HBsAg水平对ALT正常的HBeAg阳性慢性HBV感染者肝脏炎症发生的预测价值

Value of HBsAg level in predicting liver inflammation in patients with HBeAg-positive chronic hepatitis B virus infection and normal alanine aminotransferase

目的探讨ALT正常且高病毒载量的HBeAg阳性慢性HBV感染者人群的肝炎发生情况及预测因素。方法本研究临床注册号为NCT04032275。回顾性选取2008年10月—2015年5月ALT正常、高病毒载量、HBeAg阳性的慢性HBV感染者183例,根据其肝穿刺活检结果分为肝炎组和无肝炎组。计量资料两组间比较采用t检验或Mann-Whitney U检验。计数资料两组间比较采用χ^(2)检验。使用单因素二元logistics回归分析预测因素,使用逐步后退法进行多因素二元logistics回归,使用受试者工作特征曲线(ROC)和约登指数分析截断值。结果肝炎组37例(20.2%),无肝炎组146例(79.8%),肝炎组的男性比例低于无肝炎组(45.9%vs 68.5%,χ^(2)=6.508,P=0.011)、AST高于无肝炎组[24(21.25~35.55)U/L vs 21.2(18.08~24.65)U/L,Z=-3.344,P=0.001]、HBsAg log值低于无肝炎组[4.4(4.28~4.49)vs 4.46(4.4~4.74),Z=-2.184,P=0.029]。HBsAg log值是肝炎发生的预测因素(OR=0.077,P=0.017)。HBsAg的截断值为33884.4 IU/mL。结论ALT正常、高病毒载量的HBeAg阳性患者中有20.2%肝脏存在炎症,HBsAg或许是肝脏炎症发生的预测因素。

Objective To investigate the onset of liver inflammation and related predictive factors in patients with HBeAg-positive chronic hepatitis B virus(HBV)infection who have normal alanine aminotransferase(ALT)and a high viral load.Methods A retrospective analysis was performed for the clinical data of 183 patients with HBeAg-positive chronic HBV infection who had normal ALT and a high viral load and were treated from October 2008 to May 2015,and according to the results of liver biopsy,they were divided into hepatitis group and non-hepatitis group.The t-test or Mann-Whitney U testwas used for comparison of normally distributed continuous data between groups,the chi-square test was used for comparison of categorical data.The predictive factors were analyzed by univariate binary logistic regression,the multivariate binary logistic regression was carried out by stepback method,and the cut-off values were analyzed by receiver operating characteristic curve(ROC)and Jordan index.Results There were 37 patients(20.2%)in the hepatitis group and 146 patients(79.8%)in the non-hepatitis group.Compared with the non-hepatitis group,the hepatitis group had a significantly lower proportion of male patients(45.9%vs 68.5%,χ^(2)=6.508,P=0.011),a significantly higher level of aspartate aminotransferase[24(21.25~35.55)U/L vs 21.2(18.08~24.65)U/L,Z=-3.344,P=0.001],and a significantly lower log(HBsAg)value[4.4(4.28~4.49)vs 4.46(4.4~4.74),Z=-2.184,P=0.029].Log(HBsAg)value was a predictive factor for hepatitis(odds ratio=0.077,P=0.017),and the cutoff value of HBsAg was 33884.4I U/mL.Conclusion Among the patients with HBeAg-positive chronic HBV infection who have normal ALT and a high viral load,20.2%have liver inflammation,and HBsAg may be a predictive factor for liver inflammation.