简单的HBV评分准确，适用于分散诊断

StephenW

  Simple HBV score accurate, applicable for decentralizing diagnosis

Shimakawa Y, et al. J Hepatol. 2018;doi:10.1016/j.cgh.2018.05.024.
July 3, 2018

A diagnostic score based on hepatitis B e-antigen and alanine aminotransferase was highly accurate in selecting patients for HBV therapy, according to a recent study conducted in Africa.

Yusuke Shimakawa, MD, from the Institut Pasteur in France, and colleagues noted that the TREAT-B score’s simplicity could be useful in low- and middle-income settings with limited access to standard diagnostic tools such as liver biopsy or virus DNA testing.

“TREAT-B, a simple and inexpensive treatment eligibility score validated in African patients, may facilitate the scale up and decentralization of HBV treatment programs in sub-Saharan Africa, which may ultimately contribute towards the global HBV elimination,” Shimakawa and colleagues wrote. “Moreover, TREAT-B performed well irrespective of the age groups, HBV genotypes, the presence of obesity or cirrhosis, and better than the WHO treatment criteria.”

From December 2011 to January 2014, the Prevention of Liver Fibrosis and Cancer in Africa (PROLIFICA) enrolled 804 Gambian adults (64% men) positive for HBV surface antigen in the study. Most participants were asymptomatic and unaware of their infection. All participants underwent standard clinical staging.

Additionally, the researchers analyzed a validation cohort of 327 African adults from multi-international study centers.

The TREAT-B score system was calculated as follows: HBeAg score negative (0 point) or positive (1 point) added to ALT less than 20 IU/L (0 point), between 20 IU/L and 39 IU/L (1 point), between 40 IU/L and 79 IU/L (2 points) or 80 IU/L or higher (3 points), for a total of up to 4 points.

TREAT-B displayed good discrimination compared with EASL treatment criteria in both the derivation set (AUROC = 0.88) and validation set (AUROC = 0.85); compared with AASLD in derivation (AUROC = 0.89) and validation (AUROC = 0.83); and compared with APASL in derivation (AUROC = 0.87) and validation (AUROC = 0.85).

A score cut-off of 2 points had the highest sensitivity and specificity to indicate EASL (85% and 77%), AASLD (82% and 78%) and APASL (83% and 78%) treatment eligibility criteria.

Finally, the TREAT-B score had significantly higher area under receiver operating characteristic curves compared with WHO criteria in both derivation and validation sets (P < .01).

“As a public health intervention to reduce HBV-related mortality in Africa, the role of hepatitis B vaccination alone is limited because an estimated 6.1% of African adults who established chronic infection before the introduction of hepatitis B vaccines are at high risk of dying from HBV-related liver diseases in the next few decades,” the researchers wrote. “An additional population-wide ‘screen-and-treat’ may efficiently reduce these deaths, as suggested by a recent modelling study.” – by Talitha Bennett

Disclosure: Shimakawa reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.

StephenW

简单的HBV评分准确，适用于分散诊断

Shimakawa Y，et al。 J Hepatol。 2018; DOI：10.1016 / j.cgh.2018.05.024。
2018年7月3日

根据最近在非洲进行的一项研究，基于乙型肝炎e抗原和丙氨酸氨基转移酶的诊断评分在选择HBV治疗患者时非常准确。

来自法国巴斯德研究所的Shimakawa博士及其同事指出，TREAT-B评分的简单性在低收入和中等收入环境中非常有用，因为肝脏活组织检查或病毒DNA检测等标准诊断工具的使用有限。

Shimakawa及其同事写道，“TREAT-B，一种在非洲患者身上验证的简单而廉价的治疗资格评分，可能有助于撒哈拉以南非洲地区HBV治疗计划的扩大和分散，这可能最终有助于消除全球HBV。” “此外，无论年龄组，HBV基因型，肥胖或肝硬化的存在，TREAT-B表现良好，并且优于WHO治疗标准。”

2011年12月至2014年1月，非洲预防肝纤维化和癌症（PROLIFICA）招募了804名冈比亚成年人（64％男性），该研究中HBV表面抗原阳性。大多数参与者无症状且不知道自己的感染。所有参与者均接受标准临床分期。

此外，研究人员分析了来自多国际研究中心的327名非洲成年人的验证队列。

TREAT-B评分系统计算如下：HBTAg评分为负（0分）或阳性（1分）加至ALT小于20 IU / L（0分），20 IU / L至39 IU / L（1点），40 IU / L和79 IU / L（2点）或80 IU / L或更高（3点），总计最多4点。

在推导集（AUROC = 0.88）和验证集（AUROC = 0.85）中，TREAT-B与EASL治疗标准相比表现出良好的区分;与推导中的AASLD（AUROC = 0.89）和验证（AUROC = 0.83）相比较;并与推导中的APASL（AUROC = 0.87）和验证（AUROC = 0.85）进行比较。

得分为2分的敏感性和特异性最高，表明EASL（85％和77％），AASLD（82％和78％）和APASL（83％和78％）治疗资格标准。

最后，在接受者操作特征曲线下，TREAT-B评分在推导和验证集中与WHO标准相比具有显着更高的面积（P <.01）。

“作为减少非洲HBV相关死亡率的公共卫生干预措施，仅乙肝疫苗接种的作用有限，因为估计有6.1％的非洲成年人在引入乙型肝炎疫苗之前确定了慢性感染的风险很高。研究人员写道，未来几十年内与HBV有关的肝病。正如最近的一项模拟研究所表明的那样，“额外的人口范围'屏幕和治疗'可以有效地减少这些死亡。” - 作者：Talitha Bennett

披露：Shimakawa报告没有相关的财务披露。有关其他作者的相关财务披露，请参阅完整的研究。