{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T19:13:04Z","timestamp":1792696384278,"version":"4.5.0"},"reference-count":21,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,7,26]],"date-time":"2023-07-26T00:00:00Z","timestamp":1690329600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Viral Hepatitis"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Chronic HBV infection patients who do not conform to any of the usual immune states are regarded as \u2018grey zone\u2019 patients. We aimed to investigate the proportion of chronic HBV infection patients in the grey zone, and evaluate the clinical characteristics and liver pathological changes in grey zone patients. Clinical data of 1391 treatment\u2010naive chronic HBV infection patients with liver biopsy were collected. Natural history of HBV infection was determined based on European Association for the Study of the Liver (EASL) 2017, American Association for the Study of Liver Diseases (AASLD) 2018 and Chinese 2019 guidelines for the prevention and treatment of chronic HBV infection. Significant liver histological changes and associated risk factors of normal ALT grey zone patients were analysed. According to EASL, AASLD and Chinese criteria, there were 50.0%, 28% and 37.4% chronic HBV infection patients in the grey zone. Among the 353 grey zone patients with normal ALT, 72.4% had significant liver histological changes. ALT (optimal cut\u2010off value 25\u2009IU\/L) and HBV DNA (optimal cut\u2010off value 18,000\u2009IU\/mL) were independent risk factors of significant liver histological abnormalities. In conclusion, a substantial proportion of grey zone patients with normal ALT have significant liver histological changes that can be predicted by levels of serum ALT and HBV DNA. These results provide guidance of antiviral treatment in grey zone patients.<\/jats:p>","DOI":"10.1111\/jvh.13873","type":"journal-article","created":{"date-parts":[[2023,7,27]],"date-time":"2023-07-27T04:43:46Z","timestamp":1690433026000},"page":"803-809","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Clinical and histological features of patients with chronic hepatitis B virus infection in the grey zone"],"prefix":"10.1111","volume":"30","author":[{"given":"Qin Yi","family":"Gan","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases Ruijin Hospital, Shanghai Jiao Tong University School of Medicine  Shanghai China"},{"name":"Department of Gastroenterology The First Affiliated Hospital, Zhejiang University School of Medicine  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie Xiao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Ruijin Hospital, Shanghai Jiao Tong University School of Medicine  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Qian","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases The Affiliated Infectious Diseases Hospital of Soochow University  Suzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yin Ling","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases The Affiliated Infectious Diseases Hospital of Soochow University  Suzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Ruijin Hospital, Shanghai Jiao Tong University School of Medicine  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zheng Lan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Ruijin Hospital, Shanghai Jiao Tong University School of Medicine  Shanghai China"},{"name":"Department of Infectious Diseases Shanghai Pudong Hospital, Fudan University Pudong Medical Center  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shao Wen","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Ruijin Hospital, Shanghai Jiao Tong University School of Medicine  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen Xi","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Ruijin Hospital, Shanghai Jiao Tong University School of Medicine  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming Hao","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases 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