Background. Noninvasive methods are useful for investigating patients with chronic HBV infection. The severity of liver disease in inactive HBsAg carriers can be noninvasively assessed by transient elastography (TE) alone or in association with biochemical markers of fibrosis. Objectives. The study evaluates the effectiveness of the TE compared to common fibrosis scores (FSs), APRI, Forns Index, and FIB4, for identifying significant fibrosis in Italian and foreigner HBsAg carriers. To investigate the risk of progression of the liver disease, liver stiffness (LS) and HBV-DNA were monitored over time. Methods. Viral load, biochemical parameters, and LS have been retrospectively evaluated in 125 putative inactive HBV carriers, who visited two outpatient departments (Colleferro Hospital and INMP) from 01/03/2014 to 31/12/2019. Differences in clinical, biochemical, and demographic variables between Italians and foreigners were analyzed. 66 of 125 patients were followed up for 24 months by monitoring liver stiffness and HBV-DNA. Results. Mean overall LS was 5.55 ± 1.92 kPa; 18 (14.4%) patients had a LS ≥7.5 kPa. Mean of APRI, Forns, and FIB4 was 0.29 ± 0.11, 4.15 ± 1.63, and 1.16 ± 0.59, respectively. FS did not differ between the patients with LS <7.5 kPa and those with LS ≥7.5 kPa. Italians displayed a significant lower ALT (0.53 ± 0.18 vs. 0.67 ± 0.33, ) and AST (0.59 ± 0.16 vs. 0.70 ± 0.21, ) value than foreigners. No differences in LS and HBV-DNA levels were observed. In 66 patients followed up for 24 months, HBV-DNA increased by ≥2000 UI/ml after 12 months in 15 individuals and remained ≥2000 UI/ml after 24 months in 10/15 individuals. 7/10 patients showed LS ≥ 7.5 kPa after 24 months, and 4 of them underwent antiviral therapy for HBV. Patients with HBV-DNA <2000 IU/ml had a significantly lower LS than those with HBV-DNA ≥2000 IU/ml (5.30 ± 1.43 vs. 7.69 ± 1.07, ). Conclusions. Analysis shows lower effectiveness of FS vs. TE in the assessment of putative inactive HBV carriers. Furthermore, using FibroScan® and HBV-DNA can identify “false” inactive carriers.

中文翻译：

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意大利罗马假定非活动性 HBV 携带者样本中肝纤维化的无创评估

背景。无创方法可用于研究慢性 HBV 感染患者。非活动性 HBsAg 携带者肝脏疾病的严重程度可以通过单独的瞬时弹性成像 (TE) 或结合纤维化的生化标志物进行无创评估。目标。该研究评估了 TE 与常见纤维化评分 (FSs)、APRI、Forns 指数和 FIB4 相比的有效性，用于识别意大利和外国 HBsAg 携带者的显着纤维化。为了研究肝病进展的风险，随着时间的推移监测肝硬度（LS）和HBV-DNA。方法. 对 2014 年 1 月 3 日至 2019 年 12 月 31 日访问两个门诊部（Colleferro 医院和 INMP）的 125 名推定的非活动性 HBV 携带者的病毒载量、生化参数和 LS 进行了回顾性评估。分析了意大利人和外国人之间临床、生化和人口统计学变量的差异。通过监测肝脏硬度和 HBV-DNA 对 125 名患者中的 66 名进行了 24 个月的随访。结果。平均整体 LS 为 5.55 ± 1.92 kPa；18 名 (14.4%) 患者的 LS ≥ 7.5 kPa。APRI、Forns 和 FIB4 的平均值分别为 0.29 ± 0.11、4.15 ± 1.63 和 1.16 ± 0.59。LS <7.5 kPa 和 LS ≥ 7.5 kPa 患者的 FS 没有差异。意大利人的 ALT 显着降低（0.53 ± 0.18 vs. 0.67 ± 0.33，)和 AST (0.59 ± 0.16 对 0.70 ± 0.21,)比外国人值。没有观察到 LS 和 HBV-DNA 水平的差异。66 名患者随访 24 个月，15 人 12 个月后 HBV-DNA 增加≥2000 UI/ml，10/15 人 24 个月后仍保持 ≥2000 UI/ml。7/10 患者 24 个月后 LS ≥ 7.5 kPa，其中 4 人接受了 HBV 抗病毒治疗。HBV-DNA <2000 IU/ml 患者的 LS 显着低于 HBV-DNA ≥2000 IU/ml 患者（5.30 ± 1.43 vs. 7.69 ± 1.07，）。 结论。分析显示 FS 与 TE 在评估假定的非活动性 HBV 携带者方面的有效性较低。此外，使用 FibroScan® 和 HBV-DNA 可以识别“假”非活动携带者。