HBsAg定量水平不能鉴定HBeAg阴性慢性乙型肝炎患者的肝纤维化

StephenW

Quantitative HBsAg levels do not identify hepatic fibrosis in HBeAg-negative chronic hepatitis B patients

Fatima A Ahmed1, Maryam S Bajaifar2, Mohammed A Ahmed1, Abduljaleel Alalwan3, Faraaz A Sanai4, Khalid Albeladi5, Abdulrahman A Aljumah3, Faisal M Sanai6
1 College of Medicine, Ibn Sina National College for Medical Studies, Jeddah, Saudi Arabia
2 College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
3 Hepatology Division, Department of Hepatobiliary Sciences and Organ Transplant Center, King Abdulaziz Medical City; King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
4 Emergency Department, King Fahd Hospital, Jeddah, Saudi Arabia
5 Gastroenterology Unit, Department of Medicine, King Abdulaziz Medical City, Jeddah, Saudi Arabia
6 Gastroenterology Unit, Department of Medicine, King Abdulaziz Medical City, Jeddah; Liver Disease Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia

Correspondence Address:
Dr. Faisal M Sanai
Gastroenterology Unit, Dept. of Medicine, King Abdulaziz Medical City, PO Box: 9515, Jeddah 21423
Saudi Arabia
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Source of Support: None, Conflict of Interest: None
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DOI: 10.4103/sjg.SJG_80_19
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Background/Aims: Quantitative serum hepatitis B surface antigen (qHBsAg) has been evaluated in limited patient groups as a marker of histological fibrosis. The accurate identification of inactive chronic hepatitis B virus (HBV) carriers from those with active carriers is difficult because of wide and frequent HBV DNA fluctuations. We aimed to assess the utility of qHBsAg in distinguishing histologically significant fibrosis in untreated HBeAg-negative chronic HBV patients. Patients and Methods: qHBsAg levels were measured at baseline as single-point quantification and correlated with virologic and biochemical profiles of consecutive carriers (median, 29; range, 12-110 months). HBeAg-negative patients (n = 75) with HBV DNA <2000 (n = 5), 2000-20,000 (n = 16) and >20,000 IU/mL (n = 54) were included and all had liver biopsy. A qHBsAg cutoff point of 1000 IU/mL was assessed to demonstrate whether it better delineated patients with non-significant histology (F0-1, inflammatory grade A0-1). Results: Mean age of the patients was 39.4 ± 11.4 years and 58 (77.3%) were male. Patients with qHBsAg levels >1000 IU/mL were more likely to be males (84.5%, P = 0.006) or with elevated AST (68.4%, P = 0.0002) and ALT levels (72.4%, P < 0.0001), higher HBV DNA (log10 6.4 ± 1.4, P < 0.0001) and those with F2-4 fibrosis (48.3%, P = 0.028). Serum log10 qHBsAg were significantly lower in patients with HBV DNA <2000 (2.80 ± 1.47) and HBV DNA 2000-20,000 (2.71 ± 0.83) vs. >20,000 IU/mL (3.89 ± 0.61, P < 0.0001). Overall, qHBsAg were not different in patients with F0-1 (3.44 ± 0.91) and F2-4 fibrosis (3.74 ± 0.85, P = 0.161). Serum qHBsAg were higher in patients with significant (A2-3) inflammation (3.85 ± 0.72) compared to A0-1 (3.38 ± 0.95; P = 0.018). Serum qHBsAg demonstrated poor accuracy (AUROC, 0.61, P = 0.111) in identification of F2-4 fibrosis. Conclusion: Serum qHBsAg levels do not help differentiate between those with HBV DNA <2000 or 2000 – 20,000 IU/mL or distinguish patients with significant fibrosis. Moreover, more than half of the patients with non-significant fibrosis have a qHBsAg level greater than 1000 IU/mL.

StephenW

HBsAg定量水平不能鉴定HBeAg阴性慢性乙型肝炎患者的肝纤维化

法蒂玛·艾哈迈德1，玛利亚姆·S·巴贾法尔2，穆罕默德·艾哈迈德1，阿卜杜勒·耶勒·阿尔勒旺3，法拉兹·阿萨奈4，哈立德·阿尔贝拉迪5，阿卜杜勒·拉赫曼·阿勒朱玛3，费萨尔·M·萨奈6
1沙特阿拉伯吉达伊本·西那国立医学院的医学院
2沙特阿拉伯吉达阿卜杜勒阿齐兹国王大学医学院
3阿卜杜勒阿齐兹国王医学城肝胆科学与器官移植中心肝病科；沙特阿拉伯利雅得国民警卫队卫生事务部国王沙特·本·阿卜杜勒阿齐兹国王卫生科学大学和阿卜杜拉国王国际医学研究中心
4沙特阿拉伯吉达法赫德国王医院急诊科
5沙特阿拉伯吉达阿卜杜勒阿齐兹国王医疗城医学部消化内科
6吉达阿卜杜勒阿齐兹国王医学城医学部消化内科；沙特阿拉伯利雅得金沙特大学医学院肝脏疾病研究中心

通讯地址：
Faisal M Sanai博士
阿卜杜勒阿齐兹国王医学城医学部消化内科，邮政信箱：9515，吉达21423
沙特阿拉伯
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DOI：10.4103 / sjg.SJG_80_19
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背景/目的：在有限的患者组中评估了定量的血清乙型肝炎表面抗原（qHBsAg）作为组织学纤维化的标志物。由于广泛而频繁的HBV DNA波动，很难从具有活动性的携带者中准确识别出非活动性慢性乙型肝炎病毒（HBV）携带者。我们旨在评估qHBsAg在区分未经治疗的HBeAg阴性慢性HBV患者中组织学上显着的纤维化中的效用。患者和方法：qHBsAg水平在基线时作为单点定量测量，并与连续携带者的病毒学和生化特征相关（中位数，29；范围，12-110个月）。 HBV DNA阴性的患者（n = 75），HBV DNA <2000（n = 5），2000-20,000（n = 16）和> 20,000 IU / mL（n = 54），均行肝活检。评估的qHBsAg临界点为1000 IU / mL，以证明其是否能更好地描述组织学不重要的患者（F0-1，炎性A0-1）。结果：患者的平均年龄为39.4±11.4岁，男性为58（77.3％）。 qHBsAg水平> 1000 IU / mL的患者更有可能是男性（84.5％，P = 0.006）或AST（68.4％，P = 0.0002）和ALT水平（72.4％，P <0.0001），HBV DNA升高的患者（log10 6.4±1.4，P <0.0001）和F2-4纤维化患者（48.3％，P = 0.028）。 HBV DNA <2000（2.80±1.47）和HBV DNA 2000-20,000（2.71±0.83）的患者的血清log10 qHBsAg明显低于20,000 IU / mL（3.89±0.61，P <0.0001）。总体而言，F0-1（3.44±0.91）和F2-4纤维化（3.74±0.85，P = 0.161）患者的qHBsAg并无差异。具有严重（A2-3）炎症的患者（3.85±0.72）的血清qHBsAg高于A0-1（3.38±0.95; P = 0.018）。血清qHBsAg不能准确鉴定F2-4纤维化（AUROC，0.61，P = 0.111）。结论：血清qHBsAg水平无助于区分HBV DNA <2000或2000 – 20,000 IU / mL的患者或区分具有明显纤维化的患者。此外，超过一半的非明显纤维化患者的qHBsAg水平大于1000 IU / mL。

StephenW

http://www.saudijgastro.com/temp ... -3629215_100452.pdf