中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 38 Issue 5
May  2022
Turn off MathJax
Article Contents

Value of HBsAg level in predicting liver inflammation in patients with HBeAg-positive chronic hepatitis B virus infection and normal alanine aminotransferase

DOI: 10.3969/j.issn.1001-5256.2022.05.011
Research funding:

Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support (XMLX201706);

Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support (XMLX 202127);

National Science and Technology Major Project of China (2017ZX10201201-001-006);

National Science and Technology Major Project of China (2017ZX10201201-002-006);

National Science and Technology Major Project of China (2018ZX10715-005-003-005);

Special Public Health Project for Health Development in Capital (2021-1G-4061);

Special Public Health Project for Health Development in Capital (2022-1-2172);

The Digestive Medical Coordinated Development Center of Beijing Hospitals Authority (XXZ0302);

The Digestive Medical Coordinated Development Center of Beijing Hospitals Authority (XXT28);

Beijing Science and Technology Commission (D161100002716002);

Beijing Municipal Science & Technology Commission (Z151100004015122)

More Information
  • Corresponding author: XIE Yao, xieyao00120184@sina.com(ORCID: 0000-0003-4108-737)
  • Received Date: 2022-02-03
  • Accepted Date: 2022-03-14
  • Published Date: 2022-05-20
  •   Objective  To investigate the onset of liver inflammation and related predictive factors in patients with HBeAg-positive chronic hepatitis B virus (HBV) infection who have normal alanine aminotransferase (ALT) and a high viral load.  Methods  A retrospective analysis was performed for the clinical data of 183 patients with HBeAg-positive chronic HBV infection who had normal ALT and a high viral load and were treated from October 2008 to May 2015, and according to the results of liver biopsy, they were divided into hepatitis group and non- hepatitis group. The t-test or Mann-Whitney U testwas used for comparison of normally distributed continuous data between groups, the chi-square test was used for comparison of categorical data. The predictive factors were analyzed by univariate binary logistic regression, the multivariate binary logistic regression was carried out by stepback method, and the cut-off values were analyzed by receiver operating characteristic curve (ROC) and Jordan index.  Results  There were 37 patients (20.2%) in the hepatitis group and 146 patients (79.8%) in the non-hepatitis group. Compared with the non-hepatitis group, the hepatitis group had a significantly lower proportion of male patients (45.9% vs 68.5%, χ2=6.508, P=0.011), a significantly higher level of aspartate aminotransferase [24 (21.25~35.55) U/L vs 21.2 (18.08~ 24.65) U/L, Z=-3.344, P=0.001], and a significantly lower log(HBsAg) value [4.4(4.28~4.49) vs 4.46(4.4~4.74), Z=-2.184, P=0.029]. Log(HBsAg) value was a predictive factor for hepatitis (odds ratio=0.077, P=0.017), and the cutoff value of HBsAg was 33884.4I U/mL.  Conclusion  Among the patients with HBeAg-positive chronic HBV infection who have normal ALT and a high viral load, 20.2% have liver inflammation, and HBsAg may be a predictive factor for liver inflammation.

     

  • loading
  • [1]
    TAN M, BHADORIA AS, CUI F, et al. Estimating the proportion of people with chronic hepatitis B virus infection eligible for hepatitis B antiviral treatment worldwide: A systematic review and meta-analysis[J]. Lancet Gastroenterol Hepatol, 2021, 6(2): 106-119. DOI: 10.1016/S2468-1253(20)30307-1.
    [2]
    European Association for the Study of the Liver. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection[J]. J Hepatol 2017, 67(2): 370-398. DOI: 10.1016/j.jhep.2017.03.021.
    [3]
    Chinese Society of Infectious Diseases, Chinese Medical Association, Chinese Society of Hepatology, Chinese Medical Association. Guidelines for the prevention and treatment of chronic hepatitis B (version 2019)[J]. J Clin Hepatol, 2019, 35(12): 2648-2669. DOI: 10.3969/j.issn.1001-5256.2019.12.007.

    中华医学会感染病学分会, 中华医学会肝病学分会. 慢性乙型肝炎防治指南(2019年版)[J]. 临床肝胆病杂志, 2019, 35(12): 2648-2669. DOI: 10.3969/j.issn.1001-5256.2019.12.007.
    [4]
    KUMAR M, SARIN SK, HISSAR S, et al. Virologic and histologic features of chronic hepatitis B virus-infected asymptomatic patients with persistently normal ALT[J]. Gastroenterology, 2008, 134(5): 1376-1384. DOI: 10.1053/j.gastro.2008.02.075.
    [5]
    IANNACONE M, GUIDOTTI LG. Immunobiology and pathogenesis of hepatitis B virus infection[J]. Nat Rev Immunol, 2022, 22(1): 19-32. DOI: 10.1038/s41577-021-00549-4.
    [6]
    CAI Y, PAN L, LIN B, et al. Relationship between Treg/Th17 balance and changes in HBeAg among HBeAg-positive chronic hepatitis B patients receiving entecavir therapy[J]. Int J Virol, 2020, 27(5): 407-411. DOI: 10.3760/cma.j.issn.1673-4092.2020.05.013.

    蔡云, 潘良, 林斌, 等. 恩替卡韦治疗HBeAg阳性慢性乙型肝炎患者外周血Treg/Th17平衡与HBeAg的变化[J]. 国际病毒学杂志, 2020, 27(5): 407-411. DOI: 10.3760/cma.j.issn.1673-4092.2020.05.013.
    [7]
    VLACHOGIANNAKOS J, PAPATHEODORIDIS GV. Hepatitis B: Who and when to treat?[J]. Liver Int, 2018, 38 Suppl 1: 71-78. DOI: 10.1111/liv.13631.
    [8]
    GAO P, LUO Y, CHEN L, et al. The effect of hepatitis B virus on T lymphocyte and its subsets in chronic hepatitis B patients in different ALT stages: A new concept ALT in HBV infection[J]. Int Immunopharmacol, 2021, 101(Pt A): 108182. DOI: 10.1016/j.intimp.2021.108182.
    [9]
    SEONG G, SINN DH, KANG W, et al. Age and fibrosis index for the prediction of hepatocellular carcinoma risk in patients with high hepatitis B virus DNA but normal alanine aminotransferase[J]. Eur J Gastroenterol Hepatol, 2022, 34(1): 69-75. DOI: 10.1097/MEG.0000000000001915.
    [10]
    KIM GA, LIM YS, HAN S, et al. High risk of hepatocellular carcinoma and death in patients with immune-tolerant-phase chronic hepatitis B[J]. Gut, 2018, 67(5): 945-952. DOI: 10.1136/gutjnl-2017-314904.
    [11]
    LI MH, XIE Y. Antiviral therapy is not recommended for patients in the immune-tolerant phase of hepatitis B virus infection[J]. J Clin Hepatol, 2021, 37(4): 783-784. DOI: 10.3969/j.issn.1001-5256.2021.04.011.

    李明慧, 谢尧. HBV感染免疫耐受期患者不建议抗病毒治疗[J]. 临床肝胆病杂志, 2021, 37(4): 783-784. DOI: 10.3969/j.issn.1001-5256.2021.04.011.
    [12]
    LEE HA, LEE HW, KIM IH, et al. Extremely low risk of hepatocellular carcinoma development in patients with chronic hepatitis B in immune-tolerant phase[J]. Aliment Pharmacol Ther, 2020, 52(1): 196-204. DOI: 10.1111/apt.15741.
    [13]
    JIANG XY, HUANG B, HUANG DP, et al. Long-term follow-up of cumulative incidence of hepatocellular carcinoma in hepatitis B virus patients without antiviral therapy[J]. World J Gastroenterol, 2021, 27(11): 1101-1116. DOI: 10.3748/wjg.v27.i11.1101.
    [14]
    CHI Z, ZHAO W, LI JW, et al. Combination of quantitative hepatitis B core antibody (qHBcAb) and aspartate aminotransferase (AST) can accurately diagnose immune tolerance of chronic hepatitis B virus infection based on liver biopsy[J]. Clin Res Hepatol Gastroenterol, 2021, 45(6): 101563. DOI: 10.1016/j.clinre.2020.10.008.
    [15]
    TERRAULT NA, LOK A, MCMAHON BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance[J]. Hepatology, 2018, 67(4): 1560-1599. DOI: 10.1002/hep.29800.
    [16]
    LU J. A study on the influence of ALT, AST and ALP on the occurrence and development of viral hepatitis[J]. Labeled Immunoassays Clin Med, 2020, 27(1): 67-69, 95. DOI: 10.11748/bjmy.issn.1006-1703.2020.01.015.

    卢瑾. ALT、AST、ALP对病毒性肝炎患者病情发生发展的影响研究[J]. 标记免疫分析与临床, 2020, 27(1): 67-69, 95. DOI: 10.11748/bjmy.issn.1006-1703.2020.01.015.
    [17]
    VAILLANT A. HBsAg, subviral particles, and their clearance in establishing a functional cure of chronic hepatitis B virus infection[J]. ACS Infect Dis, 2021, 7(6): 1351-1368. DOI: 10.1021/acsinfecdis.0c00638.
    [18]
    LI MH, CHEN QQ, ZHANG L, et al. Association of cytokines with hepatitis B virus and its antigen[J]. J Med Virol, 2020. DOI: 10.1002/jmv.26301.
    [19]
    LIN YJ, SUN FF, ZENG Z, et al. Combination and intermittent therapy based on pegylated interferon Alfa-2a for chronic hepatitis B with Nucleoside (Nucleotide) analog-experienced resulting in hepatitis B surface antigen clearance: A case report[J]. Viral Immunol, 2022, 35(1): 71-75. DOI: 10.1089/vim.2021.0112.
    [20]
    LI MH, ZHANG L, QU XJ, et al. The predictive value of baseline HBsAg level and early response for HBsAg loss in patients with HBeAg-positive Chronic Hepatitis B during pegylated interferon alpha-2a treatment[J]. Biomed Environ Sci, 2017, 30(3): 177-184. DOI: 10.3967/bes2017.025.
    [21]
    PAN CQ, LI MH, YI W, et al. Outcome of Chinese patients with hepatitis B at 96 weeks after functional cure with IFN versus combination regimens[J]. Liver Int, 2021, 41(7): 1498-1508. DOI: 10.1111/liv.14801.
    [22]
    LI M, ZHANG L, LU Y, et al. Early serum HBsAg kinetics as predictor of HBsAg loss in patients with HBeAg-Negative chronic hepatitis B after treatment with pegylated interferonα-2a[J]. Virol Sin, 2021, 36(2): 311-320. DOI: 10.1007/s12250-020-00290-7.
    [23]
    CHAN HL, WONG VW, WONG GL, et al. A longitudinal study on the natural history of serum hepatitis B surface antigen changes in chronic hepatitis B[J]. Hepatology, 2010, 52(4): 1232-1241. DOI: 10.1002/hep.23803.
    [24]
    LIU J, WANG J, YAN X, et al. Presence of liver inflammation in Asian patients with chronic hepatitis B with normal ALT and detectable HBV DNA in absence of liver fibrosis[J]. Hepatol Commun, 2021. DOI: 10.1002/hep4.1859.
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(2)  / Tables(2)

    Article Metrics

    Article views (617) PDF downloads(69) Cited by()
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return