Zeng Da-Wu, Zhang Jie-Min, Liu Yu-Rui, Dong Jing, Jiang Jia-Ji, Zhu Yue-Yong
From Liver Center (D-WZ, Y-RL, JD, J-JJ, Y-YZ); and Department of Pharmacy, The First Affiliated Hospital, Fujian Medical University, Taijiang District, Fuzhou, Fujian, China (J-MZ).
Medicine (Baltimore). 2016 Feb;95(8):e2503. doi: 10.1097/MD.0000000000002503.
To investigate changes in the HBV replication level along with the natural course of chronic HBV infection and to examine the accuracy of the immune tolerant phase defined by the serological profile.A total of 390 chronic HBV-infected patients were retrospectively recruited for this study. They were classified into immune-tolerance (IT), immune-clearance (IC), low-replicative (LR), and HBeAg-negative hepatitis (ENH) phases according to serological profiles (single-standard, SS) or dual-standard (DS) with the inclusion of liver histology. Serum HBV DNA and HBsAg were quantitatively measured, and liver histology was quantitatively analyzed.The accuracy of the SS-defined IT phase was low, and active pathological changes were detected in 56 of 112 SS-defined IT patients. DS-defined IT patients had higher HBsAg levels (P = 0.0002) than the SS-defined patients. The quantitative HBsAg level can help identify SS-defined IT patients with potential liver injury. The area under the received operating characteristic curve for predicting the DS-defined IT phase was 0.831 (HBsAg 4.398 log IU/mL; sensitivity 87.5%; specificity 73.2%). HBV DNA was reduced by 4 logs, whereas HBsAg was only decreased by 2 logs with HBeAg positive to negative phase conversion.Approximately half of IT patients defined by SS may have medium or severe liver injury. Quantitative measurement of the HBsAg level can help identify SS-defined IT patients with potential liver injury.
研究慢性乙型肝炎病毒（HBV）感染自然病程中HBV复制水平的变化，并检验血清学特征所定义的免疫耐受期的准确性。本研究共回顾性纳入390例慢性HBV感染患者。根据血清学特征（单标准，SS）或双标准（DS）并结合肝脏组织学，将他们分为免疫耐受（IT）、免疫清除（IC）、低复制（LR）和HBeAg阴性肝炎（ENH）期。对血清HBV DNA和HBsAg进行定量检测，并对肝脏组织学进行定量分析。SS定义的IT期准确性较低，在112例SS定义的IT患者中有56例检测到活动性病理改变。DS定义的IT患者的HBsAg水平高于SS定义的患者（P = 0.0002）。定量HBsAg水平有助于识别有潜在肝损伤的SS定义的IT患者。预测DS定义的IT期的受试者工作特征曲线下面积为0.831（HBsAg 4.398 log IU/mL；敏感性87.5%；特异性73.2%）。随着HBeAg从阳性转为阴性，HBV DNA降低了4个对数，而HBsAg仅降低了2个对数。约一半由SS定义的IT患者可能有中度或重度肝损伤。定量检测HBsAg水平有助于识别有潜在肝损伤的SS定义的IT患者。
