Serum hepatitis B surface antigen titer and transient elastography in screening for insignificant fibrosis in HBeAg-positive chronic hepatitis B patients

Abstract

Objective

To explore the predictive value of serum hepatitis B surface antigen (HBsAg) titer and transient elastography in screening for insignificant fibrosis in hepatitis B e antigen (HBeAg)-positive chronic hepatitis B patients.

Methods

We conducted a cross-sectional study of eligible patients treated from March 2012 to May 2013 at the West China Hospital of Sichuan University. Eligible patients underwent liver transient elastography and liver biopsy. We assessed the serum HBsAg level, serum hepatitis B virus (HBV) deoxyribonucleic acid (DNA) level, HBV genotypes, liver stiffness measurement (LSM) values by transient elastography, and histological fibrosis staging by METAVIR classification.

Results

A total of 129 consecutive patients were recruited. The LSM value (P<0.001, odds ratio 14.67, 95% CI 0.158–0.551) and log₁₀HBsAg (P=0.045, odds ratio 4.03, 95% CI 0.136–0.976) correlated with a liver fibrosis score <F2, independently. Inverse correlations were found between log₁₀HBsAg and the LSM value (r=−576, P<0.001) and fibrosis staging (r=−374, P<0.001). Patients with a fibrosis score <F2 had a significantly higher log₁₀HBsAg than patients with a fibrosis score ≥F2 among those with an LSM value under 9.4 kPa (4.6±0.7 vs 4.3±0.5, P=0.006). The HBsAg titer achieved an area under the receiver operating characteristic curve of 0.758 (P<0.001, 95% CI 0.631–0.884) in predicting a fibrosis score <F2, with a cut-off value of 10,400 IU/mL, a positive predictive value of 73%, and a negative predictive value of 79%.

Conclusion

In HBeAg-positive patients with an alanine aminotransferase level <2× the upper limit of normal, high serum HBsAg levels can predict a fibrosis score <F2, and a lower HBsAg titer could be supportive of early fibrosis in patients with an LSM value under 9.4 kPa.

Keywords:

• hepatitis B e antigen
• HBsAg
• HBV

Acknowledgments

This research was supported by the National Twelve-Five Project of China, and no benefits in any form have been or will be received from a commercial party directly or indirectly related to the subject of this article.

Author contributions

All authors conceived and designed the study. Ling-Bo Liang, Xia Zhu, Li-Bo Yan, and Juan Liao acquired the data and performed liver transient elastography. Cong Liu and Li-Yu Chen performed liver biopsy and prepared liver biopsy specimens. Ling-Bo Liang and Ling-Yao Du carried out the statistical analysis. All authors took part in either drafting the article or revising it critically for important intellectual content and gave final approval of the version to be published.

Disclosure

The authors report no conflicts of interest in this work.