Objective: To analyze the correlation between indocyanine green retention rate at 15 minutes (ICG-R15) and modified Scheuer score in liver tissues of patients with hepatitis B e antigen-positive/negative chronic hepatitis B (CHB), and further explore the indocyanine green clearance test (ICGCT) applied value in judging the progress of CHB-related liver disease. Methods: 407 HBeAg (+) / HBeAg (-) CHB inpatients with normal or slightly elevated serum alanine aminotransferase (ALT) [< 2 times the upper limit of normal (ULN)] and modified Scheuer score were collected, and divided into mild liver disease group (M group, 131 cases, modified Scheuer score < G2S2) and progressive liver disease group (A group, 276 cases, modified Scheuer score≥G2 and / or S2). Furthermore, the groups were sub-divided into HBeAg (+) - M group, HBeAg (-) - M group, HBeAg (+) - A group and HBeAg (-) - A group. The correlation between ICG-R15 and modified Scheuer score was analyzed retrospectively. The data were analyzed by SPSS 24.0 software. Results: Basic clinical characteristics: Among the 407 CHB cases with normal or mildly elevated serum ALT, 171 were HBeAg(+) CHB and 236 were HBeAg(-) CHB. The baseline mean serum HBV DNA was higher in HBeAg(+) CHB patients [(6.06 ± 1.95) log10IU/ml] than HBeAg(-) CHB patients [(3.60±1.37)log10IU/ml (P = 0.000)]. Included patients ICG-R15 detection characteristics: (1) The baseline mean value of ICG-R15 was not statistically significant between the two groups of HBeAg(+) CHB and HBeAg(-) CHB, and was basically within the normal range (< 10%); (2) Comparison of ICG-R15 baseline mean value among the subgroups showed that the patients in the HBeAg(+)-A group/HBeAg(-)-A group were higher than the HBeAg(+)-M group/HBeAg(-)-M group patients, and the difference was statistically significant (P = 0.013/P = 0.000). Included patients' correlation analysis between ICG-R15 and modified Scheuer score: (1) ICG-R15 and modified Scheuer score had shown weak positive correlation with inflammatory activity grade (g) in HBeAg (+) / HBeAg (-) CHB (r = 0.237, P = 0.002); r = 0.244, P = 0.000); (2) There was a weak positive correlation between ICG-R15 and fibrosis stage (s) in HBeAg (+) / HBeAg (-) CHB (r = 0. 254, P = 0; r = 0.225, P = 0.001). Included patients ICG-R15 predictive value for the severity of liver histological progression: when the cut-off value of ICG-R15 was 5.1%, the area under the receiver operating characteristic curve from M group to A group was 0.601 (P = 0.001) for predicting HBeAg (+) / HBeAg (-) CHB patients. Conclusion: ICG-R15 is positively correlated with the modified Scheuer score of liver tissue in HBeAg (+)/HBeAg (-) CHB patients with normal or slightly elevated ALT. In addition, when the cut-off value of ICG-R15 was 10%, it could not accurately reflect the effective hepatocyte reserve function of HBeAg (+) / HBeAg (-) CHB patients with normal or slightly elevated ALT. Importantly, when the cut-off value of ICG-R15 is 4.0% ~ 5.0%, it may have predictive value for liver disease progression to modified Scheuer score ≥ G2 and / or ≥S2 in HBeAg (+) / HBeAg (-) CHB patients with normal or slightly elevated ALT.
目的： 分析吲哚菁绿15 min滞留率（ICG-R15）与乙型肝炎e抗原阳性/阴性[HBeAg（+）/HBeAg（-）]慢性乙型肝炎（CHB）患者肝组织改良Scheuer评分的相关性，以探索吲哚菁绿清除试验（ICGCT）在判断CHB肝病进展方面的应用价值。 方法： 收集407例血清丙氨酸转氨酶（ALT）正常或轻度升高[< 2倍正常值上限（ULN）]且经改良Scheuer评分的HBeAg（+）/HBeAg（-） CHB住院患者，分为轻度肝病组（M组，131例，改良Scheuer评分<G2S2）和进展肝病组（A组，276例，改良Scheuer评分≥G2和/或S2）；亚组分为: HBeAg（+）-M组、HBeAg（-）-M组、HBeAg（+）-A组、HBeAg（-）-A组。回顾性分析ICG-R15与各组间改良Scheuer评分的相关性。对数据采用t检验、U检验，相关分析采用Spearman等级相关检验。 结果： 临床基本特征：407例血清ALT正常或轻度升高的CHB患者中HBeAg（+） CHB 171例，HBeAg（-） CHB 236例；HBeAg（+） CHB患者血清HBV DNA基线均值[（6.06±1.95）log(10)IU/ml]高于HBeAg（-） CHB[（3.60±1.37）log(10)IU/ml，P＝0.000]。纳入患者ICG-R15检测特征: （1）ICG-R15基线均值在HBeAg（+） CHB和HBeAg（-） CHB两组患者间差异无统计学意义，且基本在正常值范围（<10%）；（2）ICG-R15基线均值在各亚组间比较显示，HBeAg（+）-A组/HBeAg（-）-A组患者分别高于HBeAg（+）-M组/HBeAg（-）-M组患者，且差异具有统计学意义（P＝0.003，P＝0.048）。纳入患者ICG-R15与改良Scheuer评分的相关性分析: （1）ICG-R15与HBeAg（+）/HBeAg（-） CHB两组患者改良Scheuer评分中炎症活动分级（G）均分别呈弱正相关性（r＝0.237, P＝0.002；r＝0.244, P＝0.000）；（2）ICG-R15与HBeAg（+）/HBeAg（-） CHB两组患者改良Scheuer评分中纤维化分期（S）均分别呈弱正相关性（r＝0.254, P＝0.001；r＝0.225, P＝0.001）。ICG-R15对纳入患者肝组织学进展严重程度的预测价值:当ICG-R15截断值取5.1%时，基于ICG-R15预测HBeAg（+）/HBeAg（-） CHB患者M组进展至A组的受试者工作特征曲线下面积为0.601（P＝0.001）。 结论： ICG-R15与ALT正常或轻度升高的HBeAg（+）/HBeAg（-） CHB患者肝组织改良Scheuer评分具有一定的正相关性；ICG-R15的截断值为10%时不能准确反映ALT正常或轻度升高的HBeAg（+）/HBeAg（-） CHB患者有效肝细胞储备功能；ICG-R15的截断值前移为4.0%~5.0%时可能具有对ALT正常或轻度升高的HBeAg（+）/HBeAg（-） CHB患者肝病进展至改良Scheuer评分≥G2和/或≥S2的预测价值。.
Keywords: Alanine aminotransferase; Chronic hepatitis B; Indocyanine green retention rate at 15 minutes; Modified Scheuer score.