低病毒载量HBeAg阴性慢性HBV感染者肝组织学特点及不同诊断指标对非活动携带的诊断价值

肝脏 ›› 2017, Vol. 22 ›› Issue (9): 789-793.

低病毒载量HBeAg阴性慢性HBV感染者肝组织学特点及不同诊断指标对非活动携带的诊断价值

李阳, 肖丽, 叶茂聪, 杨秀珍, 张会, 耿爱文, 李晓琴, 孙鸿展, 徐洪涛, 咸建春

225300 江苏南通大学附属泰州市人民医院肝病科

收稿日期:2017-05-05 出版日期:2017-09-30 发布日期:2020-08-03
通讯作者: 咸建春,Email: xianjc09@163.com
基金资助:
中国肝炎防治基金会天晴肝病研究基金项目(CFHPC20132110)

Diagnostic value of different criteria for inactive HBsAg carriers and liver histological features in HBeAg-negative chronic hepatitis B patients with low HBV DNA level

LI Yang, XIAO li, YE Mao-cong, YANG Xiu-zhen, ZHANG Hui, GENG Ai-wen, LI Xiao-qin, SUN Hong-zhan, XU Hong-tao, XIAN Jian-chun

Department of Liver Disease, Taizhou People′s Hospital, Taizhou 225300, China

Received:2017-05-05 Online:2017-09-30 Published:2020-08-03
Contact: XIAN Jian-chun, Email: xianjc09@163.com

摘要/Abstract

摘要： 目的探讨低病毒载量HBeAg阴性慢性HBV感染者的肝组织学特点,评价不同临床标准对非活动HBsAg携带(IC)的诊断价值。方法选择HBV DNA < 4.3 lg IU/mL、ALT< 2×正常值上限(ULN)、HBeAg阴性的慢性HBV感染者为研究对象,观察其肝组织特点,炎症活动指数(HAI) ≤ 3或病变轻微定义为病理学的IC。临床诊断标准：A组为2015年中国指南标准(ALT正常,HBV DNA< 2.3 lg IU/mL),B组为2015年亚太与美国指南标准(ALT正常,HBV DNA < 3.3 lg IU/mL),C组为ALT < 2×ULN、HBV DNA < 2.3 lg IU/mL,D组为ALT < 2×ULN,HBV DNA < 3.3 lg IU/mL)。以肝组织学结果为“金标准”评价四组IC临床诊断标准的价值。结果 171例患者入选,其中男性125例,女46例,年龄22 ~ 69岁,平均(45.5±4.2)岁。HAI 1~11分,平均(4.3±2.1)分,其中≤3分者94例,占55.0%;纤维化积分(S)0~4分,平均(2.0±1.6)分,其中0 ~ 1分101例,占59.1%。不同临床IC诊断标准筛选的病例与病理IC的符合率没有显著差异。四种筛查方法的约登指数为0.08~0.11,AUC为0.544~0.558,判断IC的价值有限。所有入选病例中符合中国、亚太与欧美指南IC临床诊断的患者,仅有50%~60%符合病理IC,而临床非IC的患者中,有33.3%~51.4%符合病理学的IC诊断。结论低病毒载量HBeAg阴性慢性HBV感染者中有50%~60%的患者符合病理的IC诊断,而临床非IC的患者中,有33.3%~51.4%符合病理学的IC诊断。若以病理结果为IC诊断的“金标准”,现有指南推荐的临床标准诊断IC的效率不高,判断价值有限,亚太与美国指南(2015)略有优势。

关键词: 慢性HBV感染, 非活动HBsAg携带, 病理, 诊断

Abstract: ObjectiveTo investigate the histological characteristics of hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (CHB) patients with low viral load and to evaluate the diagnostic value of different criteria for inactive hepatitis B surface antigen (HBsAg) carriers (IC). Methods HBeAg-negative CHB patients with HBV DNA < 4.3 log₁₀ IU/mL and alanine aminotransferase (ALT) < 2 the upper limit of normal (ULN) were enrolled in the study. All patients underwent liver biopsy. Patients with histological activity index (HAI) ≤ 3 or mild liver pathological damage were defined as pathologically IC. Four clinical criteria were applied in the study. For diagnosis of IC, group A was based on the 2015 Chinese guidelines (normal ALT, HBV DNA < 2.3 log₁₀ IU/mL), group B was on the 2015 APASL or AASLD guidelines (normal ALT, HBV DNA < 3.3 log₁₀ IU/mL), group C was on ALT < 2 ULN and HBV DNA < 2.3 log₁₀ IU/mL, and Group D was on normal ALT and HBV DNA < 3.3 log₁₀ IU/mL. Diagnostic value of the 4 clinical criteria of IC was evaluated using liver biopsy, which was the golden standard. Results A total of 171 patients were enrolled, including 125 males and 46 females, with mean age of 45.5±4.24 (22-69) year old. HAI ranged from 1 to 11 with the average value of 4.3±2.1, which was ≤ 3 in 94 cases (55.0%). Fibrosis score ranged from 0 to 4 with the average value of 2.0±1.6. A total of 101 (59.1%) cases had fibrosis score from 0 to 1. There was no significant difference in IC diagnosis rate among the 4 groups with different clinical IC diagnostic criteria. The Yourdon′s index for the 4 criteria was 0.08 ~ 0.11 and the area under the curve (AUC) was 0.544 ~ 0.558, respectively, which suggested their limitation of IC diagnosis. There were only 50% ~ 60% patients pathologically diagnosed of IC in patients according to Chinese and APASL/AASLD guidelines. However, in the non-IC patients diagnosed with clinical criteria, there were 33.3% ~ 51.4% patients meeting the pathological IC diagnosis. Conclusion There were 50% ~ 60% patients meeting the pathological IC among HBeAg-negative CHB patients with low viral load. Among the non-IC patients diagnosed by clinical criteria, 33.3% ~ 51.4% patients were pathologically diagnosed of IC. Based on the diagnostic golden standard of histology, clinical diagnosis of IC with current Chinese, APASL and AASLD guidelines showed low sensitivity and limited value.

Key words: Chronic HBV infection, Inactive HBsAg carrying, Pathology, Diagnosis

李阳, 肖丽, 叶茂聪, 杨秀珍, 张会, 耿爱文, 李晓琴, 孙鸿展, 徐洪涛, 咸建春. 低病毒载量HBeAg阴性慢性HBV感染者肝组织学特点及不同诊断指标对非活动携带的诊断价值[J]. 肝脏, 2017, 22(9): 789-793.

LI Yang, XIAO li, YE Mao-cong, YANG Xiu-zhen, ZHANG Hui, GENG Ai-wen, LI Xiao-qin, SUN Hong-zhan, XU Hong-tao, XIAN Jian-chun. Diagnostic value of different criteria for inactive HBsAg carriers and liver histological features in HBeAg-negative chronic hepatitis B patients with low HBV DNA level[J]. Chinese Hepatolgy, 2017, 22(9): 789-793.

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