Centre de Recherche Biomédicale Bichat-Beaujon (CRB3), INSERM U-773 and Service d'Hépatologie Hôpital Beaujon APHP, Université Paris-Diderot, 92110 Clichy, France.
J Hepatol. 2013 Jun;58(6):1089-95. doi: 10.1016/j.jhep.2013.01.028. Epub 2013 Jan 28.
BACKGROUND & AIMS: Little is currently known about the association between serum HBsAg or HBV DNA levels and the severity of liver disease in chronic hepatitis B (CHB) patients. Therefore, we investigated these relationships in a large cohort of unselected, well-characterized, treatment-naïve CHB patients.
CHB patients were assessed at the Hôpital Beaujon in Paris, France, between 2000 and 2008. Serum samples and liver biopsies were obtained on the same day. HBsAg, HBV DNA, and HBV genotype were investigated using commercial diagnostic assays and liver histology was scored using the METAVIR system.
406 patients were included in this cross-sectional study. Serum HBsAg and HBV DNA levels in hepatitis B e antigen-positive (HBeAg[+]) patients showed strong correlation (r=0.44, p<0.0001), as did serum HBsAg levels and fibrosis severity (r=0.43, p<0.0001). HBeAg(+) patients with moderate to severe fibrosis exhibited significantly lower serum HBsAg and HBV DNA levels compared with patients with no or mild fibrosis. Modeling analysis suggested a serum HBsAg cut-off of 3.85 logIU/ml would provide a theoretical sensitivity of 100% (95% CI: 0-100), theoretical specificity of 86% (95% CI: 50-100), and a negative predictive value of 100% (95% CI: 67-100) in HBeAg(+) patients infected with HBV genotype B or C.
We found an association between low serum HBsAg levels and moderate to severe fibrosis in HBeAg(+) CHB patients. Furthermore, we described a serum HBsAg cut-off for the prediction of fibrosis severity in CHB patients infected with HBV genotype B or C.
目前对于慢性乙型肝炎（CHB）患者的血清 HBsAg 或 HBV DNA 水平与肝病严重程度之间的关系知之甚少。因此，我们在一大群未经选择、特征良好、未经治疗的 CHB 患者中对此进行了研究。
2000 年至 2008 年期间，法国巴黎博让医院对 CHB 患者进行了评估。在同一天获得血清样本和肝活检。使用商业诊断检测方法检测 HBsAg、HBV DNA 和 HBV 基因型，使用 METAVIR 系统对肝组织学进行评分。
本横断面研究共纳入 406 例患者。HBeAg（+）患者的血清 HBsAg 和 HBV DNA 水平呈强相关性（r=0.44，p<0.0001），HBsAg 水平与纤维化严重程度也呈强相关性（r=0.43，p<0.0001）。中重度纤维化的 HBeAg（+）患者的血清 HBsAg 和 HBV DNA 水平明显低于无或轻度纤维化患者。模型分析提示，血清 HBsAg 截断值为 3.85 logIU/ml 时，理论敏感性为 100%（95%CI：0-100），理论特异性为 86%（95%CI：50-100），阴性预测值为 100%（95%CI：67-100），适用于感染 HBV 基因型 B 或 C 的 HBeAg（+）患者。
我们发现 HBeAg（+）CHB 患者的血清 HBsAg 水平与中重度纤维化之间存在关联。此外，我们描述了用于预测感染 HBV 基因型 B 或 C 的 CHB 患者纤维化严重程度的血清 HBsAg 截断值。
