Department of Infectious Diseases, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China; Department of Liver Diseases, The Sixth People's Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang, China.
J Gastroenterol Hepatol. 2013 Nov;28(11):1746-55. doi: 10.1111/jgh.12304.
The role of serum quantitative hepatitis B surface antigen (qHBsAg) in identifying hepatitis B virus (HBV) carriers with significant fibrosis is unknown. This study aims to evaluate the diagnostic value of qHBsAg for hepatic fibrosis in hepatitis B e antigen (HBeAg)-positive HBV carriers.
Consecutive biopsy-proven HBeAg-positive HBV carriers were prospectively recruited in our center from 2009 to 2011 and were randomly divided into training and validation set. Area under receiver-operator curve (AUC) was used to determine the diagnostic accuracy of simple tests for significant fibrosis (Scheuer stage, F ≥ 2).
Overall, a total of 197 eligible patients (median age 31 years; 149 males) were enrolled. The median qHBsAg was 4.20 (log10 IU/mL). Significant fibrosis was confirmed in 112 (56.9%) patients. By logistical regression analysis, qHBsAg and γ-glutamyl transpeptidase were identified as predictors for significant fibrosis in training set (n = 124). Thus, qHBsAg index and γ-glutamyl transpeptidase to qHBsAg ratio (GqHBsR) were selected for the subsequent analysis. In the training set, an AUC of 0.762, 0.826, 0.749, and 0.771 was observed for qHBsAg index, GqHBsR, FIB-4, and aspartate aminotransferase to platelet ratio index, respectively (all P < 0.05). GqHBsR yielded a higher AUC than aspartate aminotransferase to platelet ratio index and FIB-4 (both P < 0.05). Using the optimal cut-off of 7.78, GqHBsR showed a sensitivity of 78.9% and a specificity of 73.6%. About 80% of liver biopsy could be avoided in the entire cohort.
Serum qHBsAg-based simple tests, especially GqHBsR, can accurately and specifically identify significant fibrosis in treatment-naïve HBeAg-positive HBV carriers.
血清乙型肝炎表面抗原定量（qHBsAg）在识别乙型肝炎病毒（HBV）携带者的显著纤维化中的作用尚不清楚。本研究旨在评估 qHBsAg 在乙型肝炎 e 抗原（HBeAg）阳性 HBV 携带者中诊断肝纤维化的价值。
2009 年至 2011 年，我们中心前瞻性连续招募了经肝活检证实的 HBeAg 阳性 HBV 携带者，并将其随机分为训练集和验证集。受试者工作特征曲线（AUC）用于确定简单测试对显著纤维化（Scheuer 分期，F≥2）的诊断准确性。
共有 197 名符合条件的患者（中位年龄 31 岁；149 名男性）入组。qHBsAg 的中位数为 4.20（log10 IU/mL）。在 124 名训练集患者中，确认存在显著纤维化。通过逻辑回归分析，qHBsAg 和γ-谷氨酰转肽酶被确定为显著纤维化的预测因子。因此，qHBsAg 指数和γ-谷氨酰转肽酶与 qHBsAg 的比值（GqHBsR）被用于后续分析。在训练集中，qHBsAg 指数、GqHBsR、FIB-4 和天冬氨酸氨基转移酶与血小板比值指数的 AUC 分别为 0.762、0.826、0.749 和 0.771（均 P<0.05）。GqHBsR 的 AUC 高于天冬氨酸氨基转移酶与血小板比值指数和 FIB-4（均 P<0.05）。使用 7.78 的最佳截断值，GqHBsR 的灵敏度为 78.9%，特异性为 73.6%。在整个队列中，约 80%的肝活检可以避免。
基于血清 qHBsAg 的简单测试，尤其是 GqHBsR，可以准确、特异的识别治疗前 HBeAg 阳性 HBV 携带者的显著纤维化。
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