Frontiers in cellular and infection microbiology · 2026
Normal ALT masks occult liver injury in young chronic hepatitis B patients: a call for early treatment intervention.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Wang Pei-Pei, Wu Yi, Liu Ting, Zhang Ying, Yang Qing, Li Xiang-Yong
Аннотация
BACKGROUND: Guidelines provide limited guidance on antiviral therapy for CHB patients ≤30 years with normal ALT despite occult injury risks.
METHODS: This multicenter cross-sectional study included 423 treatment-naïve CHB patients aged ≤30 years with persistently normal ALT who underwent liver biopsy. Significant injury was defined as METAVIR necroinflammation ≥G2 and/or fibrosis ≥S2. A non-invasive model was developed and internally validated.
RESULTS: Significant necroinflammation and fibrosis were present in 48.0% and 48.5%, respectively. Independent predictors included anti-HBc, LSM, and AST. The Y-HAL model showed excellent discrimination (AUC: 0.918), outperforming 12 existing models. A three-tier pathway stratified patients into low-risk (monitoring), high-risk (antiviral therapy), and intermediate-risk (biopsy) categories.
CONCLUSIONS: A substantial proportion of young CHB patients with normal ALT have significant histological injury. The Y-HAL model and three-tier strategy offer an evidence-based framework for early intervention.
METHODS: This multicenter cross-sectional study included 423 treatment-naïve CHB patients aged ≤30 years with persistently normal ALT who underwent liver biopsy. Significant injury was defined as METAVIR necroinflammation ≥G2 and/or fibrosis ≥S2. A non-invasive model was developed and internally validated.
RESULTS: Significant necroinflammation and fibrosis were present in 48.0% and 48.5%, respectively. Independent predictors included anti-HBc, LSM, and AST. The Y-HAL model showed excellent discrimination (AUC: 0.918), outperforming 12 existing models. A three-tier pathway stratified patients into low-risk (monitoring), high-risk (antiviral therapy), and intermediate-risk (biopsy) categories.
CONCLUSIONS: A substantial proportion of young CHB patients with normal ALT have significant histological injury. The Y-HAL model and three-tier strategy offer an evidence-based framework for early intervention.