FibroScan对乙肝e抗原阴性慢性乙型肝炎患者肝纤维化的预测价值，这些患者的HBV DNA为2000 - 20000 IU/ml，ALT为正常上限的1 - 2倍，以及HBV DNA>20000 IU/ml且ALT正常的患者。
Predictive value of FibroScan in detecting liver fibrosis in HBeAg negative patients with chronic hepatitis B whose HBV DNA 2000-20000 IU/ml with ALT 1-2 times the upper limit of normal and those with HBV DNA >20000 IU/ml and normal ALT.
作者信息
Danis Nilay, Salih Akarca Ulus, Turan Ilker, Karasu Zeki, Ersoz Galip, Yilmaz Funda, Nart Deniz, Zeytinoglu Aysin, Selda Erensoy Memnune, Gunsar Fulya
机构信息
Division of Gastroenterology, Department of Internal Medicine, Karabuk University Faculty of Medicine, Karabuk, Turkey.
Division of Gastroenterology, Department of Internal Medicine, Ege University Faculty of Medicine, Izmir, Turkey.
出版信息
North Clin Istanb. 2021 Dec 31;8(6):568-574. doi: 10.14744/nci.2021.35545. eCollection 2021.
OBJECTIVE
In hepatitis B infection, it is difficult to make a treatment decision in patients with slightly elevated transaminases and HBV DNA level between 2000 and 20000 IU/ml, and in those with normal ALT, despite high levels of HBV DNA. Objectives: In HBeAg negative patients whose HBV DNA levels were between 2000 and 20000 IU/ml with ALT 1-2 times the upper limit of normal (ULN) and those with HBV DNA >20000 IU/ml and normal ALT, the concordance between liver fibrosis in biopsy and liver stiffness measured by transient elastography with FibroScan (FS) was investigated, and diagnostic value of FS to predict the liver fibrosis was tested.
METHODS
The patients were selected from the outpatient hepatology clinics between the dates of November 2014 and October 2016 among those who were taken liver biopsy. Transient elastography was obtained within 3 months after liver biopsy. The diagnostic value of FS in detecting advanced fibrosis or moderate to advanced (MTA) fibrosis was investigated for each group.
RESULTS
In 38 patients with HBV DNA 2000-20000 IU/ml and ALT 1-2×ULN, advanced fibrosis was detected in only one patient (2.6%) on liver biopsy, sensitivity of FS to show advanced fibrosis is 100%, specificity 78.3%, and diagnostic accuracy rate 79%. The area under curve was determined to be 0.892. In detecting MTA fibrosis, these values are 100%, 62%, 71%, and 0.810, respectively. Of 79 patients with HBV DNA >20000 IU/ml and normal ALT, five had advanced (5.5%) and 18 had MTA (23%) fibrosis. Sensitivity of FS in detecting advanced fibrosis was 100%, specificity 87.8%, and accuracy 88.6%, and these values for MTA fibrosis were 85.7%, 81%, and 82.3%, respectively.
CONCLUSION
Because of false negativity in a few patients with HBV DNA >20000 IU/ml in detecting MTA, FS may be combined with other non-invasive techniques. Negative predictive values of FS in predicting advanced or MTA fibrosis were very high, while positive predictive values were low. However, FS may save several patients from liver biopsy.
目的
在乙型肝炎感染中，对于转氨酶轻度升高且HBV DNA水平在2000至20000 IU/ml之间的患者，以及ALT正常但HBV DNA水平高的患者，很难做出治疗决策。目的：在HBeAg阴性患者中，研究HBV DNA水平在2000至20000 IU/ml且ALT为正常上限（ULN）的1 - 2倍的患者，以及HBV DNA>20000 IU/ml且ALT正常的患者，肝活检中的肝纤维化与通过FibroScan（FS）瞬时弹性成像测量的肝脏硬度之间的一致性，并测试FS预测肝纤维化的诊断价值。
方法
从2014年11月至2016年10月期间门诊肝病诊所接受肝活检的患者中选取研究对象。在肝活检后3个月内进行瞬时弹性成像检查。研究FS在每组中检测高级纤维化或中度至高级（MTA）纤维化的诊断价值。
结果
在38例HBV DNA为2000 - 20000 IU/ml且ALT为1 - 2×ULN的患者中，肝活检仅发现1例（2.6%）存在高级纤维化，FS检测高级纤维化的敏感性为100%，特异性为78.3%，诊断准确率为79%。曲线下面积确定为0.892。在检测MTA纤维化时，这些值分别为100%、62%、71%和0.810。在79例HBV DNA>20000 IU/ml且ALT正常的患者中，5例有高级（5.5%）纤维化，18例有MTA（23%）纤维化。FS检测高级纤维化的敏感性为100%，特异性为87.8%，准确性为88.6%，检测MTA纤维化的这些值分别为85.7%、81%和82.3%。
结论
由于在检测MTA时，少数HBV DNA>20000 IU/ml的患者存在假阴性，FS可与其他非侵入性技术联合使用。FS预测高级或MTA纤维化的阴性预测值非常高，而阳性预测值较低。然而，FS可使一些患者免于肝活检。
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