Tunçer Gülşah, Geyiktepe-Güçlü Ceyda, Bayramlar Osman Faruk, Atasoy-Bozan Burcu, Yücel Çiğdem, Sürme Serkan, Çopur Betül, Güçlü Kadir Görkem, Mustafayev Khalis, İkizceli Türkan, Uzuner Esen Gül, Yıldırım Mustafa, Şengöz Gönül, Pehlivanoglu Filiz
Department of Infectious Diseases and Clinical Microbiology, Haseki Training Research Hospital, İstanbul, Türkiye.
Bakırköy District Health Directorate, İstanbul, Türkiye.
Infect Dis Clin Microbiol. 2024 Mar 8;6(1):22-31. doi: 10.36519/idcm.2024.311. eCollection 2024 Mar.
This study aimed to determine the predictors for significant hepatic abnormality (SHA), a treatment indication, by assessing demographic, laboratory, and radiological results of chronic hepatitis B (CHB) patients who underwent liver biopsy.
In this retrospective study, individuals with untreated hepatitis B e-antigen (HBeAg)-negative CHB infection were enrolled. Multivariate analysis modeling was conducted with parameters identified as predictors for SHA in univariate analysis. Optimal threshold levels for variables to predict SHA in patients with chronic hepatitis B were determined based on receiver operating characteristic (ROC) curve analysis.
A total of 566 patients with untreated chronic hepatitis B were included in the cohort; 61% (345/566) were male, and the median age was 41 years (interquartile range [IQR]=34-50). Notably, 36.9% (209/566) had SHA. In the multivariate analysis, utilizing different models, age, gender, HBV-DNA, LDL, ALT, and platelet count were identified as the most reliable predictors for SHA in CHB patients. For predicting SHA, the area under the ROC curve values of HBV-DNA, AST, and ALT were 0.704 (sensitivity=62.8%, specificity=76.2%; <0.0001), 0.747 (sensitivity=51.9%, specificity=88.9%; <0.0001), and 0.737 (sensitivity=68.6%, specificity=68.4%; <0.0001), respectively.
In our study, age, male gender, ALT, AST, HBV-DNA, LDL cholesterol, platelet count, and FIB-4 score were independent predictors of SHA in HBeAg-negative chronic hepatitis B. The most sensitive parameters for SHA were LDL and ALT. The most specific parameters were age, AST, and APRI score. SHA may occur in patients with high HBV-DNA levels, even if ALT values are normal in HBeAg-negative patients.
本研究旨在通过评估接受肝活检的慢性乙型肝炎（CHB）患者的人口统计学、实验室检查和影像学结果，确定作为治疗指征的显著肝脏异常（SHA）的预测因素。
在这项回顾性研究中，纳入了未经治疗的乙肝e抗原（HBeAg）阴性CHB感染患者。对单因素分析中确定为SHA预测因素的参数进行多因素分析建模。基于受试者工作特征（ROC）曲线分析确定慢性乙型肝炎患者预测SHA的变量的最佳阈值水平。
该队列共纳入566例未经治疗的慢性乙型肝炎患者；61%（345/566）为男性，中位年龄为41岁（四分位间距[IQR]=34-50）。值得注意的是，36.9%（209/566）有SHA。在多因素分析中，利用不同模型，年龄、性别、HBV-DNA、低密度脂蛋白（LDL）、丙氨酸氨基转移酶（ALT）和血小板计数被确定为CHB患者SHA最可靠的预测因素。对于预测SHA，HBV-DNA、天门冬氨酸氨基转移酶（AST）和ALT的ROC曲线下面积值分别为0.704（敏感性=62.8%，特异性=76.2%；<0.0001）、0.747（敏感性=51.9%，特异性=88.9%；<0.0001）和0.737（敏感性=68.6%，特异性=68.4%；<0.0001）。
在我们的研究中，年龄、男性性别、ALT、AST、HBV-DNA、LDL胆固醇、血小板计数和FIB-4评分是HBeAg阴性慢性乙型肝炎中SHA的独立预测因素。SHA最敏感的参数是LDL和ALT。最具特异性的参数是年龄、AST和天冬氨酸氨基转移酶与血小板比值指数（APRI）评分。即使HBeAg阴性患者的ALT值正常，HBV-DNA水平高的患者也可能发生SHA。
