Diagnostic Value of Combined Detection of Serum HBsAg，HBV RNA，GGT and GPR in the Natural History of Chronic HBV Infection
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摘要:
目的 探讨慢性乙型肝炎病毒（HBV）感染自然史各期患者血清乙型肝炎病毒表面抗原（HBsAg）、乙型肝炎病毒核糖核酸（HBV RNA）、γ-谷氨酰转肽酶（GGT）、γ-谷氨酰转肽酶/血小板比值（GPR）水平变化及联合检测对慢性HBV感染自然史分期的诊断价值。 方法 选取2020年11月至2023年12月在昆明市第三人民医院就诊的未经抗病毒治疗的172例慢性HBV感染患者为研究对象，根据HBV感染进程分为HBeAg阳性慢性HBV感染（EPI）组（n = 77）、HBeAg阳性CHB（EPH）组（n = 42）、HBeAg阴性慢性HBV感染（ENI）组（n = 26）、HBeAg阴性CHB（ENH）组（n = 27）。比较各组患者血清HBsAg、HBV RNA、GGT、GPR水平差异，绘制受试者工作特征（ROC）曲线探究血清HBsAg、HBV RNA、GGT、GPR联合检测对慢性HBV感染自然史中EPH期和ENH期的诊断价值。 结果 4组患者血清HBsAg、HBV RNA、GGT、GPR水平比较，差异均有统计学意义（P < 0.05）。血清HBsAg、HBV RNA、GGT、GPR联合检测诊断EPH期和ENH期的ROC曲线下面积（AUC）分别为0.869和0.836，敏感度和特异度分别为76.19%、59.26%和84.42%、96.15%。 结论 血清HBsAg、HBV RNA、GGT、GPR联合检测对慢性HBV感染自然史诊断有较高的准确性和低误诊率，有望取代传统的有创检查，对于慢性HBV感染自然史各期患者的精准诊断及个体化治疗策略的制订发挥着重要的临床意义。 -
关键词:
- 慢性乙型肝炎病毒感染自然史 /
- 联合诊断 /
- 乙型肝炎病毒表面抗原 /
- 乙型肝炎病毒核糖核酸 /
- γ-谷氨酰转肽酶
Abstract:Objective To investigate the changes of serum hepatitis B virus surface antigen （HBsAg）, hepatitis B virus ribonucleic acid （HBV RNA）, γ-glutamyl transpeptidase （GGT）, γ-glutamyl transpeptidase to platelet ratio （GPR） levels in patients with different stages of natural history of chronic hepatitis B virus （HBV） infection and the diagnostic value of combined detection in the staging of natural history of chronic HBV infection. Methods A total of 172 patients with chronic HBV infection who were not treated with antiviral therapy in the Third People’ s Hospital of Kunming from November 2020 to December 2023 were selected as the research objects. According to the process of HBV infection, they were divided into HBeAg-positive chronic HBV infection （EPI） group （n = 77）, HBeAg-positive CHB （EPH） group （n = 42）, HBeAg-negative chronic HBV infection （ENI） group （n = 26）, HBeAg-negative CHB （ENH） group （n = 27）. The differences of serum HBsAg, HBV RNA, GGT and GPR levels in each group were compared, and the receiver operating characteristic （ROC） curve was drawn to explore the diagnostic value of combined detection of serum HBsAg, HBV RNA, GGT and GPR in EPH and ENH stages in the natural history of chronic HBV infection. Results There were significant differences in serum HBsAg, HBV RNA, GGT and GPR levels among the four groups （P < 0.05）. The area under the ROC curve （AUC） of combined detection of serum HBsAg, HBV RNA, GGT and GPR in the diagnosis of EPH and ENH was 0.869 and 0.836, respectively, and the sensitivity and specificity were 76.19%, 59.26% and 84.42%, 96.15%, respectively. Conclusion The combined detection of serum HBsAg, HBV RNA, GGT and GPR has high accuracy and low misdiagnosis rate in the diagnosis of natural history of chronic HBV infection, which is expected to replace the traditional invasive examination. It plays an important clinical significance in the accurate diagnosis and individualized treatment strategy of patients with a natural history of chronic HBV infection. -
图 1 各项检测指标诊断EPH期的ROC曲线
Figure 1. ROC curve of each detection index in the diagnosis of EPH stage
图 2 各项检测指标诊断ENH期的ROC曲线
Figure 2. ROC curve of each detection index in the diagnosis of ENH stage
表 1 慢性HBV感染自然史各期患者各项检测指标比较[M（P25，P75）]
Table 1. Comparison of various detection indexes in patients with natural history of chronic HBV infection [M（P25，P75）]
组别 HBsAg
（lg IU/mL）HBV RNA
（lg copies/mL）GGT（U/L） GPR EPI组 4.65（4.39，4.72）bcd 7.66（6.99，8.02）cd 14.00（12.00，19.00）bcd 0.12（0.10，0.17）bcd EPH组 4.28（3.81，4.72）acd 7.58（6.13，8.00）cd 30.50（21.83，45.00）a 0.29（0.19，0.47）a ENI组 2.63（1.48，3.31）ab 2.00（0.00，3.03）ab 20.00（15.00，29.50）a 0.19（0.14，0.31）a ENH组 2.97（2.47，3.42）ab 3.20（2.00，4.92）ab 33.00（21.00，51.00）a 0.34（0.19，0.46）a H 92.623 94.882 64.691 62.818 P <0.001* <0.001* <0.001* <0.001* *P < 0.05；与EPI组比较，aP < 0.0083；与EPH组比较，bP < 0.0083；与ENI组比较，cP < 0.0083；与ENH组比较，dP < 0.0083。 
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表 2 4项指标单独及联合检测对EPH期的诊断效能分析
Table 2. The diagnostic efficacy of single and combined detection of four indicators in EPH stage
指标 AUC（95%CI） 敏感度（%） 特异度（%） 临界值 P HBsAg（lg IU/mL） 0.677（0.567～0.787）# 61.90 79.20 4.354 0.001* HBV RNA（lg copies/mL） 0.549（0.434～0.666）# 23.81 93.51 5.940 0.374 GGT（U/L） 0.859（0.790～0.928） 76.20 84.40 21.550 <0.001* GPR 0.835（0.759～0.910） 78.60 79.20 0.184 <0.001* HBsAg+HBV RNA+GGT+GPR 0.869（0.804～0.934） 76.19 84.42 <0.001* *P < 0.05；与HBsAg+HBV RNA+GGT+GPR比较，#P < 0.05。
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表 3 4项指标单独及联合检测对ENH期的诊断效能分析
Table 3. The diagnostic efficacy of single and combined detection of four indicators in ENH stage
指标 AUC（95%CI） 敏感度（%） 特异度（%） 临界值 P HBsAg（lg IU/mL） 0.624（0.472～0.776）# 96.30 30.77 2.043 0.122 HBV RNA（lg copies/mL） 0.702（0.560～0.844）# 51.90 92.30 3.195 0.012* GGT（U/L） 0.723（0.587～0.859） 96.30 38.50 17.000 0.005* GPR 0.744（0.612～0.876） 59.30 84.60 0.332 0.002* HBsAg+HBV RNA+GGT+GPR 0.836（0.729～0.944） 59.26 96.15 <0.001* *P < 0.05；与HBsAg+HBV RNA+GGT+GPR比较，#P < 0.05。
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