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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 37 Issue 1
Jan.  2021
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Article Navigation >  Journal of Clinical Hepatology  > 2021  >  37(1): 51-55

Noninvasive indicators of indications for antiviral therapy in HBeAg-negative chronic HBV infection patients with alanine aminotransferase ≤40 U/L

DOI: 10.3969/j.issn.1001-5256.2021.01.011

  • Department of Infectious Diseases, Affiliated Hospital of Yan'an University, Yan'an, Shaanxi 716000, China

  • Received Date: 2020-07-06
  • Accepted Date: 2020-09-07
  • Published Date: 2021-01-20
    Abstract
  •   Objective  To investigate the noninvasive indicators of indications for antiviral therapy in HBeAg-negative chronic hepatitis B virus (HBV) infection patients with alanine aminotransferase (ALT) ≤40 U/L under the guidance of liver pathology.  Methods  A retrospective analysis was performed for the clinical data of 377 HBeAg-negative chronic HBV infection patients with ALT ≤40 U/L who were hospitalized in Affiliated Hospital of Yan'an University, from October 2013 to August 2018 and underwent liver biopsy, among whom the patients with inflammatory activity < A2 and fibrosis stage < F2 were enrolled as non-antiviral therapy group(n=266), and the patients with inflammatory activity ≥A2 or fibrosis stage ≥F2 were enrolled as antiviral therapy group(n=111). The chi-square test was used for comparison of categorical data between two groups; the t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; univariate and multivariate binary logistic regression analyses were used to screen out the influencing factors for the initiation of antiviral therapy; the receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic efficiency of each indicator in determining the need for antiviral therapy in HBeAg-negative chronic HBV infection patients with ALT ≤40 U/L.  Results  Of all 377 patients, 266 (70.6%) did not need antiviral therapy for the time being, and 111 (29.4%) had marked liver damage and thus needed active antiviral therapy. The multivariate analysis showed that liver stiffness measurement (LSM) (odds ratio [HR]=2.003, 95% confidence interval [CI]: 1.647-2.437, P < 0.05), HBsAg (HR=1.563, 95% CI: 1.110-2.200, P < 0.05), HBV DNA (HR=1.519, 95% CI: 1.173-1.966, P < 0.05), and albumin (HR=0.939, 95% CI: 0.884-0.998, P < 0.05) were independent influencing factors for the initiation of antiviral therapy. The ROC curve analysis showed that the area under the ROC curve (AUC) was 0.749 (95% CI: 0.699-0.799) for LSM, 0.642 (95% CI: 0.586-0.699) for HBV DNA, and 0.565 (95% CI: 0.507-0.623) for HBsAg, and the combination of LSM, HBV DNA, and HBsAg had a larger AUC of 0.779 (95% CI: 0.732-0.827).  Conclusion  The levels of LSM, HBV DNA, and HBsAg have a reference value in determining the initiation of antiviral therapy in HBeAg-negative chronic HBV infection patients with ALT≤40 U/L.

     

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