Performance evaluation of serum ALT in tandem with HBsAg and in tandem with HBV DNA in identifying HBeAg-positive chronic non-aggressive hepatitis
HUANG Dan1, LU Wei1, ZHANG Zhanqing1, LI Haicong2, ZHU Zhaoqin2
1. Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China; 2. Department of Medical Laboratory, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
Abstract：Hepatitis B e antigen (HBeAg)-positive chronic hepatitis B virus (HBV) infection undergoes two phases in sequence, termed non-aggressive hepatitis (NAH) and aggressive hepatitis (AH), respectively. But there is still a lack of perfect standard for defining HBeAg-positive NAH and AH. In this study, based on a long-term follow-up cohort of 179 patients, the functional cutoffs for alanine transaminase (ALT), hepatitis B surface antigen (HBsAg) and HBV DNA in identifying HBeAg-positive NAH were designated using Kaplan-Meier survival analysis with spontaneous HBeAg seroconversion as the endpoint event; On this basis, the performance of ALT in tandem with HBsAg and in tandem with HBV DNA in identifying HBeAg-positive NAH was evaluated. The results showed that, ALT≤60 IU/L, HBsAg >4.602 log10 IU/mL and HBV DNA >7.477 log10 IU/mL were the functional cutoffs in identifying HBeAg-positive NAH. Based on the functional cutoffs, among patients with ALT in tandem with HBsAg, the proportion of patients with pathological grade≤G1 and “grade≤G1 and stage≤S2” were both 100%, and with pathological stage≤S1 and “grade≤G2 and stage≤S1” were both 68.2%; among patients with ALT in tandem with HBV DNA, the proportion of patients with pathological grade≤G1 and “grade≤G1 and stage≤S2” were both 86.2%, and with pathological stage≤S1 and “grade≤G2 and stage≤S1” were both 69.0%; the positive likelihood ratios of ALT in tandem with HBsAg in identifying pathological grade≤G1 and “grade≤G1 and stage≤S2” were both ＋∞， and in identifying pathological stage≤S1 and “grade≤G2 and stage≤S1” were both 2.034; the positive likelihood ratios of ALT in tandem with HBV DNA in identifying pathological grade≤G1 and “grade≤G1 and stage≤S2” were 3.000 and 3.068, respectively, and in identifying pathological stage≤S1 and “grade≤G2 and stage≤S1” were both 2.106. The results suggested that, both ALT in tandem with HBsAg and in tandem with HBV DNA can effectively identify HBeAg-positive NAH. The performance of ALT in tandem with HBsAg in identifying HBeAg-positive NAH is better than that of ALT in tandem with HBV DNA.
黄丹1，陆伟1，张占卿1，李海聪2，朱召芹2. 血清ALT串联HBsAg和串联HBV DNA识别HBeAg阳性慢性HBV感染非活动性肝炎的性能评价[J]. 微生物与感染, 2024, 19(1): 12-26.
HUANG Dan1, LU Wei1, ZHANG Zhanqing1, LI Haicong2, ZHU Zhaoqin2. Performance evaluation of serum ALT in tandem with HBsAg and in tandem with HBV DNA in identifying HBeAg-positive chronic non-aggressive hepatitis. JOURNAL OF MICROBES AND INFECTIONS, 2024, 19(1): 12-26.
2024, Vol. 19 
