Abstract: Objective To evaluate the predictive value of serum hepatitis B surface antigen (HBsAg), hepatitis B core-related antigen (HBcrAg) and hepatitis B virus (HBV) DNA for liver pathology in chronic hepatitis B (CHB) patients. Methods CHB patients, containing 324 HBeAg-positive and 255 HBeAg-negative cases, were randomly divided into 3 paired train and validation sets. Serum HBsAg and HBcrAg were measured by Lumipulse G1200 and Abbott Architect I2000 automatic chemiluminescence immunoassay analyzers, respectively. Serum HBV DNA was detected by Bio-Rad Icycler fluorescence quantitative PCR system. Scheuer scoring system was applied for pathological evaluation of liver tissues, containing 5 grades from G0 to G4 and 5 stages from S0 to S4. Results Gender ratio, average age and proportion of pathological grades and stages in 3 paired train and validation sets showed no statistically significant differences (P>0.05) in both HBeAg positive and negative cases. In HBeAg-positive patients, the areas under receiver operating characteristic curve (ROC) of serum HBsAg, HBcrAg and HBV DNA for predicting ≥ G3 and ≥ S4 in complete set were the largest. Referring to the optimal cutoffs for predicting ≥ G3 and ≥ S4 in 3 train sets, the ranges of sensitivities of serum HBsAg, HBcrAg and HBV DNA for predicting ≥ G3 and ≥ S4 in the 3 matched validation sets were 37%, 30%, 17% and 9%, 16%, 14%, respectively. Meanwhile, the ranges of specificity were 12%, 13%, 15% and 5%, 3%, 6%, respectively. In HBeAg-negative patients, the areas under ROC of serum HBcrAg and HBV DNA for predicting ≥ G2 and ≥ S2 in complete set were the largest. Based on the optimal cutoffs in 3 train sets, the ranges of sensitivity of serum HBcrAg and HBV DNA for predicting ≥ G2 and ≥ S2 in the 3 matched validation sets were 11%, 46% and 19%, 20%, respectively, and the ranges of specificities were 15%, 38% and 2%, 16%, respectively. Conclusion In HBeAg-positive patients, serum HBsAg, HBcrAg and HBV DNA were suitable for predicting pathologic states of ≥ G3 and ≥ S4, and the stabilities for predicting ≥ S4 were better than those for predicting ≥ G3. In HBeAg-negative patients with pathologic states of ≥ G2 and ≥ S2, serum HBcrAg and HBV DNA were the best predictable indicators, and serum HBcrAg showed better stabilities than serum HBV DNA.

Key words: Hepatitis B surface antigen; Hepatitis B core-related antigen; Hepatitis B virus DNA; Liver tissue; Pathology; Noninvasive diagnosis