Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France.
The Gambia Hepatitis Intervention Study, IARC, c/o MRC Unit, Fajara, The Gambia.
J Hepatol. 2018 Oct;69(4):776-784. doi: 10.1016/j.jhep.2018.05.024. Epub 2018 Jul 1.
BACKGROUND & AIMS: To eliminate hepatitis B virus (HBV) infection, it is essential to scale up antiviral treatment through decentralized services. However, access to the conventional tools to assess treatment eligibility (liver biopsy/Fibroscan®/HBV DNA) is limited and not affordable in resource-limited countries. We developed and validated a simple score to easily identify patients in need of HBV treatment in Africa.
As a reference, we used treatment eligibility determined by the European Association for the Study of the Liver based on alanine aminotransferase (ALT), liver histology and/or Fibroscan and HBV DNA. We derived a score indicating treatment eligibility by a stepwise logistic regression using a cohort of chronic HBV infection in The Gambia (n = 804). We subsequently validated the score in an external cohort of HBV-infected Africans from Senegal, Burkina Faso, and Europe (n = 327).
Out of several parameters, two remained in the final model, namely HBV e antigen (HBeAg) and ALT level, constituting a simple score (treatment eligibility in Africa for the hepatitis B virus: TREAT-B). The score demonstrated a high area under the receiver operating characteristic curve (0.85, 95% CI 0.79-0.91) in the validation set. The score of 2 and above (HBeAg-positive and ALT ≥20 U/L or HBeAg-negative and ALT ≥40 U/L) had a sensitivity and specificity for treatment eligibility of 85% and 77%, respectively. The sensitivity and specificity of the World Health Organization criteria based on the aspartate aminotransferase-to-platelet ratio index (APRI) and ALT were 90% and 40%, respectively.
A simple score based on HBeAg and ALT had a high diagnostic accuracy for the selection of patients for HBV treatment. This score could be useful in African settings.
Limited access to the diagnostic tools used to assess treatment eligibility (liver biopsy/Fibroscan/hepatitis B virus DNA) has been an obstacle to the scale up of hepatitis B treatment programs in low- and middle-income countries. Using the data from African patients with chronic HBV infection, we developed and validated a new simple diagnostic score for treatment eligibility, which only consists of hepatitis B virus e antigen and alanine aminotransferase level. The diagnostic accuracy of the score for selecting patients for HBV treatment was high and could be useful in African settings.
要消除乙型肝炎病毒（HBV）感染，必须通过分散的服务扩大抗病毒治疗。然而，在资源有限的国家，获得评估治疗资格的常规工具（肝活检/Fibroscan®/HBV DNA）是有限的，也是负担不起的。我们开发并验证了一种简单的评分方法，以便在非洲容易识别需要接受 HBV 治疗的患者。
作为参考，我们使用欧洲肝脏研究协会根据丙氨酸氨基转移酶（ALT）、肝组织学和/或 Fibroscan 和 HBV DNA 确定的治疗资格。我们使用冈比亚慢性 HBV 感染患者队列（n=804）进行逐步逻辑回归，得出指示治疗资格的评分。随后，我们在来自塞内加尔、布基纳法索和欧洲的 HBV 感染非洲人外部队列（n=327）中验证了该评分。
在几个参数中，有两个参数保留在最终模型中，即 HBV e 抗原（HBeAg）和 ALT 水平，构成了一个简单的评分（用于乙型肝炎病毒的非洲治疗：TREAT-B）。该评分在验证组中具有较高的受试者工作特征曲线下面积（0.85，95%CI 0.79-0.91）。评分 2 分及以上（HBeAg 阳性且 ALT≥20 U/L 或 HBeAg 阴性且 ALT≥40 U/L）对治疗资格的敏感性和特异性分别为 85%和 77%。基于天门冬氨酸氨基转移酶-血小板比值指数（APRI）和 ALT 的世界卫生组织标准的敏感性和特异性分别为 90%和 40%。
基于 HBeAg 和 ALT 的简单评分对选择 HBV 治疗患者具有较高的诊断准确性。该评分可能在非洲环境中有用。
背景与目的：为了消除乙型肝炎病毒（HBV）感染，扩大抗病毒治疗至关重要。然而，在资源有限的国家，评估治疗资格的常规工具（肝活检/Fibroscan®/HBV DNA）获取受限且费用高昂。我们开发并验证了一种简单的评分方法，以便在非洲地区能够轻松识别需要接受 HBV 治疗的患者。
我们使用欧洲肝脏研究协会（EASL）基于丙氨酸氨基转移酶（ALT）、肝组织学和/或 Fibroscan 以及 HBV DNA 确定的治疗资格作为参考。我们使用冈比亚慢性 HBV 感染患者队列（n=804）进行逐步逻辑回归，得出指示治疗资格的评分。随后，我们在来自塞内加尔、布基纳法索和欧洲的 HBV 感染非洲人外部队列（n=327）中验证了该评分。
在多个参数中，有两个参数（HBV e 抗原和 ALT）保留在最终模型中，构成了一个简单的评分（用于乙型肝炎病毒的非洲治疗：TREAT-B）。该评分在验证组中具有较高的受试者工作特征曲线下面积（0.85，95%CI 0.79-0.91）。评分 2 分及以上（HBeAg 阳性且 ALT≥20 U/L 或 HBeAg 阴性且 ALT≥40 U/L）对治疗资格的敏感性和特异性分别为 85%和 77%。基于天门冬氨酸氨基转移酶-血小板比值指数（APRI）和 ALT 的世界卫生组织（WHO）标准的敏感性和特异性分别为 90%和 40%。
基于 HBeAg 和 ALT 的简单评分对选择 HBV 治疗患者具有较高的诊断准确性。该评分可能在非洲环境中有用。
