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JOURNAL OF MICROBES AND INFECTIONS
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Performance evaluation of serum ALT in tandem with HBsAg and in tandem with HBV DNA in identifying HBeAg-positive chronic non-aggressive hepatitis
huang dan
Shanghai Public Health Clinical Center

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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 was better than that of ALT in tandem with HBV DNA.
Received: 25 September 2023      Published: 25 February 2024
Corresponding Authors: huang dan   
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huang dan. Performance evaluation of serum ALT in tandem with HBsAg and in tandem with HBV DNA in identifying HBeAg-positive chronic non-aggressive hepatitis[J]. JOURNAL OF MICROBES AND INFECTIONS, 2024, 19(1): 12-26.
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http://jmi.fudan.edu.cn/EN/     OR     http://jmi.fudan.edu.cn/EN/Y2024/V19/I1/12
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