Saudi Med J. 2019 Feb;40(2):131-139. doi: 10.15537/smj.2019.2.23934.
Are there optimal alanine aminotransferase and HBV DNA thresholds for discriminating HBeAg-positive chronic infection from chronic hepatitis? An evaluation of 215 young and male cases.
Yenilmez E1, Cetinkaya RA.
Author information
1
Department of Infectious Diseases and Clinical Microbiology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey. E-mail. [email protected].
Abstract
OBJECTIVES:
To define the importance of biochemical and virological thresholds for the prediction of significant liver diseases.
METHODS:
A total of 215 young and male HBeAg-positive cases followed up in a tertiary training and research hospital in Turkey between 2008 and 2017 enrolled in the retrospective diagnostic accuracy study. Results: Fibrosis scores varied between 0-4, F1 (n=81, 37.6%) and F2 (n=82, 38.1%) were the most frequent fibrosis stages. Of the patients, 58.6% (126/215) had a significant histopathological abnormality (SHA). The ratio of SHA was higher for ALT greater than 90 U/L (n=68/95; 71.6%) and HBV-DNA between 2,000,000-200,000,000 IU/mL (n=47/73; 64.4%). Thresholds for the higher odds ratio (OR) for SHA were greater than 90 U/L for alanine aminotransferase (ALT) and greater than 2,000,000 IU/mL for HBV-DNA. Based on receiver operating characteristic analysis, 90.5 U/L of ALT and 22,607,500 IU/mL of HBV-DNA were levels with the optimum sensitivity and specificity for the prediction of SHA.
CONCLUSION:
Hepatitis B virus-DNA levels between 106 and 108 IU/mL and ALT levels of 2~3 x ULN might be considered to be good indicators for discriminating chronic hepatitis phase from chronic infection in hepatitis B e-antigen-positive chronic hepatitis. However, we think that the current biochemical, serological and molecular markers are inadequate for differentiating chronic hepatitis phase than chronic infection, and non-invasive test and/or liver histopathology should be carried out in selected cases.
Saudi Med J. 2019 Feb; 40（2）：131-139。 doi：10.15537 / smj.2019.2.23934。
是否有最佳的丙氨酸氨基转移酶和HBV DNA阈值来区分慢性肝炎的HBeAg阳性慢性感染？评估215例男女病例。
Yenilmez E1，Cetinkaya RA。
作者信息
2008年至2017年期间，在土耳其的一所高等培训和研究医院随访了215例年轻和男性HBeAg阳性病例，参加了回顾性诊断准确性研究。结果：纤维化评分在0-4之间变化，F1（n = 81,37.6％）和F2（n = 82,38.1％）是最常见的纤维化阶段。在这些患者中，58.6％（126/215）具有显着的组织病理学异常（SHA）。 ALT的SHA比率高于90 U / L（n = 68/95; 71.6％），HBV-DNA在2,000,000-200,000,000 IU / mL之间（n = 47/73; 64.4％）。 SHA的较高比值比（OR）的阈值对于丙氨酸氨基转移酶（ALT）大于90U / L，对于HBV-DNA大于2,000,000IU / mL。基于受试者工作特征分析，ALT为90.5 U / L，HBV-DNA为22,607,500 IU / mL，对SHA的预测具有最佳灵敏度和特异性。
结论：
乙型肝炎病毒-DNA水平在106和108 IU / mL之间，ALT水平在2~3 x ULN可能被认为是区分慢性肝炎阶段与乙型肝炎e抗原阳性慢性肝炎慢性感染的良好指标。然而，我们认为目前的生化，血清学和分子标记不足以区分慢性肝炎阶段而不是慢性感染，并且应在特定病例中进行非侵入性试验和/或肝脏组织病理学检查。