Serum hepatitis B surface antigen levels predict insignificant fibrosis and non-cirrhosis in hepatitis B e antigen positive patients with normal or mildly elevated alanine transaminase levels
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Qiang Li1,2, Weixia Li1, Chuan Lu1, Yuxian Huang1,2 and Liang Chen1
1Department of Hepatitis, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
2Department of Infectious Disease, Huashan Hospital, Fudan University, Shanghai 200040, China
Liang Chen, email: [email protected]
Qiang Li, email: [email protected]
Keywords: chronic hepatitis B, liver fibrosis, cirrhosis, non-invasive marker, hepatitis B surface antigen
Received: July 18, 2017 Accepted: August 27, 2017 Published: September 23, 2017
Background/Aims: We aimed to evaluate the diagnostic value of serum hepatitis B surface antigen (HBsAg) levels for liver fibrosis in hepatitis B e antigen-positive [HBeAg (+)] chronic hepatitis B (CHB) patients with alanine transaminase (ALT)≤twice upper limit of normal (ULN). Methods: 505 patients who underwent liver biopsies and HBsAg quantitative detections were included. Liver histology was scored using METAVIR scoring system. The area under the receiver-operator curve (AUROC) was used to determine the diagnostic accuracy. Results: Of 505 CHB patients, 333 have HBeAg (+), and 172 have HBeAg (-). HBsAg levels and METAVIR fibrosis scores showed strong correlation (r=-0.50, p<0.001) in HBeAg (+) patients, but no correlation in HBeAg (-) patients (r=0.09, p=0.239). HBeAg (+) patients with insignificant fibrosis (F0-1) exhibited higher HBsAg levels than those with significant fibrosis (F2-4) (4.60 vs 4.12 log10IU/ml, p<0.001). HBeAg (+) patients with non-cirrhosis (F0-3) exhibited higher HBsAg levels than those with cirrhosis (F4) (4.48 vs 3.95 log10IU/ml, p<0.001). In this study, the AUROC of HBsAg was 0.86 for diagnosing insignificant fibrosis, and 0.91 for diagnosing non-cirrhosis in HBeAg (+) CHB patients. Conclusions: Serum HBsAg level can identify insignificant fibrosis and non-cirrhosis in HBeAg (+) CHB patients with ALT≤2 ULN, and thus avoid liver biopsy in this population.
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