定量乙型肝炎核心抗体水平在预测具有正常或接近正常的丙

StephenW

Hepatol Res. 2017 Jul 14. doi: 10.1111/hepr.12937. [Epub ahead of print]
Role of quantitative hepatitis B core antibody levels in predicting significant liver inflammation in chronic hepatitis B patients with normal or near-normal alanine aminotransferase levels.Li J1, Zhang TY2,3, Song LW2,3, Qi X1, Yu XP1, Li FH1, Zhou P1, Qin YL1, Yang L2,3, Zhao JH2,3, Mao RC1, Zhang YM1, Wang JY1, Yang FF1, Zhu HX1, Yang SS1, Huang YX1, Yuan Q2,3, Zhang J2,3, Zhang JM1, Xia NS2,3.
Author information
1Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, 200040, China.2State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life Science & School of Public Health, Xiamen University, Xiamen, 361102, China.3National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Science & School of Public Health, Xiamen University, Xiamen, 361102, China.

AbstractAIM: Chronic hepatitis B (CHB) patients with normal alanine aminotransferase (ALT) levels are not free from significant hepatic lesions. Recently, there has been an improved understanding of the clinical significance of quantitative hepatitis B core antibody levels (qAnti-HBc) during CHB management. In this cross-section study, we evaluated the utility of qAnti-HBc in identifying significant liver inflammation in CHB patients.
METHODS: A total of 469 patients (the training set: 363; the validation set: 106) underwent liver biopsy (LB) were included. The qAnti-HBc levels were quantified and the relationship between histology and serum markers was systematically analyzed.
RESULTS: In the training set, qAnti-HBc levels were found to have significant diagnostic value for moderate to severe liver inflammation (≥G2) in all patients (AUROC=0.768, 95%CI: 0.721-0.810, P < 0.001) and in patients with normal or near-normal ALT levels (AUROC = 0.767, 95%CI: 0.697-0.828, P < 0.001). Our novel index (AC index) for the identification of ≥G2 inflammation, which combined the qAnti-HBc and ALT levels, significantly improved diagnostic performance (AUROC = 0.813, 95%CI: 0.768-0.852) compared to the use of ALT alone (AUROC = 0.779, 95%CI: 0.732-0.821) in all patients. In the validation set, AC index showed an improved AUROC of 0.890 (95%CI: 0.814-0.942) and 0.867 (95%CI: 0.749-0.943) in all patients and patients with normal ALT levels, respectively.
CONCLUSIONS: The qAnti-HBc level predicts significant liver inflammation well, even in patients with normal or near-normal ALT levels. Compared with conventional ALT level, AC index is a more reliable non-invasive biomarker for significant liver inflammation in CHB patients.

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KEYWORDS: chronic HBV infection; hepatitis B virus; non-invasive marker; quantitative anti-HBc

PMID:28707778DOI:10.1111/hepr.12937

StephenW

Hepatol Res。 2017年7月14日。doi：10.1111 / hepr.12937。 [提前印刷]
定量乙型肝炎核心抗体水平在预测具有正常或接近正常的丙氨酸氨基转移酶水平的慢性乙型肝炎患者中显着的肝脏炎症的作用。
Li J1，Zhang TY2,3，Song LW2,3，Qi X1，Yu XP1，Li FH1，Zhou P1，Qin YL1，Yang L2,3，Zhao JH2,3，Mao RC1，Zhang YM1，Wang JY1，Yang FF1，朱HX1，杨SS1，黄YX1，元Q2,3，张J2,3，张JM1，夏NS2,3。
作者信息

1
    复旦大学华山医院感染科，上海200040。
2
    厦门大学生命科学与公共卫生学院分子疫苗与分子诊断国家重点实验室厦门361102。
3
    厦门大学生命科学与公共卫生学院传染病诊断与疫苗开发研究所，厦门，361102。

抽象
目标：

具有正常丙氨酸氨基转移酶（ALT）水平的慢性乙型肝炎（CHB）患者没有明显的肝脏病变。最近，CHB管理中对定量乙型肝炎核心抗体水平（qAnti-HBc）的临床意义有了较大的了解。在本横断面研究中，我们评估了qAnti-HBc在确定CHB患者肝脏重要炎症中的效用。
方法：

共纳入469例患者（训练组：363;验证组：106）进行肝活检（LB）。量化qAnti-HBc水平，系统分析组织学和血清标志物之间的关系。
结果：

在训练集中，所有患者（AUROC = 0.768,95％CI：0.721-0.810，P <0.001）和患者的中度至重度肝炎（≥G2）发现qAnti-HBc水平具有显着诊断价值正常或接近正常的ALT水平（AUROC = 0.767,95％CI：0.697-0.828，P <0.001）。与单独使用ALT相比，我们用于鉴定组合qAnti-HBc和ALT水平的≥G2炎症的新型指数（AC指数）显着提高了诊断性能（AUROC = 0.813,95％CI：0.768-0.852） AUROC = 0.779,95％CI：0.732-0.821）。在验证集中，所有患者和ALT水平正常的患者，AC指数分别显示出0.890（95％CI：0.814-0.942）和0.867（95％CI：0.749-0.943）的AUROC改善。
结论：

即使在正常或接近正常ALT水平的患者中，qAnti-HBc水平也能很好的预测明显的肝脏炎症。与常规ALT水平相比，AC指数是CHB患者显着肝脏炎症的更可靠的非侵入性生物标志物。

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关键词：

慢性HBV感染;乙型肝炎病毒;非侵入性标记;定量抗HBc

结论：
    28707778
DOI：
    10.1111 / hepr.12937