Relation between laboratory test results and histological hepatitis activity in individuals positive for hepatitis B surface antigen and antibodies to hepatitis B e antigen.
BACKGROUND
Hepatitis B surface antigen (HBsAg) and antibodies to hepatitis B e antigen (anti-HBe) commonly coexist, and laboratory tests are often requested to assess histological hepatitis activity. An optimum panel of tests has not been found and the usefulness of hepatitis B virus (HBV) DNA assays in this context has not been established. We assessed various blood tests to find which best predicted hepatitis activity.


METHODS
Routine plasma biochemical liver tests and serum HBV DNA (hybridisation and PCR assays) were assessed prospectively in 123 patients positive for HBsAg and anti-HBe. We scored histological hepatitis activity (hepatitis activity index) and determined whether chronic active hepatitis (chronic hepatitis with portal and periportal lesions) was present. We analysed the relation between laboratory data and the hepatitis activity index or risk of chronic active hepatitis by multiple regression and multiple logistic regression, respectively.


RESULTS
The analyses provided models for predicting either the hepatitis activity index or the risk of chronic active hepatitis. Aspartate aminotransferase was the most important test in the two models. The contribution of HBV DNA and other assays, especially alanine-aminotransferase activity, were of no practical importance.


CONCLUSIONS
Because screening by aspartate-aminotransferase activity could not be improved by the addition of other assays or HBV DNA, patients positive for HBsAg and anti-HBe could be screened for chronic active hepatitis with a single assay and counselling of patients can be improved if proper reference values are used.
ter Borg
F
F
Department of Gastrointestinal and Liver Diseases, Academic Medical Centre, University of Amsterdam, The Netherlands.
ten Kate
F J
FJ
Cuypers
H T
HT
Leentvaar-Kuijpers
A
A
Oosting
J
J
Wertheim-van Dillen
P M
PM
Honkoop
P
P
Rasch
M C
MC
de Man
R A
RA
van Hattum
J
J
Chamuleau
R A
RA
Reesink
H W
HW
Jones
E A
EA
D000328:Adult; D001219:Aspartate Aminotransferases / Q000097:blood*; D001706:Biopsy; D004796:Clinical Enzyme Tests / Q000706:statistics & numerical data; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006510:Hepatitis B Antibodies / Q000032:analysis*; D006514:Hepatitis B Surface Antigens / Q000032:analysis*; D006513:Hepatitis B e Antigens / Q000276:immunology*; D006515:Hepatitis B virus / Q000302:isolation & purification; D019694:Hepatitis B, Chronic / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology* / Q000821:virology; D008111:Liver Function Tests / Q000706:statistics & numerical data; D008297:Male; D011446:Prospective Studies; D012372:ROC Curve; D012044:Regression Analysis
D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens; D001219:Aspartate Aminotransferases