HBeAg阴性患者评估瞬时弹性的有用性

StephenW

The usefulness of transient elastography in the assessment of patients with
HBeAg- negative chronic hepatitis B virus infection

G. V. Papatheodoridis1,*, S. Manolakopoulos1, A. Margariti1, M. V.
Papageorgiou1, H. Kranidioti1, A. Katoglou1, G. Kontos1, S. Adamidi1, G.
Kafiri2, M. Deutsch1, D. Pectasides1 Article first published online: 6 OCT
2013 DOI: 10.1111/jvh.12176 © 2013 John Wiley & Sons Ltd

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)

StephenW

总结
组织学严重程度往往是强制性的管理
HBeAg阴性慢性乙肝患者。我们评估的性能
瞬时弹性成像（ TE ）在此设置。包括357未处理的
HBeAg阴性患者≥1可靠的肝脏硬度测量
由TE （LSM千帕） ：182非活动性携带者， HBV - DNA <2000 （N = 139 ）或
2000-19 999 IU / ML组（n = 43 ）和175例慢性乙型肝炎
（ CHB ） 。在运营商中， HBV-DNA > 2000年和/或LSM > 6.5视为
活检的迹象。个LSM并无不同运营商之间的低和高
病毒血症，但均低于携带者比CHB患者（ 5.8 ±1.7
与9.0 ± 5.6， P <0.001） ，提供适度区分这些
两组（ AUROC ： 0.705 ） 。个LSM没有显着改变运营
16（ 12-24）个月后。携带者肝活检，伊沙克的分期
评分相似套管高和低病毒血症，但更高
例LSM > 6.5 ≤6.5千帕。中度纤维化（阶段： 2-3 ）
0 /10中的载流子与检测到的唯一的HBV-DNA > 2000 IU / mL的， 2/10 （20％ ） 。
运营商只有LSM > 6.5和5/10 （50％）的HBV-DNA两个载波>
2000年和LSM > 6.5 （P = 0.009 ）。在慢性乙肝患者中，相关LSMS
显著分级分期的成绩，并提供了出色的
精度≥中度，≥严重肝纤维化或肝硬化（ AUROC ≥
0.919-0.950 ） 。 TE可以帮助无创性评估
HBeAg阴性慢性乙肝患者。总之，个LSM提供优良
HBeAg阴性的慢性乙型肝炎患者的肝纤维化严重程度和精度可以
拣选载波中度纤维化的高风险，这可能是本
在高达35％的载流子与LSM > 6.5千帕和50％的载流子与LSM >
6.5 kPa和HBV-DNA > 2000 IU /毫升。