Liver function tests (LFTs) are widely used to assess hepatic health and integrity. Variations in enzyme levels may reflect prior hepatitis B virus (HBV) exposure or immunity status. This study aimed to compare serum levels of liver enzymes among participants of the Azar cohort according to HBV serological profiles.

This cross-sectional study included 4,949 individuals aged 35–70 years from the Azar cohort. Participants were classified into five groups based on HBsAg, HBsAb, and HBcAb markers: vaccinated, chronic hepatitis B, spontaneously recovered, anti-HBc positive, and seronegative. Mean serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) were compared using one-way ANOVA.

The vaccinated group showed significantly lower AST levels than the spontaneously recovered and anti-HBc positive groups (P = 0.003 and P < 0.001). Both the spontaneously recovered and anti-HBc positive groups had higher AST levels compared with the seronegative group (P = 0.003 and P < 0.001). ALT levels were significantly higher in the vaccinated group compared with the anti-HBc positive group (P = 0.004), while the anti-HBc positive group had lower ALT levels than the seronegative group (P < 0.001). For ALP, participants with chronic hepatitis B had significantly higher values than those in the spontaneously recovered (P = 0.03) and seronegative (P = 0.04) groups. These patterns are summarized in Figure 1.

Distinct differences in liver enzyme patterns were observed across HBV serological groups. The AST/ALT ratio was lower in vaccinated individuals than in the spontaneously recovered and anti-HBc positive groups, while higher ratios were found in the latter compared with seronegative participants. These findings highlight the influence of HBV infection and immune status on liver enzyme profiles at the population level.