慢性乙型肝炎病毒感染的晚期肝纤维化的预测因子持续正常

StephenW

Exp Ther Med. 2017 Dec;14(6):5363-5370. doi: 10.3892/etm.2017.5219. Epub  2017 Sep 29.
Predictors for advanced liver fibrosis in chronic hepatitis B virus infection with persistently normal or mildly elevated alanine aminotransferase.Wang D1, Zhang P1, Zhang M1.
Author information
1Department of Medicine, The Sixth People's Hospital of Qingdao, Qingdao, Shandong 266033, P.R. China.

AbstractThe aim of the present study was to evaluate the predictors for advanced liver fibrosis in patients with chronic hepatitis B virus (HBV) infection with persistently normal alanine aminotransferase (PNALT), or persistently or intermittently mildly elevated ALT (PIEALT). A total of 305 patients were included in the present study. Liver biopsies were evaluated using the METAVIR scoring system. Liver stiffness (LS) was measured using Fibroscan. Multivariate logistic regression and the area under the receiver operating characteristic curve (AUROC) were used to examine the diagnostic value of the predictors for advanced liver fibrosis. HBV DNA viral load in the PNALT group was significantly lower compared with the PIEALT group (4.57±1.68 vs. 5.71±1.69 log10 IU/ml; P<0.001). Body mass index and LS were also significantly lower in the PNALT group compared with the PIEALT group (P<0.001). The proportion of patients with liver fibrosis was significantly higher in the PIEALT group compared with the PNATL group (P=0.001). High ALT levels were an independent predictor for liver fibrosis, with an odds ratio (OR) of 2.69 (P=0.002). Male sex (OR=0.34, P=0.007), high ALT levels (OR=2.37, P=0.029) and a high HBV DNA load (OR=1.39, P=0.005) were independent predictors for advanced liver fibrosis. The AUROC was 0.65 (P=0.003) when using ALT levels to predict advanced liver fibrosis. ALT levels at ≥0.88 upper limit of normal (ULN; 35 IU/l) were considered as positive for advanced liver fibrosis, the sensitivity and specificity were 87.8 and 47.4%, respectively. The AUROC was 0.64 (P=0.004) when using the HBV DNA value to predict advanced liver fibrosis. When an HBV DNA value of ≥4.99 log10 IU/ml was considered as positive for advanced liver fibrosis, the sensitivity and specificity were 78.0 and 49.5%, respectively. The AUROC was 0.72 (P<0.001) when combining ALT, HBV DNA load and sex into a formulation to predict advanced liver fibrosis. When the formulation score at >-2.22 was considered as positive for advanced liver fibrosis, the sensitivity and specificity were 61.5 and 70.7%, respectively. Therefore, normal ALT levels do not always indicate the absence of hepatic fibrosis. A combination of ALT levels, sex and serum HBV DNA load may more effectively identify patients with CHB at high risk of developing fibrosis. These patients may benefit from liver biopsy.


KEYWORDS: Fibroscan; METAVIR scoring system; alanine aminotransferase; hepatitis B; liver fibrosis; upper limit of normal

PMID:29285064PMCID:PMC5740558DOI:10.3892/etm.2017.5219

StephenW

Exp Ther Med。 2017年12月; 14（6）：5363-5370。 doi：10.3892 / etm.2017.5219。电子书2017年9月29日。
慢性乙型肝炎病毒感染的晚期肝纤维化的预测因子持续正常或轻度升高的丙氨酸转氨酶。
王D1，张P1，张M1。
作者信息

1
    青岛市第六人民医院医学科，山东青岛266033，中国。

抽象

本研究旨在评估慢性乙型肝炎病毒（HBV）持续正常丙氨酸转氨酶（PNALT）感染或持续性或间歇性轻度ALT升高（PIEALT）的晚期肝纤维化的预测因子。本研究共纳入305例患者。使用METAVIR评分系统评估肝脏活组织检查。使用Fibroscan测量肝硬度（LS）。采用多因素Logistic回归分析和受试者工作特征曲线下面积（AUROC）检验预测因子对晚期肝纤维化的诊断价值。与PIEALT组相比，PNALT组HBV DNA病毒载量显着降低（4.57±1.68比5.71±1.69 log10 IU / ml; P <0.001）。与PIEALT组相比，PNALT组的体重指数和LS显着降低（P <0.001）。 PIEALT组的肝纤维化患者比例显着高于PNATL组（P = 0.001）。高ALT水平是肝纤维化的独立预测因子，优势比（OR）为2.69（P = 0.002）。男性（OR = 0.34，P = 0.007），高ALT水平（OR = 2.37，P = 0.029）和高HBV DNA载量（OR = 1.39，P = 0.005）是晚期肝纤维化的独立预测因子。当使用ALT水平预测晚期肝纤维化时，AUROC为0.65（P = 0.003）。 ALT水平≥0.88正常上限（ULN; 35 IU / l）被认为是晚期肝纤维化的阳性，敏感性和特异性分别为87.8％和47.4％。当使用HBV DNA值预测晚期肝纤维化时，AUROC为0.64（P = 0.004）。当HBV DNA值≥4.99log10 IU / ml被认为是晚期肝纤维化的阳性时，敏感性和特异性分别为78.0和49.5％。当将ALT，HBV DNA载量和性别组合成预测晚期肝纤维化的制剂时，AUROC为0.72（P <0.001）。当认为配方评分> -2.22为晚期肝纤维化阳性时，敏感性和特异性分别为61.5和70.7％。因此，正常的ALT水平并不总是表明没有肝纤维化。 ALT水平，性别和血清HBV DNA载量的组合可以更有效地鉴别患有发展为纤维化的高风险CHB的患者。这些患者可能受益于肝活检。
关键词：

Fibroscan的; METAVIR评分系统;丙氨酸转氨酶;乙肝;肝纤维化;正常的上限

结论：
    29285064
PMCID：
    PMC5740558
DOI：
    10.3892 / etm.2017.5219