血清ALT串联HBsAg和串联HBV DNA识别HBeAg阳性慢性HBV感染非活动性肝炎的性能评价

Performance evaluation of serum ALT in tandem with HBsAg and in tandem with HBV DNA in identifying HBeAg-positive chronic non-aggressive hepatitis

乙型肝炎病毒(hepatitis B virus,HBV)e抗原(hepatitis B e antigen,HBeAg)阳性的慢性HBV感染依次经历非活动性肝炎(non-aggressive hepatitis,NAH)和活动性肝炎(aggressive hepatitis,AH)2个分期,但仍缺乏界定HBeAg阳性NAH与AH的可靠标准。本文根据179例患者的长期随访队列,以自发性HBeAg血清转换作为终点事件,采用Kaplan-Meier生存分析,指定了丙氨酸转氨酶(alanine transaminase,ALT)、HBV表面抗原(hepatitis B surface antigen,HBsAg)和HBV DNA识别HBeAg阳性NAH的功能截断值;在此基础上,评价了ALT串联HBsAg和串联HBV DNA识别HBeAg阳性NAH的性能。结果显示,ALT≤60 IU/L、HBsAg>4.602 log10IU/mL和HBV DNA>7.477 log10IU/mL为识别HBeAg阳性NAH的功能截断值。基于功能截断值,ALT串联HBsAg的患者中,病理学分级≤G1和“分级≤G1且分期≤S2”的构成比均为100%,病理学分期≤S1和“分级≤G2且分期≤S1”的构成比均为68.2%;ALT串联HBV DNA的患者中,病理学分级≤G1和“分级≤G1且分期≤S2”的构成比均为86.2%,病理学分期≤S1和“分级≤G2且分期≤S1”的构成比均为69.0%;ALT串联HBsAg识别病理学分级≤G1和“分级≤G1且分期≤S2”的阳性似然比均为+∞,识别病理学分期≤S1和“分级≤G2且分期≤S1”的阳性似然比均为2.034;ALT串联HBV DNA识别病理学分级≤G1和“分级≤G1且分期≤S2”的阳性似然比分别为3.000和3.068,识别病理学分期≤S1和“分级≤G2且分期≤S1”的阳性似然比均为2.106。以上结果提示,ALT串联HBsAg和串联HBV DNA均可有效识别HBeAg阳性NAH;且ALT串联HBsAg识别HBeAg阳性NAH的性能优于ALT串联HBV DNA。

Hepatitis B e antigen(HBeAg)-positive chronic hepatitis B virus(HBV)infection undergoes two phases in sequence,termed non-aggressive hepatitis(NAH)and aggressive hepatitis(AH),respectively.But there is still a lack of perfect standard for defining HBeAg-positive NAH and AH.In this study,based on a long-term follow-up cohort of 179 patients,the functional cutoffs for alanine transaminase(ALT),hepatitis B surface antigen(HBsAg)and HBV DNA in identifying HBeAg-positive NAH were designated using Kaplan-Meier survival analysis with spontaneous HBeAg seroconversion as the endpoint event;On this basis,the performance of ALT in tandem with HBsAg and in tandem with HBV DNA in identifying HBeAg-positive NAH was evaluated.The results showed that,ALT≤60 IU/L,HBsAg>4.602 log10 IU/mL and HBV DNA>7.477 log10 IU/mL were the functional cutoffs in identifying HBeAg-positive NAH.Based on the functional cutoffs,among patients with ALT in tandem with HBsAg,the proportion of patients with pathological grade≤G1 and“grade≤G1 and stage≤S2”were both 100%,and with pathological stage≤S1 and“grade≤G2 and stage≤S1”were both 68.2%;among patients with ALT in tandem with HBV DNA,the proportion of patients with pathological grade≤G1 and“grade≤G1 and stage≤S2”were both 86.2%,and with pathological stage≤S1 and“grade≤G2 and stage≤S1”were both 69.0%;the positive likelihood ratios of ALT in tandem with HBsAg in identifying pathological grade≤G1 and“grade≤G1 and stage≤S2”were both+∞,and in identifying pathological stage≤S1 and“grade≤G2 and stage≤S1”were both 2.034;the positive likelihood ratios of ALT in tandem with HBV DNA in identifying pathological grade≤G1 and“grade≤G1 and stage≤S2”were 3.000 and 3.068,respectively,and in identifying pathological stage≤S1 and“grade≤G2 and stage≤S1”were both 2.106.The results suggested that,both ALT in tandem with HBsAg and in tandem with HBV DNA can effectively identify HBeAg-positive NAH.The performance of ALT in tandem with HBsAg in identifying HBeAg-positive NAH is better than that of ALT in tandem with HBV DNA.