[慢性乙型肝炎病毒（HBV）感染：HBeAg与ALT联合检测预测高HBV-DNA水平的效用以及因此将患者转诊至专科医生处进行可能的抗病毒治疗的必要性]

[Chronic hepatitis B virus (HBV) infection: usefulness of the combination of HBeAg and ALT determination to predict a high HBV-DNA level and therefore the necessity of referral to a specialist for possible antiviral treatment].

作者信息

Veldhuijzen I K, Mostert M C, Niesters H G M, Richardus J H, de Man R A

机构信息

GGD Rotterdam-Rijnmond, Cluster Infectieziektebestrijding, Postbus 70.032, 3000 LP Rotterdam.

出版信息

Ned Tijdschr Geneeskd. 2008 Jun 21;152(25):1426-30.

PMID:18624006

Abstract

OBJECTIVE

To assess the usefulness of a simple practical guideline based on hepatitis B e-antigen (HBeAg) status and a single alanine aminotransferase (ALT) determination to predict hepatitis B virus (HBV) load in chronic HBV patients as a criterion for referral to a specialist for possible antiviral therapy.

DESIGN

Prospective observational study.

METHOD

420 patients with chronic HBV infection were seen at the Municipal Health Service (MHS) in Rotterdam between 2002 and 2005. The usefulness ofa guideline based on HBeAg positivity and/or elevated ALT levels to predict high HBV DNA levels (defined as more than 10(5) copies/ml) was determined. Patients with HBeAg or an elevated ALT level were referred to a specialist according to the practical guideline. Positive and negative predictive value, sensitivity, and specificity of the referral guideline for a high HBV-DNA level were calculated.

RESULTS

Less than half, 43% (181/420) of the patients, were eligible for referral to specialist care. The positive predictive value of the referral guideline was 45% (82/181, 95% CI: 38-53). The negative predictive value, i.e. the proportion of patients with low viral loads who were (rightly) not selected for referral, was 95% (227/239; 95% CI: 71-97). The sensitivity was 87% (95% CI: 80-93): the patients selected included 82 of 94 patients with a high HBV DNA level. Of the 12 patients with high viral loads not referred according to the guideline, 11 had a viral load of between 10(5)-10(6) copies/ml.

CONCLUSION

A referral guideline based on HBeAg status and a single ALT determination can successfully predict viral load in chronic HBV patients and can be used in primary care to select patients for referral to specialist care. This guideline may limit the number of unnecessarily referred patients, enhancing the efficiency of the care for patients with chronic HBV infection.

摘要

目的

评估基于乙肝e抗原（HBeAg）状态和单次丙氨酸氨基转移酶（ALT）测定的简单实用指南，以预测慢性乙肝病毒（HBV）感染者的HBV载量，作为转诊至专科医生处进行抗病毒治疗的标准。

设计

前瞻性观察研究。

方法

2002年至2005年期间，在鹿特丹市卫生服务中心（MHS）对420例慢性HBV感染患者进行了观察。确定基于HBeAg阳性和/或ALT水平升高的指南对预测高HBV DNA水平（定义为超过10⁵拷贝/ml）的有效性。根据实用指南，将HBeAg阳性或ALT水平升高的患者转诊至专科医生处。计算高HBV-DNA水平转诊指南的阳性预测值、阴性预测值、敏感性和特异性。

结果

不到一半（43%，181/420）的患者符合转诊至专科护理的条件。转诊指南的阳性预测值为45%（82/181；95%CI：38-53）。阴性预测值，即病毒载量低（正确）未被选择转诊的患者比例为95%（227/239；95%CI：71-97）。敏感性为87%（95%CI：80-93）：所选患者包括94例高HBV DNA水平患者中的82例。在未按指南转诊的12例高病毒载量患者中，11例病毒载量在10⁵-1⁶拷贝/ml之间。