Division of Clinical and Molecular Hepatology, University Hospital of Messina, Messina, Italy.
Department of Human Pathology, University of Messina, Messina, Italy.
Liver Int. 2017 Mar;37(3):362-368. doi: 10.1111/liv.13246. Epub 2016 Oct 5.
BACKGROUND & AIMS: Serial evaluation of hepatitis B virus (HBV) DNA and aminotransferase values is required for identification of inactive HBV carriers (ICs). Recently, HBV surface antigen quantification (qHBsAg) and liver stiffness measurement (LSM) have been proposed as diagnostic tools in chronic HBV infection. The aim of this study was to evaluate the efficacy of HBV DNA quantification, qHBsAg and LSM in diagnosing ICs at a single time point.
Fifty-seven previously characterized ICs and 90 untreated HBsAg-/anti-HBe-positive patients [49 chronic hepatitis (CH), 41 cirrhosis] were enrolled. HBV DNA ≤2000 IU/mL, LSM ≤6.2 kPa and qHBsAg ≤1000 IU/mL were used as cut-offs to evaluate sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy (DA).
Combined HBV DNA quantification and qHBsAg correctly identified 30/57 (52.6%) ICs showing 94% sensitivity, 96% specificity, 98% PPV, 87% NPV and 95% DA. HBV DNA coupled with LSM identified 40/57 (70.2%) ICs showing 97% sensitivity, 97% specificity, 98% PPV, 95% NPV and 97% DA. Combined LSM and qHBsAg identified 33/57 (57.9%) ICs showing 95% sensitivity, 78% specificity, 89% PPV, 89% NPV and 89% DA. The evaluation of the three parameters altogether allowed the identification of 23/57 (40.3%) ICs showing 100% specificity, 96% sensitivity, 100% PPV, 92% NPV and 97% DA. Similar results were obtained when either CH or cirrhotic patients were excluded from the analysis.
Combined evaluation of HBV DNA amount with LSM and/or qHBsAg is a highly reliable tool allowing the identification of a considerable number of HBV ICs at a single time point evaluation.
为了确定乙型肝炎病毒（HBV）携带者（IC），需要对 HBV DNA 和氨基转移酶值进行连续评估。最近，HBV 表面抗原定量（qHBsAg）和肝脏硬度测量（LSM）已被提议作为慢性 HBV 感染的诊断工具。本研究旨在评估单次检测时 HBV DNA 定量、qHBsAg 和 LSM 诊断 IC 的效果。
纳入 57 例已明确的 IC 和 90 例未经治疗的 HBsAg/抗-HBe 阳性患者[49 例慢性肝炎（CH），41 例肝硬化]。HBV DNA≤2000 IU/mL、LSM≤6.2 kPa 和 qHBsAg≤1000 IU/mL 被用作评估灵敏度、特异性、阳性预测值（PPV）、阴性预测值（NPV）和诊断准确性（DA）的截断值。
联合 HBV DNA 定量和 qHBsAg 正确识别 57 例 IC 中的 30 例（52.6%），其灵敏度为 94%，特异性为 96%，PPV 为 98%，NPV 为 87%，DA 为 95%。HBV DNA 联合 LSM 识别出 57 例 IC 中的 40 例（70.2%），其灵敏度为 97%，特异性为 97%，PPV 为 98%，NPV 为 95%，DA 为 97%。联合 LSM 和 qHBsAg 识别出 57 例 IC 中的 33 例（57.9%），其灵敏度为 95%，特异性为 78%，PPV 为 89%，NPV 为 89%，DA 为 89%。联合评估这三个参数可以识别 57 例 IC 中的 23 例（40.3%），其特异性为 100%，灵敏度为 96%，PPV 为 100%，NPV 为 92%，DA 为 97%。当排除 CH 或肝硬化患者进行分析时，也得到了相似的结果。
联合评估 HBV DNA 量与 LSM 和/或 qHBsAg 是一种高度可靠的工具，可以在单次检测时识别出相当数量的 HBV IC。
