乙肝表面抗原血清预测纤维化严重的患者e抗原阳性慢性乙型

StephenW

Serum Levels of Hepatitis B Surface Antigen Predict Severity of Fibrosis in Patients With E Antigen-Positive Chronic Hepatitis B
Patrick Marcellincorrespondenceemail
, Michelle Martinot-Peignoux
, Tarik Asselah
, Richard Batrla
, Diethelm Messinger
, Vivien Rothe
, George Lau
, Yun-Fan Liaw
Published Online: December 23, 2014
Article has an altmetric score of 2
DOI: http://dx.doi.org/10.1016/j.cgh.2014.12.017 |
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Publication History
Published Online: December 23, 2014

   
Background & Aims

Noninvasive techniques are needed to assess hepatic fibrosis in patients with chronic hepatitis B. We developed a scoring system to determine the degree of fibrosis in patients with genotype B or genotype C hepatitis B virus (HBV) infection and positive for the hepatitis B e antigen.
Methods

We performed a retrospective study to identify baseline variables associated with the severity of fibrosis (METAVIR scores, F0–F4) in a large phase 3 clinical trial of predominantly Asian patients (n = 710), using multivariate logistic regression analyses. Significant variables were used to construct predictive models using optimal cut-off values. The final model was validated in similar patients from a large phase 4 clinical trial (n = 465).
Results

We developed 2 prediction scoring systems (PSs). PS1 analyzed data on HBV genotype (B vs C), patient age (<30 vs ≥30 y), level of hepatitis B surface antigen (≤17,500 vs >17,500 IU/mL), and level of alanine aminotransferase (≤3-fold vs >3-fold the upper limit of normal). PS2 analyzed data on only age and level of hepatitis B surface antigen. PS1 identified patients with F0 to F1 vs F2 to F4 fibrosis with more than 87% specificity and a positive predictive value greater than 75; it identified patients with F0 to F2 vs F2 to F4 fibrosis with approximately 95% specificity and a positive predictive value (PPV) of approximately 97%. PS2 identified patients with F0 to F1 fibrosis with less accuracy than PS1, but identified patients with F0 to F2 fibrosis with an almost identical level of sensitivity and PPV.
Conclusions

We developed a simple scoring system to determine the severity of fibrosis in patients with genotypes B or C HBV infection who are hepatitis B e antigen positive. Our system differentiated patients with no or mild fibrosis (F0–F1) from those with marked or severe (F2–F4) fibrosis with a high PPV. The high level of specificity for the identification of nonsevere fibrosis (F0–F2) limits the risk of overlooking patients with severe fibrosis (F3–F4).

StephenW

乙肝表面抗原血清预测纤维化严重的患者e抗原阳性慢性乙型肝炎
帕特里克Marcellincorrespondenceemail
米歇尔马丁诺特-Peignoux
，塔里克Asselah
理查德Batrla
，Diethelm Messinger
，费雯丽罗特
乔治·刘
，云帆廖
发布时间：2014年12月23日
文章有altmetric比分2
DOI：http://dx.doi.org/10.1016/j.cgh.2014.12.017 |
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出版物历史
发布时间：2014年12月23日

   
背景与目的

需要无创技术来评估肝纤维化治疗慢性乙型肝炎我们制定了一个评分系统，以确定肝纤维化的患者，B型或C型肝炎病毒（HBV）感染阳性乙肝e抗原的程度。
方法

我们进行了一项回顾性研究，以亚裔为主的患者（n = 710），大3期临床试验鉴定与纤维化的严重程度有关基线变量（METAVIR评分，F0-F4），采用多因素Logistic回归分析。显著变量被用来构建最佳的使用临界值预测模型。最终的模型是在类似患者从大4期临床试验（n = 465）验证。
结果

我们开发了2预测评分系统（PSS）。 PS1分析数据对HBV基因型（B对C）中，患者年龄（<30 VS≥30y）时，B型肝炎表面抗原的（与≤17,500水平> 17500 IU / mL）中，水平谷丙转氨酶（≤3倍VS> 3倍正常上限）。 PS2分析了只年龄和B型肝炎表面抗原的水平的数据。 PS1确定患者F0至F1的VS F2至F4纤维化与超过87％的特异性和阳性预测值大于75;它确定了患者F0至F2 VS F2至F4纤维化约95％的特异性和大约97％的阳性预测值（PPV）。 PS2确定患者的F0到F1纤维化的精度比PS1少，但确定患者的F0到F2纤维化的敏感性和PPV的几乎相同的水平。
结论

我们开发了一种简单的评分系统，以确定纤维化患者基因型B或C HBV感染谁是乙型肝炎e抗原阳性的严重性。我们的系统区分患者无或轻度纤维化（F0-F1）的那些明显或重度（F2-F4）纤维化具有很高的PPV。对于非严重纤维化（F0-F2）的标识高水平特异性限制俯瞰重症患者纤维化（F3-F4）的风险。