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

Journal of Microbes and Infections ›› 2024, Vol. 19 ›› Issue (1) : 12-26.

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Journal of Microbes and Infections ›› 2024, Vol. 19 ›› Issue (1) : 12-26. DOI: 10.3969/j.issn.1673-6184.2024.01.002
Original Article

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
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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 is better than that of ALT in tandem with HBV DNA.

Key words

Hepatitis B virus DNA / Hepatitis B surface antigen / Chronic hepatitis B / Natural history / Survival analysis

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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[J]. Journal of Microbes and Infections. 2024, 19(1): 12-26 https://doi.org/10.3969/j.issn.1673-6184.2024.01.002
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