Park Ji Won, Kwak Kyeong Min, Kim Sung Eun, Jang Myoung Kuk, Kim Dong Joon, Lee Myung Seok, Kim Hyoung Su, Park Choong Kee
Ji Won Park, Sung Eun Kim, Choong Kee Park, Department of Internal Medicine, Hallym University Medical Center, Anyang 431-070, South Korea.
World J Gastroenterol. 2015 Apr 7;21(13):3953-9. doi: 10.3748/wjg.v21.i13.3953.
To identify the factors that differentiate acute hepatitis B (AHB) from chronic hepatitis B with acute exacerbation (CHB-AE).
From 2004 to 2013, a total of 82 patients (male n = 52, 63.4%; female n = 30, 36.6%) with clinical features of acute hepatitis with immunoglobulin M antibodies to the hepatitis B core antigen (IgM anti-HBc) were retrospectively enrolled and divided into two groups; AHB (n = 53) and CHB-AE (n = 29). The AHB group was defined as patients without a history of hepatitis B virus (HBV) infection before the episode and with loss of hepatitis B surface antigen within 6 mo after onset of acute hepatitis. Biochemical and virological profiles and the sample/cutoff (S/CO) ratio of IgM anti-HBc were compared to determine the differential diagnostic factors.
The multivariate analysis demonstrated that, the S/CO ratio of IgM anti-HBc and HBV DNA levels were meaningful factors. The S/CO ratio of IgM anti-HBc was significantly higher in the AHB group, while the HBV DNA level was significantly higher in the CHB-AE group. The optimal cutoff values of IgM anti-HBc and HBV DNA levels for differentiating the two conditions were 8 S/CO ratio and 5.5 log₁₀ IU/mL, respectively. The sensitivity and specificity were 96.2% and 89.7% for the S/CO ratio of IgM anti-HBc and 81.1% and 72.4% for HBV DNA levels, respectively. The area under receiver operating characteristic curves of both the S/CO ratio of IgM anti-HBc and HBV DNA levels were not significantly different (0.933 vs 0.844, P = 0.105). When combining IgM anti-HBc and HBV DNA, the diagnostic power significantly improved compared to HBV DNA alone (P = 0.0056). The combination of these factors yielded a sensitivity and specificity of 98.1% and 86.2%, respectively.
The combination of the S/CO ratio of IgM anti-HBc and HBV DNA levels was a useful tool for differentiating AHB from CHB-AE in patients with positive IgM anti-HBc.
确定区分急性乙型肝炎(AHB)与慢性乙型肝炎急性加重(CHB-AE)的因素。
回顾性纳入2004年至2013年期间共82例具有急性肝炎临床特征且抗乙型肝炎核心抗原免疫球蛋白M抗体(IgM抗-HBc)阳性的患者(男性n = 52,占63.4%;女性n = 30,占36.6%),并将其分为两组;AHB组(n = 53)和CHB-AE组(n = 29)。AHB组定义为在急性肝炎发作前无乙型肝炎病毒(HBV)感染史且在急性肝炎发病后6个月内乙型肝炎表面抗原消失的患者。比较生化和病毒学指标以及IgM抗-HBc的样本/临界值(S/CO)比值,以确定鉴别诊断因素。
多因素分析表明,IgM抗-HBc的S/CO比值和HBV DNA水平是有意义的因素。AHB组IgM抗-HBc的S/CO比值显著更高,而CHB-AE组的HBV DNA水平显著更高。区分这两种情况的IgM抗-HBc和HBV DNA水平的最佳临界值分别为8 S/CO比值和5.5 log₁₀ IU/mL。IgM抗-HBc的S/CO比值的敏感性和特异性分别为96.2%和89.7%,HBV DNA水平的敏感性和特异性分别为81.1%和72.4%。IgM抗-HBc的S/CO比值和HBV DNA水平的受试者工作特征曲线下面积无显著差异(0.933对0.844,P = 0.105)。当联合IgM抗-HBc和HBV DNA时,与单独使用HBV DNA相比,诊断效能显著提高(P = 0.0056)。这些因素的联合使用产生的敏感性和特异性分别为98.1%和86.2%。
IgM抗-HBc的S/CO比值和HBV DNA水平的联合是鉴别IgM抗-HBc阳性患者中AHB与CHB-AE的有用工具。