Are alanine aminotransferase, hepatitis B virus DNA or IgM antibody to hepatitis B core antigen serum levels predictors of histological grading in chronic hepatitis B?

: Paired sera and liver biopsies from 105 patients with chronic hepatitis B virus infection (34 HBeAg positive and 71 anti‐HBe positive) were studied to investigate the relation between the degree of histological activity and alanine aminotransferase (ALT), hepatitis B virus DNA (HBV‐DNA) or IgM antibody to hepatitis B core antigen (IgM anti‐HBc) levels. ALT levels were significantly higher in patients with piecemeal necrosis (155±124 vs 75±42, p=0.0017), but there were no differences in the ALT values of patients with or without intralobular necrosis. ALT values were within normal range in 29% of 31 patients without versus 15% of 65 with piecemeal necrosis (p=0.19). Serum HBV‐DNA levels were not related to the grade of lobular or portal/periportal activity in HBeAg‐positive patients. Anti‐HBe‐positive subjects with piecemeal necrosis had higher HBV‐DNA levels (34±93 vs 4±6, p=0.01). IgM anti‐HBc indexes were significantly higher in patients with intralobular necrosis (0.635±0.600 vs 0.356±0.367, p=0.0005) or piecemeal necrosis (0.671 ±0.633 vs 0.321 ±0.219, p=0.0002). In summary, since serum IgM anti‐HBc‐IMx indexes can reflect the grade of histological activity, the quantitative assessement of this antibody could be useful for non‐invasive monitoring of hepatocellular damage in chronic hepatitis B.