乙型肝炎核心抗体对慢性乙型肝炎初治患者显著纤维化的预测价值

Predictive value of hepatitis B core antibody for significant fibrosis in patients with initial treatment of chronic hepatitis B

目的探讨乙型肝炎核心抗体(HBcAb)定量水平对慢性乙型肝炎(CHB)初次治疗患者显著纤维化阶段的预测价值。方法回顾性分析2018年4月至2022年4月于福建医科大学孟超肝胆医院感染科住院并行肝脏穿刺活检的157例CHB初治患者的资料和相关指标,根据Scheuer评分系统将91例S0-1期患者定义为轻度纤维化组,66例S2-4期患者定义为显著纤维化组,比较两组相关指标的差异,对差异有统计学意义的指标进行logistic回归分析,同时绘制相关指标预测显著纤维化的受试者工作特征曲线。结果HBcAb定量水平与CHB患者肝纤维化程度呈正相关(r=0.175,P=0.028),HBc Ab、丙氨酸转氨酶(ALT)、血小板(PLT)和乙型肝炎病毒脱氧核糖核酸(HBV DNA)是CHB患者进展至显著纤维化阶段的独立危险因素(OR=1.794、1.017、0.989、0.779,P<0.05),对显著纤维化阶段均有预测价值(曲线下面积=0.628、0.659、0.729、0.594,P<0.05)。HBcAb最佳截断值为3.65 log10 IU/ml,预测显著纤维化的敏感度为83.33%,特异度为41.76%(P=0.004)。结论HBcAb对CHB初治患者显著纤维化阶段有较好的预测价值,值得进一步研究。

Objective To explore the predictive value of the quantitative level for hepatitis B core antibody(HBcAb)in the significant fibrosis stage of patients with initial treatment of chronic hepatitis B(CHB).Methods A retrospective analysis was conducted on the data and related indicators of 157 patients with initial treatment of CHB who were hospitalized and underwent liver biopsy in the Department of Infectious Disease,Mengchao Hepatobiliary Hospital of Fujian Medical University from April 2018 to April 2022.According to the Scheuer scoring system,91 patients in phase S0-1 were defined as the mild fibrosis group,and 66 patients in phase S2-4 were defined as the significant fibrosis group.The differences in related indicators between the two groups were compared.Logistic regression analysis on indicators with statistically significant differences were performed,and relevant indicators were drawn to predict the receiver operating characteristic curve with significant fibrosis.Results The quantitative level of HBcAb was positively correlated with the degree of liver fibrosis in CHB patients(r=0.175,P=0.028).HBcAb,alanine aminotransferase(ALT),platelet(PLT),and hepatitis B virus deoxyribonucleic acid(HBV DNA)were independent risk factors(OR=1.794,1.017,0.989,0.779,P<0.05)for CHB patients to progress to significant fibrosis stage,and had predictive value for significant fibrosis stage(area under the curve=0.628,0.659,0.729,0.594,P<0.05).When the optimal cutoff value of HBcAb was 3.65 log10 IU/ml,the sensitivity for predicting significant fibrosis was 83.33%,and the specificity was 41.76%(P=0.004).Conclusion HBcAb had good predictive value for patients with initial treatment of CHB in the significant fibrosis stage and was worth further research.