低血病伴显着纤维化的诊断困境; HBV DNA阈值水平是预测肝损

StephenW

Balkan Med J. 2018 May 4. doi: 10.4274/balkanmedj.2017.0888. [Epub ahead of print]
Diagnostic Dilemma for Low Viremia with Significant Fibrosis; Is HBV DNA Threshold Level a Good Indicator for Predicting Liver Damage?
Yenilmez E1, Çetinkaya RA1, Tural E2.
Author information

1
    Department of Infectious Diseases and Clinical Microbiology, İstanbul Sultan Abdulhamid Han Training and Research Hospital, İstanbul, Turkey.
2
    Department of Pediatrics, İstanbul Sultan Abdulhamid Han Training and Research Hospital, İstanbul, Turkey.

Abstract
BACKGROUND:

The most important difficulties about management of hepatitis B are still determining the liver damage and the right time to start antiviral therapy.
AIMS:

To reveal the role of hepatitis B virus DNA threshold level for prediction of liver fibrosis and inflammation in young-aged hepatitis B e antigen negative chronic hepatitis B patients.
STUDY DESIGN:

Diagnostic accuracy study.
METHODS:

A total of 273 hepatitis B e antigen negative young chronic hepatitis B patients with any hepatitis B virus DNA levels between 2008 and 2016, who had liver biopsy after at least 6 months follow up period, enrolled in this retrospective study. We created two groups as case and control, cases with hepatitis B virus DNA levels below 2.000 IU/mL and controls with hepatitis B virus DNA levels over 2.000 IU/mL. Having histological activity index ≥4 or/and fibrosis scores ≥2 were defined as significant histological abnormality. Then, we analyzed the relationship between these groups.
RESULTS:

We showed that significant fibrosis may occur in one third of young chronic hepatitis B patients with low viremia (30.2%, n=42/139 in cases, %55.2, n=74/134 in controls). Among the 42 cases with low viremia and significant fibrosis, 21.4% had alanine aminotransferase level between 40-59 U/L, 42.8% had alanine aminotransferase level between 60-79 U/L, and 35.7% had alanine aminotransferase level over 80 U/L. There was weak correlation between hepatitis B virus DNA threshold level and fibrosis score (p=0.000, rho=0.253). The optimum serum hepatitis B virus DNA threshold level in our study for predicting significant fibrosis was 1293 IU/mL (p=0.00, AUC: 0.657±0.034). The optimum alanine aminotransferase threshold level for predicting significant histological activity index and fibrosis was 64.5 and 59.5 U/L, respectively. The sensitivity and the specificity of 1293 vs 2000 IU/mL hepatitis B virus DNA threshold with 60 U/L alanine aminotransferase threshold level for predicting F≥2 fibrosis score were similar (sensitivity: 0.43 and 0.38, respectively; specificity: 0.76 and 0.77, respectively).
CONCLUSION:

Significant fibrosis may occur even in young cases with low viremia. It is not possible to define a single threshold hepatitis B virus DNA level for differentiating inactive carriers from patients with hepatitis B e antigen-negative chronic hepatitis. Diagnostic accuracy of hepatitis B virus DNA with alanine aminotransferase thresholds for the prediction of significant fibrosis is weak.
KEYWORDS:

Chronic hepatitis B; fibrosis; hepatitis B e antigen negative; hepatitis B virus DNA threshold level young patients.; low viremia

PMID:
    29726399
DOI:
    10.4274/balkanmedj.2017.0888

StephenW

Balkan Med J.20185月4日。doi：10.4274 / balkanmedj.2017.0888。 [电子版提前打印]
低血病伴显着纤维化的诊断困境; HBV DNA阈值水平是预测肝损害的良好指标吗？
Yenilmez E1，ÇetinkayaRA1，Tural E2。
作者信息

1
    土耳其伊斯坦布尔伊斯坦布尔苏丹阿卜杜勒哈米德韩培训与研究医院传染病与临床微生物学系。
2
    儿科，伊斯坦布尔苏丹阿卜杜勒哈米德韩训练和研究医院，伊斯坦布尔，土耳其。

抽象
背景：

关于乙肝治疗的最重要困难仍然是确定肝脏损害和开始抗病毒治疗的正确时间。
目的：

揭示乙型肝炎病毒DNA阈值水平对预测年轻人乙型肝炎e抗原阴性慢性乙型肝炎患者肝纤维化和炎症的作用。
学习规划：

诊断准确性研究。
方法：

在2008至2016年期间，共有273名乙型肝炎e抗原阴性的慢性乙型肝炎患者，其乙型肝炎病毒DNA水平在至少6个月随访期后进行了肝活检，参加了这项回顾性研究。我们创建了两组作为病例和对照，乙型肝炎病毒DNA水平低于2.000 IU / mL的病例以及乙型肝炎病毒DNA水平超过2.000 IU / mL的对照组。组织学活性指数≥4或/和纤维化评分≥2被定义为显着的组织学异常。然后，我们分析了这些群体之间的关系。
结果：

我们发现，三分之一的低病毒血症的慢性乙型肝炎患者中有三分之一可发生明显的纤维化（对照组为30.2％，n = 42/139例，％55.2，n = 74/134）。在42例低病毒血症和显着纤维化病例中，21.4％丙氨酸转氨酶水平在40-59 U / L之间，42.8％丙氨酸转氨酶水平在60-79 U / L之间，35.7％丙氨酸氨基转移酶水平超过80 U / L.乙型肝炎病毒DNA阈值水平与纤维化评分之间的相关性很弱（p = 0.000，rho = 0.253）。我们研究中用于预测显着纤维化的最佳血清乙型肝炎病毒DNA阈值水平为1293IU / mL（p = 0.00，AUC：0.657±0.034）。用于预测显着组织学活性指数和纤维化的最佳丙氨酸转氨酶阈值水平分别为64.5和59.5U / L。对于预测F≥2纤维化评分的1293 vs 2000 IU / mL乙型肝炎病毒DNA阈值与60 U / L丙氨酸转氨酶阈值水平的敏感性和特异性相似（敏感性分别为0.43和0.38;特异性分别为0.76和0.77，分别）。
结论：

即使在低病毒血症的年轻病例中也可能发生显着的纤维化。无法定义单一阈值乙型肝炎病毒DNA水平来区分非活动性携带者与乙型肝炎e抗原阴性慢性肝炎患者。具有丙氨酸氨基转移酶阈值的乙型肝炎病毒DNA对预测显着纤维化的诊断准确性很弱。
关键词：

慢性乙型肝炎;纤维化;乙肝e抗原阴性;乙肝病毒DNA阈值水平年轻患者;低病毒血症

结论：
    29726399
DOI：
    10.4274 / balkanmedj.2017.0888