High-risk factors for significant liver histopathological damage in patients with indeterminate phase of chronic HBV infection

Wenchang WANG; Xuyang LI; Chunyan WANG; Mengwen HE; Yifan GUO; Yiming FU; Miao LIU; Dong JI

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High-risk factors for significant liver histopathological damage in patients with indeterminate phase of chronic HBV infection

VernacularTitle:不确定期慢性HBV感染者发生显著肝组织病理学损伤的危险因素分析
Author: Wenchang WANG ¹ ; Xuyang LI ² ; Chunyan WANG ³ ; Mengwen HE ² ; Yifan GUO ² ; Yiming FU ³ ; Miao LIU ¹ ; Dong JI ¹
Author Information

1. Chinese PLA Medical School， Beijing 100853， China
2. Peking University 302 Clinical Medical School， Beijing 100039， China
3. Senior Department of Hepatology， The Fifth Medical Center of Chinese PLA General Hospital， Beijing 100039， China
Publication Type:Journal Article
Keywords: Hepatitis B Virus; Inflammation; Hepatic Fibrosis; Indeterminate Phase
From: Journal of Clinical Hepatology 2025;41(11):2258-2264
CountryChina
Language:Chinese
Abstract: ObjectiveTo investigate the features of liver histopathological damage in patients with indeterminate phase of chronic HBV infection， as well as the timing for initiating antiviral therapy in such patients. MethodsA retrospective screening was performed for the patients with chronic HBV infection who were hospitalized in The Fifth Medical Center of Chinese PLA General Hospital and underwent liver biopsy from March 2018 to April 2022， among whom the patients who met the criteria for indeterminate phase defined in Chinese guidelines for chronic hepatitis B prevention and treatment （2022 edition） were enrolled， and their clinical data were collected. Liver histopathological stage was determined using the Scheuer scoring system， with stages 0 — 4 for inflammation grade （G） and stages 0 — 4 for fibrosis degree （S）， and the patients were divided into groups based on the presence of significant necroinflammation （≥G2） and significant liver fibrosis （≥S2）. The independent samples t-test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. A Spearman’s rank correlation analysis was used to investigate the correlation between liver histopathology and clinical factors， and the Logistic regression model was used to identify the independent influencing factors for significant necroinflammation and liver fibrosis. ResultsA total of 271 patients with indeterminate phase of chronic HBV infection were enrolled， among whom 61 （22.5%） had significant necroinflammation （≥G2） and 124 （45.8%） had significant liver fibrosis （≥S2）. The Logistic regression analysis showed that alanine aminotransferase ≥30 U/L （for male patients） or ≥19 U/L （for female patients）（odds ratio ［OR］=2.69， 95% confidence interval ［CI］： 1.39 — 5.21， P=0.003）， HBV DNA ≥2 000 IU/mL （OR=2.75， 95%CI： 1.38 — 5.48， P=0.004）， and liver stiffness measurement （LSM） ≥6.0 kPa （OR=4.57， 95%CI： 2.17 — 9.62， P<0.001） were independent risk factors for significant inflammation. HBV DNA ≥2 000 IU/mL （OR=1.82， 95%CI： 1.01 — 3.32， P=0.049） and LSM ≥6.0 kPa （OR=2.06， 95%CI： 1.23 — 3.43， P=0.006） were independent influencing factors for significant liver fibrosis. ConclusionAmong the patients with indeterminate phase of chronic HBV infection， a substantial proportion of patients have significant liver histopathological damage. Antiviral therapy should be initiated in a timely manner for patients with high-risk factors.