ALT和HBV DNA联合诊断e抗原阴性的慢性活动性乙型肝炎诊断界值的建立及评价

目的建立和评估丙氨酸氨基转移酶(ALT)、乙型肝炎病毒(HBV)DNA和天门冬氨酸氨基转移酶(AST)对乙型肝炎e抗原(HBeAg)阴性活动性乙型肝炎的诊断界值(Cut-off值)。方法将290例HBeAg阴性的慢性乙型肝炎患者以肝组织活检结果为标准分为活动性(213例)和非活动性(77例)慢性乙型肝炎,用受试者工作特征(ROC)曲线评价ALT、AST和HBV DNA载量在诊断HBeAg阴性的活动性慢性乙型肝炎中的价值。结果血清中ALT、AST、HBV DNA载量的ROC曲线下面积(AUC)分别为0.849、0.807、0.867;诊断界值为男性ALT 30 IU/L、女性ALT 19 IU/L,HBV DNA载量1×105拷贝/mL时的敏感性为90.6%、特异性为98.7%、阳性预测值为99.5%、阴性预测值为79.2%;AST以40 IU/L作为Cut-off值时的敏感性为77.0%、特异性为63.3%、阳性预测值为85.4%、阴性预测值为50.0%。结论可以以男性ALT 30 IU/L、女性ALT 19 IU/L且HBV DNA载量1×105拷贝/mL作为中国四川自贡地区HBeAg阴性的慢性活动性乙型肝炎的诊断Cut-off值。

Establishment and assessment of the cut-off value for ALT and HBV DNA combination determination to diagnose HBeAg negative chronic active hepatitis B

Objective To establish and assess the cut-off value for alanine aminotransferase （ALT）,hepatitis B virus （HBV）DNA and aspartate aminotransferase（AST）to diagnose hepatitis B eantigen （HBeAg）negative chronic active hepatitis B.Methods A total of 290 HBeAg negative chronic hepatitis B patients were enrolled and classified into 2 groups：active （213 cases）and inactive（77 cases）groups according to liver biopsy.The diagnosis significance for ALT,AST and HBV DNA load in HBeAg negative chronic active hepatitis B was evaluated by receiver operating characteristic （ROC）curves.Results The areas under ROC curve （AUC）for serum ALT,AST and HBV DNA load were 0.849,0.807 and 0.867,respectively.For the cut-off values of 30 IU/L for male ALT and 19 IU/L for female ALT and HBV DNA load 1 ×105 copies/mL,the sensitivity was 90.6%,the specificity was 98.7%,the positive predictive value was 99.5%,and the negative predictive value was 79.2%.The sensitivity of 77.0%,specificity of 63.3%,positive predictive value of 85.4% and negative predictive value of 50.0% were also observed for AST 40 IU/L as the cut-off value.Conclusions The 30 IU/L for male ALT and 19 IU/L for female ALT and HBV DNA load 1 ×105 copies/mL are suggested to be the cut-off values for discriminating HBeAg negative chronic active hepatitis B.