定量乙型肝炎核心抗体（qHBcAb）和天冬氨酸转氨酶（AST）的

StephenW

Combination of quantitative hepatitis B core antibody (qHBcAb) and aspartate aminotransferase (AST) can accurately diagnose immune tolerance of chronic hepatitis B virus infection based on liver biopsy
Zhang Chi  1 , Wu Zhao  1 , Jia-Wen Li  1 , Hui Liu  2 , Chen Shao  3 , Hong Zhao  4 , Wang Gui-Qiang  5
Affiliations
Affiliations

    1
    Department of Infectious Disease, Center for Liver Disease, Peking University First Hospital, Beijing, China.
    2
    Department of Pathology, Beijing Youan Hospital, Capital Medical University, Beijing, China.
    3
    Department of Pathology, Beijing Youan Hospital, Capital Medical University, Beijing, China; Department of Pathology, China-Japan Friendship Hospital, Beijing, China.
    4
    Department of Infectious Disease, Center for Liver Disease, Peking University First Hospital, Beijing, China; Department of Infectious Disease, Peking University International Hospital, Beijing, China. Electronic address: [email protected].
    5
    Department of Infectious Disease, Center for Liver Disease, Peking University First Hospital, Beijing, China; Department of Infectious Disease, Peking University International Hospital, Beijing, China. Electronic address: [email protected].

    PMID: 33272888 DOI: 10.1016/j.clinre.2020.10.008

Abstract

Background and aims: Immune tolerance is defined as HBeAg positive, high hepatitis B virus load (HBV), persistent normal alanine aminotransferase (ALT), no or slight inflammation or fibrosis in liver histology. However, it is still unclear the threshold of high hepatitis B virus load and how to predict histology without liver biopsy. The aim of this study was to predict immune tolerance in HBeAg positive, alanine aminotransferase -normal populations with non-invasive indicators.

Methods: Two multi-center prospective cohort study recruited 907 treatment-naïve chronic hepatitis B (CHB) patients who had undergone liver biopsy in mainland China from August 2013 to September 2016 and April 2018 to June2019. Quantitative hepatitis B core antibody, AST and HBV DNA were investigated using commercial diagnostic assays and histological grading and staging was assessed by the Ishak scoring system.

Results: One hundred and thirteen untreated CHB patients with HBeAg-positive, normal alanine aminotransferase (ALT) and high level of HBV DNA (≥5log10 IU/mL) were enrolled in this study. The area under the receiver operating characteristic curves (AUROCs) of qHBcAb, AST, HBV DNA and qHBcAb-AST index were 79.6%, 80.5%, 76.4% and 87.7%. Our novel qHBcAb-AST index, which combined qHBcAb and AST showed better performance with higher sensitivity (88.6% [95% confidence interval (CI) 72.3% - 96.3%]) and negative predictive value (NPV) (93.8% [95% CI 84.2% - 98.0%]).

Conclusions: The combination of qHBcAb and AST can more accurately predict the immune tolerance of people with HBeAg-positive, normal alanine aminotransferase (ALT).

Keywords: Diagnose; Hepatitis B; Immune tolerance; Non-Invasive marker.

Copyright © 2020. Published by Elsevier Masson SAS.

StephenW

定量乙型肝炎核心抗体（qHBcAb）和天冬氨酸转氨酶（AST）的组合可根据肝活检准确诊断慢性乙型肝炎病毒感染的免疫耐受
张驰1，吴兆1，李佳文1，刘辉2，陈韶3，洪昭4，王桂强5
隶属关系
隶属关系

    1个
    北京大学第一医院肝病中心传染病科，北京
    2
    首都医科大学附属北京佑安医院病理科，北京
    3
    首都医科大学附属北京佑安医院病理科，北京；中日友好医院病理科，北京。
    4
    北京大学第一医院肝病中心传染病科，北京；北京大学国际医院传染病科，北京。电子地址：[email protected]。
    5
    北京大学第一医院肝病中心传染病科，北京；北京大学国际医院传染病科，北京。电子地址：[email protected]。

    PMID：33272888 DOI：10.1016 / j.clinre.2020.10.008

抽象

背景和目的：免疫耐受性定义为HBeAg阳性，乙型肝炎病毒载量（HBV）高，持续的正常丙氨酸氨基转移酶（ALT），肝脏组织学无或有轻度炎症或纤维化。但是，尚不清楚乙型肝炎病毒高负荷的阈值以及如何在不进行肝活检的情况下预测组织学。这项研究的目的是预测具有非侵入性指标的HBeAg阳性，丙氨酸氨基转移酶正常人群的免疫耐受性。

方法：2013年8月至2016年9月以及2018年4月至2019年6月，在中国大陆进行的两项多中心前瞻性队列研究招募了907名接受过初治的慢性乙型肝炎（CHB）患者。使用商业诊断测定法对定量的乙型肝炎核心抗体，AST和HBV DNA进行了研究，并通过Ishak评分系统评估了组织学分级和分期。

结果：本研究纳入了113例未经治疗的CHB患者，这些患者具有HBeAg阳性，丙氨酸转氨酶（ALT）正常和HBV DNA高水平（≥5log10IU / mL）。 qHBcAb，AST，HBV DNA和qHBcAb-AST指数的受试者工作特征曲线（AUROC）下面积分别为79.6％，80.5％，76.4％和87.7％。我们结合qHBcAb和AST的新型qHBcAb-AST指数显示了更好的性能，具有更高的灵敏度（88.6％[95％置信区间（CI）72.3％-96.3％]）和阴性预测值（NPV）（93.8％[95％CI 84.2％-98.0％]）。

结论：qHBcAb和AST的组合可以更准确地预测HBeAg阳性，正常丙氨酸氨基转移酶（ALT）患者的免疫耐受性。

关键字：诊断；乙型肝炎；免疫耐受非侵入性标记。

版权所有©2020。由Elsevier Masson SAS发布。