baldus">Stephan Ernst Baldus</name><affiliation><mods:affiliation>Institute of Pathology, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</mods:affiliation></affiliation></author><author><name sortKey="Sagir, Abdurrahman" sort="Sagir, Abdurrahman" uniqKey="Sagir A" first="Abdurrahman" last="Sagir">Abdurrahman Sagir</name><affiliation><mods:affiliation>Clinic of Hepatology, Gastroenterology, and Infectious Diseases, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</mods:affiliation></affiliation></author><author><name sortKey="Heinzel Leines, Ulrike" sort="Heinzel Leines, Ulrike" uniqKey="Heinzel Leines U" first="Ulrike" last="Heinzel-Pleines">Ulrike Heinzel-Pleines</name><affiliation><mods:affiliation>Clinic of Hepatology, Gastroenterology, and Infectious Diseases, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</mods:affiliation></affiliation></author><author><name sortKey="H Ussinger, Dieter" sort="H Ussinger, Dieter" uniqKey="H Ussinger D" first="Dieter" last="H Ussinger">Dieter H Ussinger</name><affiliation><mods:affiliation>Clinic of Hepatology, Gastroenterology, and Infectious Diseases, 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Virol.</title><idno type="ISSN">0146-6615</idno><idno type="eISSN">1096-9071</idno><imprint><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><date type="published" when="2011-06">2011-06</date><biblScope unit="volume">83</biblScope><biblScope unit="issue">6</biblScope><biblScope unit="page" from="968">968</biblScope><biblScope unit="page" to="973">973</biblScope></imprint><idno type="ISSN">0146-6615</idno></series><idno type="istex">AD3821449DD4205C1C44649D9A3CDCCCEDC7EC29</idno><idno type="DOI">10.1002/jmv.22048</idno><idno type="ArticleID">JMV22048</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0146-6615</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>HBV</term><term>cirrhosis</term><term>hepatitis</term><term>liver fibrosis</term><term>normal ALT</term><term>normal transaminases</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">The indication for antiviral treatment of patients with chronic hepatitis B is based on serum HBV DNA levels, transaminases, and histological grade and stage. The relation of liver fibrosis and inflammation to ALT activity in chronic hepatitis B infection was investigated in a non‐endemic, European setting. A total of 253 patients with chronic hepatitis B who had undergone liver biopsy at the Clinic of Gastroenterology, Hepatology, and Infectious Diseases, Düsseldorf, Germany over the past 19 years (1990–2009) were evaluated. Thirty‐nine patients had persistently normal transaminases, 86 patients had ALT with 1–2 × ULN (upper limit of normal) and 128 patients had ALT >2 × ULN. Liver fibrosis or inflammation was defined as significant for stages or grades ≥ 2 according to the Desmet/Scheuer score. Significant liver fibrosis (F ≥ 2) was found in 36%, cirrhosis in 18%, and significant inflammation (G ≥ 2) in 27% of patients with normal transaminases. There was no difference in the stage of liver fibrosis and the frequency of cirrhosis between patients with normal and elevated transaminases. The most important factor associated with the presence of cirrhosis in multivariate analysis was age ≥40 years (P < 0.003). If concomitant factors like elevated GGT or male sex were furthermore present high prevalences of significant liver disease were found. The data indicate that, in a European setting, patients with chronic hepatitis B infection, and normal transaminases frequently have significant liver fibrosis or cirrhosis. Therefore, liver biopsy or liver stiffness measurement (LSM) should be performed in these patients to determine the stage of liver fibrosis. J. Med. Virol. 83:968–973, 2011. © 2011 Wiley‐Liss, Inc.</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>Thomas Göbel</name><affiliations><json:string>Clinic of Hepatology, Gastroenterology, and Infectious Diseases, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</json:string></affiliations></json:item><json:item><name>Andreas Erhardt</name><affiliations><json:string>Clinic of Hepatology, Gastroenterology, and Infectious Diseases, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</json:string><json:string>Klinik für Gastroenterologie, Hepatologie und Infektiologie, Heinrich‐Heine‐Universität Düsseldorf, Moorenstr.5, D‐40225 Düsseldorf, Germany.===</json:string></affiliations></json:item><json:item><name>Mathias Herwig</name><affiliations><json:string>Clinic of Hepatology, Gastroenterology, and Infectious Diseases, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</json:string></affiliations></json:item><json:item><name>Christopher Poremba</name><affiliations><json:string>Institute of Pathology, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</json:string><json:string>Research Park Trier, Center of Histopathology, Cytology, and Molecular Diagnostics, Trier, Germany</json:string></affiliations></json:item><json:item><name>Stephan Ernst Baldus</name><affiliations><json:string>Institute of Pathology, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</json:string></affiliations></json:item><json:item><name>Abdurrahman Sagir</name><affiliations><json:string>Clinic of Hepatology, Gastroenterology, and Infectious Diseases, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</json:string></affiliations></json:item><json:item><name>Ulrike Heinzel‐Pleines</name><affiliations><json:string>Clinic of Hepatology, Gastroenterology, and Infectious Diseases, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</json:string></affiliations></json:item><json:item><name>Dieter Häussinger</name><affiliations><json:string>Clinic of Hepatology, Gastroenterology, and Infectious Diseases, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>hepatitis</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>HBV</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>liver fibrosis</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>cirrhosis</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>normal ALT</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>normal transaminases</value></json:item></subject><articleId><json:string>JMV22048</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>article</json:string></originalGenre><abstract>The indication for antiviral treatment of patients with chronic hepatitis B is based on serum HBV DNA levels, transaminases, and histological grade and stage. The relation of liver fibrosis and inflammation to ALT activity in chronic hepatitis B infection was investigated in a non‐endemic, European setting. A total of 253 patients with chronic hepatitis B who had undergone liver biopsy at the Clinic of Gastroenterology, Hepatology, and Infectious Diseases, Düsseldorf, Germany over the past 19 years (1990–2009) were evaluated. Thirty‐nine patients had persistently normal transaminases, 86 patients had ALT with 1–2 × ULN (upper limit of normal) and 128 patients had ALT >2 × ULN. Liver fibrosis or inflammation was defined as significant for stages or grades ≥ 2 according to the Desmet/Scheuer score. Significant liver fibrosis (F ≥ 2) was found in 36%, cirrhosis in 18%, and significant inflammation (G ≥ 2) in 27% of patients with normal transaminases. There was no difference in the stage of liver fibrosis and the frequency of cirrhosis between patients with normal and elevated transaminases. The most important factor associated with the presence of cirrhosis in multivariate analysis was age ≥40 years (P > 0.003). If concomitant factors like elevated GGT or male sex were furthermore present high prevalences of significant liver disease were found. The data indicate that, in a European setting, patients with chronic hepatitis B infection, and normal transaminases frequently have significant liver fibrosis or cirrhosis. Therefore, liver biopsy or liver stiffness measurement (LSM) should be performed in these patients to determine the stage of liver fibrosis. J. Med. Virol. 83:968–973, 2011. © 2011 Wiley‐Liss, Inc.</abstract><qualityIndicators><score>7.144</score><pdfVersion>1.3</pdfVersion><pdfPageSize>594 x 792 pts</pdfPageSize><refBibsNative>true</refBibsNative><abstractCharCount>1736</abstractCharCount><pdfWordCount>4144</pdfWordCount><pdfCharCount>26596</pdfCharCount><pdfPageCount>6</pdfPageCount><abstractWordCount>256</abstractWordCount></qualityIndicators><title>High prevalence of significant liver fibrosis and cirrhosis in chronic hepatitis B patients with normal ALT in central Europe</title><refBibs><json:item><author><json:item><name>S Bondini</name></json:item><json:item><name>J Kallman</name></json:item><json:item><name>A Wheeler</name></json:item><json:item><name>S Prakash</name></json:item><json:item><name>T Gramlich</name></json:item><json:item><name>DM Jondle</name></json:item><json:item><name>ZM 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research</json:string><json:string>virology</json:string></scienceMetrix></categories><publicationDate>2011</publicationDate><copyrightDate>2011</copyrightDate><doi><json:string>10.1002/jmv.22048</json:string></doi><id>AD3821449DD4205C1C44649D9A3CDCCCEDC7EC29</id><score>0.22137323</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/AD3821449DD4205C1C44649D9A3CDCCCEDC7EC29/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/AD3821449DD4205C1C44649D9A3CDCCCEDC7EC29/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/AD3821449DD4205C1C44649D9A3CDCCCEDC7EC29/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">High prevalence of significant liver fibrosis and cirrhosis in chronic hepatitis B patients with normal ALT in central Europe</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><availability><p>Copyright © 2011 Wiley‐Liss, Inc.</p></availability><date>2011</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">High prevalence of significant liver fibrosis and cirrhosis in chronic hepatitis B patients with normal ALT in central Europe</title><author xml:id="author-1"><persName><forename type="first">Thomas</forename><surname>Göbel</surname></persName><affiliation>Clinic of Hepatology, Gastroenterology, and Infectious Diseases, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</affiliation></author><author xml:id="author-2"><persName><forename type="first">Andreas</forename><surname>Erhardt</surname></persName><affiliation>Clinic of Hepatology, Gastroenterology, and Infectious Diseases, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</affiliation><affiliation>Klinik für Gastroenterologie, Hepatologie und Infektiologie, Heinrich‐Heine‐Universität Düsseldorf, Moorenstr.5, D‐40225 Düsseldorf, Germany.===</affiliation></author><author xml:id="author-3"><persName><forename type="first">Mathias</forename><surname>Herwig</surname></persName><affiliation>Clinic of Hepatology, Gastroenterology, and Infectious Diseases, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</affiliation></author><author xml:id="author-4"><persName><forename type="first">Christopher</forename><surname>Poremba</surname></persName><affiliation>Institute of Pathology, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</affiliation><affiliation>Research Park Trier, Center of Histopathology, Cytology, and Molecular Diagnostics, Trier, Germany</affiliation></author><author xml:id="author-5"><persName><forename type="first">Stephan Ernst</forename><surname>Baldus</surname></persName><affiliation>Institute of Pathology, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</affiliation></author><author xml:id="author-6"><persName><forename type="first">Abdurrahman</forename><surname>Sagir</surname></persName><affiliation>Clinic of Hepatology, Gastroenterology, and Infectious Diseases, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</affiliation></author><author xml:id="author-7"><persName><forename type="first">Ulrike</forename><surname>Heinzel‐Pleines</surname></persName><affiliation>Clinic of Hepatology, Gastroenterology, and Infectious Diseases, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</affiliation></author><author xml:id="author-8"><persName><forename type="first">Dieter</forename><surname>Häussinger</surname></persName><affiliation>Clinic of Hepatology, Gastroenterology, and Infectious Diseases, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</affiliation></author></analytic><monogr><title level="j">Journal of Medical Virology</title><title level="j" type="abbrev">J. Med. Virol.</title><idno type="pISSN">0146-6615</idno><idno type="eISSN">1096-9071</idno><idno type="DOI">10.1002/(ISSN)1096-9071</idno><imprint><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><date type="published" when="2011-06"></date><biblScope unit="volume">83</biblScope><biblScope unit="issue">6</biblScope><biblScope unit="page" from="968">968</biblScope><biblScope unit="page" to="973">973</biblScope></imprint></monogr><idno type="istex">AD3821449DD4205C1C44649D9A3CDCCCEDC7EC29</idno><idno type="DOI">10.1002/jmv.22048</idno><idno type="ArticleID">JMV22048</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2011</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>The indication for antiviral treatment of patients with chronic hepatitis B is based on serum HBV DNA levels, transaminases, and histological grade and stage. The relation of liver fibrosis and inflammation to ALT activity in chronic hepatitis B infection was investigated in a non‐endemic, European setting. A total of 253 patients with chronic hepatitis B who had undergone liver biopsy at the Clinic of Gastroenterology, Hepatology, and Infectious Diseases, Düsseldorf, Germany over the past 19 years (1990–2009) were evaluated. Thirty‐nine patients had persistently normal transaminases, 86 patients had ALT with 1–2 × ULN (upper limit of normal) and 128 patients had ALT >2 × ULN. Liver fibrosis or inflammation was defined as significant for stages or grades ≥ 2 according to the Desmet/Scheuer score. Significant liver fibrosis (F ≥ 2) was found in 36%, cirrhosis in 18%, and significant inflammation (G ≥ 2) in 27% of patients with normal transaminases. There was no difference in the stage of liver fibrosis and the frequency of cirrhosis between patients with normal and elevated transaminases. The most important factor associated with the presence of cirrhosis in multivariate analysis was age ≥40 years (P < 0.003). If concomitant factors like elevated GGT or male sex were furthermore present high prevalences of significant liver disease were found. The data indicate that, in a European setting, patients with chronic hepatitis B infection, and normal transaminases frequently have significant liver fibrosis or cirrhosis. Therefore, liver biopsy or liver stiffness measurement (LSM) should be performed in these patients to determine the stage of liver fibrosis. J. Med. Virol. 83:968–973, 2011. © 2011 Wiley‐Liss, Inc.</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>keywords</head><item><term>hepatitis</term></item><item><term>HBV</term></item><item><term>liver fibrosis</term></item><item><term>cirrhosis</term></item><item><term>normal ALT</term></item><item><term>normal transaminases</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>article-category</head><item><term>Research Article</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2010-12-16">Registration</change><change when="2011-06">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/AD3821449DD4205C1C44649D9A3CDCCCEDC7EC29/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Wiley Subscription Services, Inc., A Wiley Company</publisherName><publisherLoc>Hoboken</publisherLoc></publisherInfo><doi registered="yes">10.1002/(ISSN)1096-9071</doi><issn type="print">0146-6615</issn><issn type="electronic">1096-9071</issn><idGroup><id type="product" value="JMV"></id></idGroup><titleGroup><title type="main" xml:lang="en" sort="JOURNAL OF MEDICAL VIROLOGY">Journal of Medical Virology</title><title type="short">J. 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Virol.</title></titleGroup></publicationMeta><publicationMeta level="part" position="60"><doi origin="wiley" registered="yes">10.1002/jmv.v83.6</doi><numberingGroup><numbering type="journalVolume" number="83">83</numbering><numbering type="journalIssue">6</numbering></numberingGroup><coverDate startDate="2011-06">June 2011</coverDate></publicationMeta><publicationMeta level="unit" type="article" position="70" status="forIssue"><doi origin="wiley" registered="yes">10.1002/jmv.22048</doi><idGroup><id type="unit" value="JMV22048"></id></idGroup><countGroup><count type="pageTotal" number="6"></count></countGroup><titleGroup><title type="articleCategory">Research Article</title><title type="tocHeading1">Research Articles</title></titleGroup><copyright ownership="publisher">Copyright © 2011 Wiley‐Liss, Inc.</copyright><eventGroup><event type="manuscriptAccepted" date="2010-12-16"></event><event type="xmlConverted" agent="Converter:JWSART34_TO_WML3G version:2.5.2 mode:FullText source:FullText 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type="wordTotal" number="5418"></count></countGroup><titleGroup><title type="main" xml:lang="en">High prevalence of significant liver fibrosis and cirrhosis in chronic hepatitis B patients with normal ALT in central Europe</title><title type="short" xml:lang="en">Peristent Normal ALT in Chronic Hepatitis B</title></titleGroup><creators><creator xml:id="au1" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Thomas</givenNames><familyName>Göbel</familyName></personName></creator><creator xml:id="au2" creatorRole="author" affiliationRef="#af1" corresponding="yes"><personName><givenNames>Andreas</givenNames><familyName>Erhardt</familyName></personName><contactDetails><email normalForm="erhardt@uni-duesseldorf.de">erhardt@uni‐duesseldorf.de</email></contactDetails></creator><creator xml:id="au3" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Mathias</givenNames><familyName>Herwig</familyName></personName></creator><creator xml:id="au4" creatorRole="author" affiliationRef="#af2 #af3"><personName><givenNames>Christopher</givenNames><familyName>Poremba</familyName></personName></creator><creator xml:id="au5" creatorRole="author" affiliationRef="#af2"><personName><givenNames>Stephan Ernst</givenNames><familyName>Baldus</familyName></personName></creator><creator xml:id="au6" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Abdurrahman</givenNames><familyName>Sagir</familyName></personName></creator><creator xml:id="au7" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Ulrike</givenNames><familyName>Heinzel‐Pleines</familyName></personName></creator><creator xml:id="au8" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Dieter</givenNames><familyName>Häussinger</familyName></personName></creator></creators><affiliationGroup><affiliation xml:id="af1" countryCode="DE" type="organization"><unparsedAffiliation>Clinic of Hepatology, Gastroenterology, and Infectious Diseases, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</unparsedAffiliation></affiliation><affiliation xml:id="af2" countryCode="DE" type="organization"><unparsedAffiliation>Institute of Pathology, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</unparsedAffiliation></affiliation><affiliation xml:id="af3" countryCode="DE" type="organization"><unparsedAffiliation>Research Park Trier, Center of Histopathology, Cytology, and Molecular Diagnostics, Trier, Germany</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en" type="author"><keyword xml:id="kwd1">hepatitis</keyword><keyword xml:id="kwd2">HBV</keyword><keyword xml:id="kwd3">liver fibrosis</keyword><keyword xml:id="kwd4">cirrhosis</keyword><keyword xml:id="kwd5">normal ALT</keyword><keyword xml:id="kwd6">normal transaminases</keyword></keywordGroup><abstractGroup><abstract type="main" xml:lang="en"><title type="main">Abstract</title><p>The indication for antiviral treatment of patients with chronic hepatitis B is based on serum HBV DNA levels, transaminases, and histological grade and stage. The relation of liver fibrosis and inflammation to ALT activity in chronic hepatitis B infection was investigated in a non‐endemic, European setting. A total of 253 patients with chronic hepatitis B who had undergone liver biopsy at the Clinic of Gastroenterology, Hepatology, and Infectious Diseases, Düsseldorf, Germany over the past 19 years (1990–2009) were evaluated. Thirty‐nine patients had persistently normal transaminases, 86 patients had ALT with 1–2 × ULN (upper limit of normal) and 128 patients had ALT >2 × ULN. Liver fibrosis or inflammation was defined as significant for stages or grades ≥ 2 according to the Desmet/Scheuer score. Significant liver fibrosis (F ≥ 2) was found in 36%, cirrhosis in 18%, and significant inflammation (G ≥ 2) in 27% of patients with normal transaminases. There was no difference in the stage of liver fibrosis and the frequency of cirrhosis between patients with normal and elevated transaminases. The most important factor associated with the presence of cirrhosis in multivariate analysis was age ≥40 years (<i>P</i> < 0.003). If concomitant factors like elevated GGT or male sex were furthermore present high prevalences of significant liver disease were found. The data indicate that, in a European setting, patients with chronic hepatitis B infection, and normal transaminases frequently have significant liver fibrosis or cirrhosis. Therefore, liver biopsy or liver stiffness measurement (LSM) should be performed in these patients to determine the stage of liver fibrosis. J. Med. Virol. 83:968–973, 2011. © 2011 Wiley‐Liss, Inc.</p></abstract></abstractGroup></contentMeta></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>High prevalence of significant liver fibrosis and cirrhosis in chronic hepatitis B patients with normal ALT in central Europe</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Peristent Normal ALT in Chronic Hepatitis B</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>High prevalence of significant liver fibrosis and cirrhosis in chronic hepatitis B patients with normal ALT in central Europe</title></titleInfo><name type="personal"><namePart type="given">Thomas</namePart><namePart type="family">Göbel</namePart><affiliation>Clinic of Hepatology, Gastroenterology, and Infectious Diseases, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Andreas</namePart><namePart type="family">Erhardt</namePart><affiliation>Clinic of Hepatology, Gastroenterology, and Infectious Diseases, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</affiliation><affiliation>Klinik für Gastroenterologie, Hepatologie und Infektiologie, Heinrich‐Heine‐Universität Düsseldorf, Moorenstr.5, D‐40225 Düsseldorf, Germany.===</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Mathias</namePart><namePart type="family">Herwig</namePart><affiliation>Clinic of Hepatology, Gastroenterology, and Infectious Diseases, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Christopher</namePart><namePart type="family">Poremba</namePart><affiliation>Institute of Pathology, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</affiliation><affiliation>Research Park Trier, Center of Histopathology, Cytology, and Molecular Diagnostics, Trier, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Stephan Ernst</namePart><namePart type="family">Baldus</namePart><affiliation>Institute of Pathology, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Abdurrahman</namePart><namePart type="family">Sagir</namePart><affiliation>Clinic of Hepatology, Gastroenterology, and Infectious Diseases, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Ulrike</namePart><namePart type="family">Heinzel‐Pleines</namePart><affiliation>Clinic of Hepatology, Gastroenterology, and Infectious Diseases, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Dieter</namePart><namePart type="family">Häussinger</namePart><affiliation>Clinic of Hepatology, Gastroenterology, and Infectious Diseases, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article"></genre><originInfo><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><place><placeTerm type="text">Hoboken</placeTerm></place><dateIssued encoding="w3cdtf">2011-06</dateIssued><dateValid encoding="w3cdtf">2010-12-16</dateValid><copyrightDate encoding="w3cdtf">2011</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="tables">4</extent><extent unit="references">29</extent><extent unit="words">5418</extent></physicalDescription><abstract lang="en">The indication for antiviral treatment of patients with chronic hepatitis B is based on serum HBV DNA levels, transaminases, and histological grade and stage. The relation of liver fibrosis and inflammation to ALT activity in chronic hepatitis B infection was investigated in a non‐endemic, European setting. A total of 253 patients with chronic hepatitis B who had undergone liver biopsy at the Clinic of Gastroenterology, Hepatology, and Infectious Diseases, Düsseldorf, Germany over the past 19 years (1990–2009) were evaluated. Thirty‐nine patients had persistently normal transaminases, 86 patients had ALT with 1–2 × ULN (upper limit of normal) and 128 patients had ALT >2 × ULN. Liver fibrosis or inflammation was defined as significant for stages or grades ≥ 2 according to the Desmet/Scheuer score. Significant liver fibrosis (F ≥ 2) was found in 36%, cirrhosis in 18%, and significant inflammation (G ≥ 2) in 27% of patients with normal transaminases. There was no difference in the stage of liver fibrosis and the frequency of cirrhosis between patients with normal and elevated transaminases. The most important factor associated with the presence of cirrhosis in multivariate analysis was age ≥40 years (P < 0.003). If concomitant factors like elevated GGT or male sex were furthermore present high prevalences of significant liver disease were found. The data indicate that, in a European setting, patients with chronic hepatitis B infection, and normal transaminases frequently have significant liver fibrosis or cirrhosis. Therefore, liver biopsy or liver stiffness measurement (LSM) should be performed in these patients to determine the stage of liver fibrosis. J. Med. Virol. 83:968–973, 2011. © 2011 Wiley‐Liss, Inc.</abstract><subject lang="en"><genre>keywords</genre><topic>hepatitis</topic><topic>HBV</topic><topic>liver fibrosis</topic><topic>cirrhosis</topic><topic>normal ALT</topic><topic>normal transaminases</topic></subject><relatedItem type="host"><titleInfo><title>Journal of Medical Virology</title></titleInfo><titleInfo type="abbreviated"><title>J. Med. Virol.</title></titleInfo><genre type="journal">journal</genre><subject><genre>article-category</genre><topic>Research Article</topic></subject><identifier type="ISSN">0146-6615</identifier><identifier type="eISSN">1096-9071</identifier><identifier type="DOI">10.1002/(ISSN)1096-9071</identifier><identifier type="PublisherID">JMV</identifier><part><date>2011</date><detail type="volume"><caption>vol.</caption><number>83</number></detail><detail type="issue"><caption>no.</caption><number>6</number></detail><extent unit="pages"><start>968</start><end>973</end><total>6</total></extent></part></relatedItem><identifier type="istex">AD3821449DD4205C1C44649D9A3CDCCCEDC7EC29</identifier><identifier type="DOI">10.1002/jmv.22048</identifier><identifier type="ArticleID">JMV22048</identifier><accessCondition type="use and reproduction" contentType="copyright">Copyright © 2011 Wiley‐Liss, Inc.</accessCondition><recordInfo><recordContentSource>WILEY</recordContentSource><recordOrigin>Wiley Subscription Services, Inc., A Wiley Company</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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