Quantitaty Of HBsAg In The Differential Diagnosis Of HBeAg-negative Chronic Hepatitis B And Inactive HBV Carriers With Normal ALT Level

Objective:To observate the liver pathology of clinically diagnosed as inactive HBV carriers;To discuss the differences of inactive HBV carriers and HBeAg-negative chronic hepatitis B with normal ALT level in the pathological diagnosis in aspects of hepatitis B family history,gender,age,blood routine,blood biochemistry,HBV DNA,serum HBsAg;To reveal the quantitative HBsAg value of differential diagnosis in HBeAg-negative chronic hepatitis B with normal ALT level and inactive HBV carriers;Through the study of quantitative HBsAg inappropriate to diagnosis and treat HBeAg-negative chronic hepatitis B with normal ALT level and provide a theoretical basis and new ideas for further study.Method:According to the diagnostic criteria,liver biopsy surgery was done in 68 patients clinically diagnosed as inactive HBV carriers,according to the results of the pathology of liver,inflammation(G)or fibrosis(S)grade ?2 level HBeAg-negative patients were diagnosed as CHB,while the G or S<2 patients were diagnosed as inactive HBV carriers.Compared various indicators in inactive HBV carriers and HBeAg-negative CHB patients with univariate analysis and multivariate Logistic regression analysis.Furthermore,used liver biopsy as the gold standard,according to the different levels of serum HBsAg for the differential diagnosis of specificity,sensitivity analysis,draw the receiver operating characteristic curve(Receiver operator characteristic curve,ROC curves)to get the optimal sensitivity and specificity of serum HBsAg levels for the diagnosis of inactive HBV carriers.Results:hrough statistical analysis],the proportion of HBeAg-negative chronic hepatitis B with normal ALT level in clinically diagnosed inactive HBV carriers was 70.59%,Logistic regression analysis showed that in clinically diagnosed inactive HBV carriers,family history of hepatitis B(RR=8.054,95%CI=1.649?39.326,P=0.01),high levels of surface antigen quantification(HBsAg>1000IU/mL)(RR=8.001,95%CI=1.538?41.629,P=0.013)and serum HBV above the minimum detection limit(HBV DNA>1 × 103 copies/mL)(RR=4.758,95%CI=1.03921.790,P=0.044)was risk factors of HBeAg-negative chronic hepatitis B.Furthermore the ROC curve showed that the area under the ROC curve of quantitative HBsAg for identification of HBeAg-negative CHB with normal ALT level was 0.844(95%Cl 0.7140.974,P=0.002)and quantitative HBsAg threshold(cut-off value)for differentiating HBeAg-negative CHB was the 285.73IU/ml,and at that time the sensitivity,specificity and Youden index were 92%,80%and 72%.Conclusion:In clinically diagnosed as inactive HBV carriers were confirmed by liver biopsy pathology mostly HBeAg-negative chronic hepatitis Bwith normal ALT level.CHB family history,high expression of serum HBsAg and serum HBV DNA above the detection limit of clinically diagnosed as inactive HBV carriers suggested the HBeAg-negative CHB,while quantitative serum HBsAg had important diagnostic value in the identification of inactive HBV carriers and HBeAg negative chronic hepatitis B,and quantitative serum HBsAg levels can effectively screen out HBeAg-negative chronic hepatitis B patients with normal ALT leve.