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Correlation between clinical indication for treatment and liver histology in HBeAg-negative chronic hepatitis B: a novel role of α-fetoprotein

Authors

  • I-Cheng Lee,

    1. Department of Medicine, Division of Gastroenterology, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
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    • *Contributed equally.

  • Yi-Hsiang Huang,

    1. Department of Medicine, Division of Gastroenterology, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
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    • *Contributed equally.

  • Che-Chang Chan,

    1. Department of Medicine, Division of Gastroenterology, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
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    • *Contributed equally.

  • Teh-Ia Huo,

    1. Department of Medicine, Division of Gastroenterology, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan
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  • Chi-Jen Chu,

    1. Department of Medicine, Division of Gastroenterology, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Chiung-Ru Lai,

    1. Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Pui-Ching Lee,

    1. Department of Medicine, Division of Gastroenterology, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Chien-Wei Su,

    1. Department of Medicine, Division of Gastroenterology, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
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  • Hung-Hsu Hung,

    1. Department of Medicine, Division of Gastroenterology, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
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  • Jaw-Ching Wu,

    1. Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Han-Chieh Lin,

    1. Department of Medicine, Division of Gastroenterology, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Shou-Dong Lee

    1. Department of Medicine, Division of Gastroenterology, Taipei Veterans General Hospital, Taipei, Taiwan
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Correspondence
Yi-Hsiang Huang, MD, PhD, Department of Medicine, Division of Gastroenterology, Taipei Veterans General Hospital, 201 Shih-Pai Road, Sec. 2, Taipei 112, Taiwan
Tel: +886 2 28 712 121 ext. 3055
Fax: +886 2 28 739 318
e-mail: yhhuang@vghtpe.gov.tw

Abstract

Background: It is unclear whether clinical indication for antiviral treatment is in agreement with histological indication in HBeAg-negative chronic hepatitis B (CHB). This study aimed to clarify this relationship and identify factors associated with liver histology.

Patients and methods: We investigated 152 consecutive, treatment-naïve, HBeAg-negative CHB patients who had undergone liver biopsies at a tertiary medical centre in Taiwan. Clinical indications for treatment included a serum alanine aminotransferase level more than twice the upper limit of normal and an hepatitis B virus DNA level >2000 IU/ml. Factors associated with the histological indication (Ishak's grade ≥7 and/or stage ≥2) were analysed.

Results: The association between the clinical and the histological indications was significant (P=0.011). However, the agreement was poor (κ value=0.197). In patients satisfying the clinical indication, age >52 years [odds ratio (OR)=2.669, P=0.042], serum α-fetoprotein (AFP) level >7 ng/ml (OR=7.070, P<0.001) and platelet count <130 × 109/L (OR=11.720, P=0.025) were identified to be independent factors associated with histological indication. In patients who did not satisfy the clinical indication, multivariate analysis revealed that only an AFP level >7 ng/ml (OR=10.345, P=0.021) was independently associated with histological indication. Combining the clinical indication and/or AFP level >7 ng/ml to predict liver histology, the sensitivity and the negative predictive value could improve from 86 to 94.4% and 66.7 to 81% respectively.

Conclusion: AFP level is associated with liver histology in HBeAg-negative CHB. Serum AFP level can serve as a surrogate indicator to identify patients who need antiviral treatment.

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