Source: Liver International, Volume 30, Number 8, September 2010 , pp.
1161-1168(8)
Publisher: Wiley-Blackwell
Abstract:
Background:
It is unclear whether clinical indication for antiviral treatment is in
agreement with histological indication in HBeAg-negative chronic hepatitis B
(CHB). This study aimed to clarify this relationship and identify factors
associated with liver histology.
Patients and methods:
We investigated 152 consecutive, treatment-naïve, HBeAg-negative CHB patients
who had undergone liver biopsies at a tertiary medical centre in Taiwan.
Clinical indications for treatment included a serum alanine aminotransferase
level more than twice the upper limit of normal and an hepatitis B virus DNA
level >2000 IU/ml. Factors associated with the histological indication
(Ishak's grade ≥7 and/or stage ≥2) were analysed.
Results:
The association between the clinical and the histological indications was
significant (P=0.011). However, the agreement was poor (κ value=0.197). In
patients satisfying the clinical indication, age >52 years [odds ratio
(OR)=2.669, P=0.042], serum α-fetoprotein (AFP) level >7 ng/ml (OR=7.070,
P<0.001) and platelet count <130 × 109/L (OR=11.720, P=0.025) were identified
to be independent factors associated with histological indication. In patients
who did not satisfy the clinical indication, multivariate analysis revealed
that only an AFP level >7 ng/ml (OR=10.345, P=0.021) was independently
associated with histological indication. Combining the clinical indication
and/or AFP level >7 ng/ml to predict liver histology, the sensitivity and
the negative predictive value could improve from 86 to 94.4% and 66.7 to 81%
respectively.
Conclusion:
AFP level is associated with liver histology in HBeAg-negative CHB. Serum AFP
level can serve as a surrogate indicator to identify patients who need
antiviral treatment.
Document Type: Research article
DOI: 10.1111/j.1478-3231.2010.02301.x
Affiliations: 1: Department of Medicine, Division of Gastroenterology, Taipei
Veterans General Hospital, Taipei, Taiwan 2: Department of Pathology, Taipei
Veterans General Hospital, Taipei, Taiwan