Summary
Histological severity is often mandatory for the management of
HBeAg-negative chronic HBV patients. We evaluated the performance of
transient elastography (TE) in this setting. We included 357 untreated
HBeAg-negative patients with ≥1 reliable liver stiffness measurement
(LSM-kPa) by TE: 182 inactive carriers with HBV-DNA < 2000 (n = 139) or
2000–19 999 IU/mL (n = 43) and 175 patients with chronic hepatitis B
(CHB). In carriers, HBV-DNA > 2000 and/or LSM > 6.5 were considered as
biopsy indications. LSMs did not differ between carriers with low and high
viremia, but were lower in carriers than in patients with CHB (5.8 ± 1.7
vs 9.0 ± 5.6, P < 0.001) offering moderate differentiation between these
two groups (AUROC: 0.705). LSMs did not change significantly in carriers
after 16 (12–24) months. In carriers with a liver biopsy, Ishak's staging
scores were similar between cased with low and high viremia but higher in
cases with LSM > 6.5 than ≤6.5 kPa. Moderate fibrosis (stages: 2–3) was
detected in 0/10 carriers with only HBV-DNA > 2000 IU/mL, 2/10 (20%)
carriers with only LSM > 6.5 and 5/10 (50%) carriers with both HBV-DNA >
2000 and LSM > 6.5 (P = 0.009). In patients with CHB, LSMs correlated
significantly with grading and staging scores and offered excellent
accuracy for ≥moderate, ≥severe fibrosis or cirrhosis (AUROC ≥
0.919–0.950). TE can be helpful for the noninvasive assessment of
HBeAg-negative chronic HBV patients. In conclusion, LSMs offer excellent
accuracy for fibrosis severity in HBeAg-negative patients with CHB and can
identify carriers with high risk of moderate fibrosis, which may be present
in up to 35% of carriers with LSM > 6.5 kPa and 50% of carriers with LSM >
6.5 kPa and HBV-DNA > 2000 IU/mL.
Journal of Viral Hepatitis
Early View (Online Version of Record published before inclusion in an
issue) 作者: StephenW 时间: 2013-10-11 19:18