γ-谷氨酰转肽酶与血小板比值可预测丙氨酸氨基转移酶正常的乙肝e抗原阴性慢性乙型肝炎患者的肝损伤
Gamma-glutamyl Transpeptidase to Platelet Ratio Predicts Liver Injury in Hepatitis B e Antigen-negative Chronic Hepatitis B Patients With Normal Alanine Aminotransferase.
作者信息
Zhao Xiang-An, Wang Jian, Wei Jie, Liu Jiacheng, Chen Guangmei, Wang Li, Wang Guiyang, Xia Juan, Wu Weihua, Yin Shengxia, Tong Xin, Yan Xiaomin, Ding Weimao, Xiang Xiaoxing, Huang Rui, Wu Chao
机构信息
Department of Gastroenterology, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China.
Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
出版信息
J Clin Transl Hepatol. 2022 Apr 28;10(2):247-253. doi: 10.14218/JCTH.2021.00151. Epub 2021 Jul 14.
BACKGROUND AND AIMS
Chronic hepatitis B virus (HBV) infection is a serious health problem worldwide. Evaluating liver injury in patients with hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (CHB) with detectable HBV DNA and normal alanine aminotransferase (ALT) is crucial to guide their clinical management. We aimed to investigate the stages of liver inflammation and fibrosis as well as the predictive accuracy of gamma-glutamyl transpeptidase-to-platelet ratio (GPR) in these patients.
METHODS
A total of 184 treatment-naïve HBeAg-negative CHB patients with detectable HBV DNA and normal ALT were enrolled. The Scheuer scoring system was used to classify liver inflammation and fibrosis.
RESULTS
The distribution of patients with different liver inflammation grades were as follows: G0, 0 (0%); G1, 97 (52.7%); G2, 68 (37.0%); G3, 12 (6.5%); and G4, 7 (3.8%). The distribution of patients with different liver fibrosis stages were as follows: S0, 22 (12.0%); S1, 72 (39.1%); S2, 42 (22.8%); S3, 19 (10.3%); and S4, 29 (15.8%). The areas under the receiver operating characteristic (AUROC) curves of GPR in predicting significant inflammation, severe inflammation, and advanced inflammation were 0.723, 0.895, and 0.952, respectively. The accuracy of GPR was significantly superior to that of ALT in predicting liver inflammation. The AUROCs of GPR in predicting significant fibrosis, severe fibrosis, and cirrhosis were 0.691, 0.780, and 0.803, respectively. The predictive accuracy of GPR was significantly higher than that of aminotransferase-to-platelet ratio index (APRI) and fibrosis index based on four factors (FIB-4) in identifying advanced fibrosis and cirrhosis, and it was superior to FIB-4 but comparable to APRI in identifying significant fibrosis.
CONCLUSIONS
Nearly half of the HBeAg-negative CHB patients with detectable HBV DNA and normal ALT levels had significant liver inflammation or fibrosis. GPR can serve as an accurate predictor of liver inflammation and fibrosis in these patients.
背景与目的
慢性乙型肝炎病毒（HBV）感染是全球范围内一个严重的健康问题。评估乙肝e抗原（HBeAg）阴性的慢性乙型肝炎（CHB）患者，其HBV DNA可检测且丙氨酸氨基转移酶（ALT）正常时的肝损伤情况，对于指导其临床管理至关重要。我们旨在研究这些患者的肝脏炎症和纤维化阶段，以及γ-谷氨酰转肽酶与血小板比值（GPR）的预测准确性。
方法
共纳入184例未经治疗的HBeAg阴性CHB患者，其HBV DNA可检测且ALT正常。采用Scheuer评分系统对肝脏炎症和纤维化进行分类。
结果
不同肝脏炎症分级的患者分布如下：G0，0例（0%）；G1，97例（52.7%）；G2，68例（37.0%）；G3，12例（6.5%）；G4，7例（3.8%）。不同肝脏纤维化阶段的患者分布如下：S0，22例（12.0%）；S1，72例（39.1%）；S2，42例（22.8%）；S3，19例（10.3%）；S4，29例（15.8%）。GPR预测显著炎症、重度炎症和进展期炎症的受试者工作特征（AUROC）曲线下面积分别为0.723、0.895和0.952。在预测肝脏炎症方面，GPR的准确性显著优于ALT。GPR预测显著纤维化、重度纤维化和肝硬化的AUROC分别为0.691、0.780和0.803。在识别进展期纤维化和肝硬化方面，GPR的预测准确性显著高于转氨酶与血小板比值指数（APRI）和基于四项因素的纤维化指数（FIB-4），在识别显著纤维化方面，GPR优于FIB-4但与APRI相当。
结论
近一半HBV DNA可检测且ALT水平正常的HBeAg阴性CHB患者存在显著的肝脏炎症或纤维化。GPR可作为这些患者肝脏炎症和纤维化的准确预测指标。
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