Sonneveld Milan J, Hansen Bettina E, Brouwer Willem P, Chan Henry L-Y, Piratvisuth Teerha, Jia Ji-Dong, Zeuzem Stefan, Chien Rong-Nan, de Knegt Robert J, Wat Cynthia, Pavlovic Vedran, Gaggar Anuj, Xie Qing, Buti Maria, de Man Robert A, Janssen Harry L A
Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Toronto Centre for Liver Disease, University Health Network, Toronto, Canada.
J Infect Dis. 2022 Jun 1;225(11):1967-1973. doi: 10.1093/infdis/jiaa192.
Serum hepatitis B surface antigen (HBsAg) levels correlate with the duration of chronic hepatitis B virus (HBV) infection and may predict the extent of hepatic fibrosis.
We analyzed data from the SONIC-B database, which contains data from 8 global randomized trials and 2 large hepatology centers. Relationship between HBsAg levels and presence of significant fibrosis (Ishak 3-4) or cirrhosis (Ishak 5-6) were explored, and clinically relevant cutoffs were identified to rule out cirrhosis.
The dataset included 2779 patients: 1866 hepatitis B e antigen (HBeAg)-positive; 322 with cirrhosis. Among HBeAg-positive patients, lower HBsAg levels were associated with higher rates of significant fibrosis (odds ratio [OR], 0.419; P < .001) and cirrhosis (OR, 0.435; P < .001). No relationship was observed among HBeAg-negative patients. Among HBeAg-positive patients, genotype-specific HBsAg cutoffs had excellent negative predictive values (>97%) and low misclassification rates (≤7.1%) and may therefore have utility in ruling out cirrhosis. Diagnostic performance of the HBsAg cutoffs was comparable among patients in whom cirrhosis could not be ruled out with fibrosis 4 (FIB-4).
Hepatitis B virus genotype-specific HBsAg cutoffs may have utility in ruling out presence of cirrhosis in HBeAg-positive patients with genotypes B, C, and D and can be an adjunct to FIB-4 to reduce the need for further testing.
血清乙肝表面抗原（HBsAg）水平与慢性乙型肝炎病毒（HBV）感染的持续时间相关，并且可能预测肝纤维化的程度。
我们分析了SONIC-B数据库中的数据，该数据库包含来自8项全球随机试验和2个大型肝病中心的数据。探讨了HBsAg水平与显著纤维化（Ishak 3-4级）或肝硬化（Ishak 5-6级）存在之间的关系，并确定了用于排除肝硬化的临床相关临界值。
数据集包括2779例患者：1866例乙肝e抗原（HBeAg）阳性；322例患有肝硬化。在HBeAg阳性患者中，较低的HBsAg水平与较高的显著纤维化发生率（优势比[OR]，0.419；P <.001）和肝硬化发生率（OR，0.435；P <.001）相关。在HBeAg阴性患者中未观察到相关性。在HBeAg阳性患者中，基因型特异性HBsAg临界值具有出色的阴性预测值（>97%）和低错误分类率（≤7.1%），因此可能有助于排除肝硬化。在无法通过纤维化4（FIB-4）排除肝硬化的患者中，HBsAg临界值的诊断性能相当。
乙肝病毒基因型特异性HBsAg临界值可能有助于排除B、C和D基因型的HBeAg阳性患者中的肝硬化存在，并且可以作为FIB-4的辅助手段以减少进一步检测的需求。
