Department of Gastroenterology, Fuzhou Second Hospital, Fujian, China.
Department of Clinical Medicine, Fujian Medical University, Fujian, China.
Immun Inflamm Dis. 2024 Jan;12(1):e1134. doi: 10.1002/iid3.1134.
This study aimed to investigate the role of immunocompetence in chronic hepatitis B (CHB) patients with normal alanine transaminase (ALT) levels and negative hepatitis B e antigen (HBeAg) in the risk assessments of the progression of liver fibrosis.
We collected the clinical data of 57 patients with CHB, with normal ALT levels and negative HBeAg from December 2020 to December 2022. With hepatitis B virus (HBV) DNA > 20 IU/mL and ALT ≤ 40 U/L, these patients had never undergone antiviral therapy. The levels of CD4 , CD4 CD25 , CD8 , and CD4 CD25 CD127 regulatory T cells (Tregs) in the patients were detected using flow cytometry; the liver stiffness measurement (LSM) values of the patients were detected using Fibroscan.
There was a statistically significant difference between the levels of fibrosis-4 (FIB-4) and hepatitis B surface antigen (HBsAg) when the cutoff point was HBsAg ≥ 1500 (p < .001). FIB-4 was negatively correlated with HBsAg (R = -0.291, p = .028) and positively correlated with age (R = 0.787, p < .001). LSM was negatively correlated with Treg but this correlation was not statistically significant (p > .05). Findings based on the analysis using logistic regression were as follows: (i) age was the independent risk factor when FIB-4 was used as the indicator for assessing liver fibrosis; (ii) Treg was the independent risk factor when LSM was used as the indicator for assessing liver fibrosis. When Treg was used to predict liver fibrosis, the cutoff value, diagnostic efficacy, area under the receiver operating characteristic (ROC) curve, and p value of the ROC curve were 6.875, 0.641, 0.84, and .027, respectively.
Age and Treg are independent risk factors for progressive liver fibrosis. The cutoff value of Treg > 6.81 indicates the need for timely antiviral treatment and can serve as an indicator for evaluating liver fibrosis.
本研究旨在探讨免疫功能在乙型肝炎病毒（HBV）携带者中的作用，这些患者的丙氨酸氨基转移酶（ALT）水平正常且乙型肝炎 e 抗原（HBeAg）阴性，其肝纤维化进展的风险评估。
我们收集了 2020 年 12 月至 2022 年 12 月期间 57 例 ALT 水平正常且 HBeAg 阴性的 CHB 患者的临床资料。这些患者 HBV DNA>20IU/ml 且 ALT≤40U/L，从未接受过抗病毒治疗。采用流式细胞术检测患者外周血 CD4+、CD4+CD25+、CD8+和 CD4+CD25+CD127+调节性 T 细胞（Tregs）水平；采用 Fibroscan 检测患者肝硬度值（LSM）。
当 HBsAg 截断值为 HBsAg≥1500 时，纤维化-4（FIB-4）和乙型肝炎表面抗原（HBsAg）的水平存在统计学差异（p<0.001）。FIB-4 与 HBsAg 呈负相关（R=-0.291，p=0.028），与年龄呈正相关（R=0.787，p<0.001）。LSM 与 Treg 呈负相关，但无统计学意义（p>0.05）。基于使用逻辑回归进行分析的结果如下：（i）当使用 FIB-4 作为评估肝纤维化的指标时，年龄是独立的危险因素；（ii）当使用 LSM 作为评估肝纤维化的指标时，Treg 是独立的危险因素。当使用 Treg 预测肝纤维化时，截断值、诊断效能、ROC 曲线下面积和 ROC 曲线的 p 值分别为 6.875、0.641、0.84 和.027。
年龄和 Treg 是进行性肝纤维化的独立危险因素。Treg>6.81 的截断值提示需要及时进行抗病毒治疗，并可作为评估肝纤维化的指标。
