ABSTRACT
Objective:To establish and evaluate a new diagnostic model for significant liver tissue damage in patients with chronic hepatitis B virus (HBV) infection in the immune tolerance phase.Methods:The clinical data of 275 chronic HBV infection patients in the immune tolerance phase who underwent liver biopsy from January 2015 to November 2020 in the Hwa Mei Hospital, University of Chinese Academy of Sciences were included. According to the liver pathological changes, patients were divided into <G2 group and ≥G2 group, <S2 group and ≥S2 group, non-significant liver pathological damage group (GS0 group, <G2+ <S2) and significant liver pathological damage group (GS1 group, G2 and/or ≥S2). The liver pathological changes and clinical features were analyzed to establish the diagnostic model. The prediction value of the model was compared. Statistical analysis was conducted by linear regression analysis, and the area under the receiver operating characteristic curve, sensitivity and specificity for the diagnostic value of the model were calculated.Results:Among 275 patients, 43 cases (15.64%) had liver histologic activity ≥G2, 30 cases (10.91%) with liver fibrosis ≥S2, and 55 cases (20.00%) with liver damage of GS1. The correlated independent risk factors associated with significant liver pathological damage were age, levels of hepatitis B e antigen, γ-glutamyl transpeptidase, platelet count, alkaline phosphatase and alanine aminotransferase (all P<0.050). The diagnostic model of Y G/S was established according to these factors. The diagnostic efficacy of Y G/Swas highest for patients with liver histologic activity≥G2 and liver pathological damage GS1, with the areas under the curve of 0.783 and 0.811, respectively. The threshold of Y G/S was 0.18, with the sensitivity, specificity and negative predictive value of 0.782, 0.736 and 93.10%, respectively. When Y G/S <0.05, the sensitivity, negative predictive value and negative likelihood ratio were 0.982, 97.96% and 0.08, respectively. When Y G/S≥0.25, the specificity and positive likelihood ratio were 0.905 and 5.14, respectively. When Y G/S≥0.30, the specificity and positive likelihood ratio were 0.959 and 9.33, respectively. Conclusions:Approximately 20.00% of patients with chronic HBV infection in immune tolerance phase have significant liver pathological damage. The diagnostic model of Y G/S (<0.05 or ≥0.30) has certain evaluation value for significant liver pathological damage, and could help these patients avoid liver biopsy to a certain extent.
ABSTRACT
Bovine tuberculosis is a worldwide spread zoonotic disease. Intradermal tuberculinizations are the most used diagnostic tests in the world. Serological tests can be an ancillary diagnosis for bovine tuberculosis. The objective of this study was to evaluate the diagnostic performance of the ELISA Mycobacterium Bovis Antibody Test Kit IDEXX ™ in infected herds, which were in different disease control stages. One hundred and twenty animals from two dairy herds of Minas Gerais state, Brazil, were subjected to the ELISA serological test and the comparative cervical tuberculin test (CCT). Diagnostic test parameters were estimated using Bayesian latent class models and concordance between tests estimated by the frequentist approach. The ELISA test presented lower sensitivity than CCT in both herds. Its sensitivity was higher in the herd in sanitation process. Specificity estimates were above 95% in both herds. Kappa index indicated low concordance or even disagreement between tests. According to the results, the ELISA IDEXX should not be used as substitution for CCT. The tests must not be associated in series. Parallel association increased diagnostic sensitivity in the herd which was in the process of sanitation.(AU)
A tuberculose bovina é uma zoonose de distribuição mundial cujos testes mais utilizados para o diagnóstico são as tuberculinizações intradérmicas, simples e compartivas. Contudo, testes sorológicos podem constituir diagnósticos auxiliares. O objetivo deste estudo foi avaliar o desempenho diagnóstico do teste ELISA Mycobacterium Bovis Antibody Test Kit IDEXX ® em rebanhos bovinos infectados, que se encontravam em diferentes estágios de controle da doença. Cento e vinte animais de dois rebanhos leiteiros provenientes do estado de Minas Geais-Brasil foram submetidos ao ELISA e à tuberculinização cervical compartiva (TCC). Avaliou-se o desempenho dos testes por meio de modelos Bayesianos de classe latente e a concordância entre os eles, por meio de estatística frequentista. Uma maior sensibilidade do teste foi observada no rebanho previamente tuberculinizado. Em ambos os rebanhos o TCC foi mais sensível que o ELISA. Especificidade acima de 95% foi encontrada em ambos os rebanhos. Foram observadas baixa concordância ou mesmo discordância entre os testes. De acordo com os resultados obtidos, o teste ELISA-IDEXX não deve ser utilizado em substituição à TCC, tampouco devem ser associados em série. Houve aumento da sensibilidade quando os testes foram associados em paralelo no rebanho que já se encontrava em processo de saneamento.(AU)