Lower baseline ALT cut-off values and HBV DNA levels better differentiate HBeAg(-) chronic hepatitis B patients from inactive chronic carriers
Lower baseline ALT cut-off values and HBV DNA levels better differentiate HBeAg(-) chronic hepatitis B patients from inactive chronic carriers
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DOI：
10.3748/wjg.15.3025
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发表时间：
2009-06-28
影响因子：
4.3
通讯作者：
Nseir, William
中科院分区：
文献类型：
--
作者：
Assy, Nimer;Beniashvili, Zaza;Nseir, William
目的：确定新的谷丙转氨酶（ALT）临界值和基线乙型肝炎病毒（HBV） DNA水平是否能更好地区分HBeAg（-）型慢性乙型肝炎（CHB）患者和非活动型慢性乙型肝炎（CHB）携带者。方法：对91例患者(32例HBeAg(+) CHB， 19例HBeAg（-) CHB， 40例HBeAg(+) CHB）进行为期2年的随访，采用基于pcr的方法检测HBV DNA水平。在最近6次小鼠实验中检测了两次ALT：男性ULN（正常上限）为30 IU/L，女性为19 IU/L。通过判别分析计算诊断准确性、敏感性、特异性、阳性预测值和阴性预测值。结果：当使用修改后的ALT临界值时，区分HBeAg(-) CHB患者与非活跃携带者的最低最佳HBV DNA水平为50000拷贝/mL。HBV DNA在确定无活性携带者时的诊断准确度为50000拷贝/毫升，与之前推荐的100000拷贝/毫升相近（91%）。在95%的无活性携带者和28%的HBeAg(-) CHB患者中，HBV DNA水平低于临界值。男性ALT < 30 IU/L，女性< 19 IU/L， HBV DNA水平< 100000拷贝/mL时，CHB的风险为5%。另一方面，如果男性ALT值为> 30 IU，女性为> 19 IU，基线HBV DNA水平为> 100000拷贝/mL，则风险为86%。结论：AASLD（美国肝病研究协会）和NIH（美国国立卫生研究院）共识提出的ALT和HBV DNA水平的新临界值似乎适合用于表征无活性携带者。(c) 2009年WJG出版社、白石登出版社。版权所有。
AIM: To determine whether new cut-off values for alanine aminotransferase (ALT) and baseline hepatitis B virus (HBV) DNA levels better differentiate HBeAg(-) chronic hepatitis B (CHB) patients from inactive chronic carriers.METHODS: Ninety-one patients [32 HBeAg(+) CHB, 19 inactive carriers and 40 HBeAg(-) CHB] were followed up for 2 years and were tested for HBV DNA levels by a PCR-based assay. ALT was tested twice during the last 6 mousing new cut-off values: ULN (upper limit of normal) 30 IU/L for males, 19 IU/L for females. Diagnostic accuracy, sensitivity, specificity, positive and negative predictive values were calculated by discriminant analysis.RESULTS: When using the revised ALT cut-off values, the lowest optimal HBV DNA level that differentiated HBeAg(-) CHB patients from inactive carriers was 50000 copies/mL. The diagnostic accuracy of HBV DNA to determine inactive carriers with a cut-off of 50000 copies/mL was similar to the previously recommended cut-off of 100000 copies/mL (91%). HBV DNA levels were lower than the cut-off value in 95% of inactive carriers and in 28% of HBeAg(-) CHB patients. With ALT < 30 IU/L in men and < 19 IU/L in women and HBV DNA levels < 100000 copies/mL, the risk of CHB is 5%. On the other hand, if ALT values were > 30 IU in men and > 19 IU in women and baseline HBV DNA levels were > 100000 copies/mL, the risk is 86%.CONCLUSION: New cut-off values for ALT together with HBV DNA levels proposed by AASLD (American Association for the Study of Liver Diseases) and NIH (National Institute of Health) consensus seem appropriate to characterize inactive carriers. (c) 2009 The WJG Press and Baishideng. All rights reserved.