Department of Infectious Disease, Sungurlu State Hospital, Çorum, Turkey.
Department of Infectious Disease, Medical School of Cerrahpasa, Istanbul University-Cerrahpasa, Istanbul, Turkey.
Wien Klin Wochenschr. 2021 Jul;133(13-14):647-653. doi: 10.1007/s00508-021-01854-7. Epub 2021 Apr 29.
We aimed to determine the contribution of quantitative HBsAg in differentiating chronic infections from chronic hepatitis in HBeAg negative patients with HBV DNA 2000-20,000 IU/ml.
A total of 79 untreated HBeAg negative patients were included. Patients were divided into 3 groups based on HBV DNA levels: group 1 (HBV DNA ≤ 2000 IU/ml), group 2 (HBV DNA: 2000-20,000 IU/ml) and group 3 (HBV DNA > 20,000 IU/ml). We collected serum from all patients for quantitative HBsAg analysis. We compared serum quantitative HBsAg levels with biochemical parameters, HBV DNA and liver biopsy results.
In this study 46 patients were female and the mean age was 42 years. Serum quantitative HBsAg levels were found to be significantly lower in chronic infections compared with chronic hepatitis. There was a positive correlation between quantitative HBsAg and HBV DNA, ALT (alanine aminotransferase), HAI score (histological activity index), fibrosis score and disease stage. The cut-off level of quantitative HBsAg was determined as 4425 IU/ml to differentiate chronic infection from chronic hepatitis. With the test specificity of 95%, we found quantitative HBsAg cut-off values 1026 IU/ml and 20,346 IU/ml for the diagnosis of chronic infection and chronic hepatitis, respectively.
Our study suggests that the quantitative HBsAg ≤ 1000 IU/ml limit value might be used for the diagnosis of chronic infection not only in HBV DNA ≤ 2000 IU/ml but also in patients with HBV DNA between 2000-20,000 IU/ml. In addition, antiviral treatment could be considered in patients with quantitative HBsAg > 20,000 IU/ml and HBV DNA > 2000 IU/ml without further examinations such as liver biopsy.
我们旨在确定定量 HBsAg 在区分 HBeAg 阴性患者慢性感染与慢性乙型肝炎中的作用，这些患者的 HBV DNA 水平在 2000-20,000 IU/ml 之间。
共纳入 79 例未经治疗的 HBeAg 阴性患者。根据 HBV DNA 水平将患者分为 3 组：第 1 组（HBV DNA≤2000IU/ml）、第 2 组（HBV DNA：2000-20,000IU/ml）和第 3 组（HBV DNA＞20,000IU/ml）。我们从所有患者收集血清进行定量 HBsAg 分析。我们比较了血清定量 HBsAg 水平与生化参数、HBV DNA 和肝活检结果。
在这项研究中，46 例患者为女性，平均年龄为 42 岁。与慢性乙型肝炎相比，慢性感染患者的血清定量 HBsAg 水平显著降低。定量 HBsAg 与 HBV DNA、ALT（丙氨酸氨基转移酶）、HAI 评分（组织学活动指数）、纤维化评分和疾病分期呈正相关。定量 HBsAg 的截止值确定为 4425IU/ml，以区分慢性感染与慢性乙型肝炎。在测试特异性为 95%的情况下，我们发现定量 HBsAg 截止值分别为 1026IU/ml 和 20,346IU/ml，可用于诊断慢性感染和慢性乙型肝炎。
我们的研究表明，定量 HBsAg≤1000IU/ml 限值不仅可用于 HBV DNA≤2000IU/ml 的慢性感染诊断，也可用于 HBV DNA 在 2000-20,000IU/ml 之间的患者。此外，对于定量 HBsAg＞20,000IU/ml 且 HBV DNA＞2000IU/ml 的患者，无需进一步检查（如肝活检）即可考虑抗病毒治疗。
