Association between hepatitis B virus markers and liver fibrosis staging in patients with chronic hepatitis B

Abstract

BACKGROUND

Existing assessment systems for chronic hepatitis B (CHB)-associated liver fibrosis (LF) exhibit insufficient accuracy, thereby requiring further improvements.

AIM

To investigate the association of LF staging with hepatitis B core antibody (HBcAb), hepatitis B virus DNA (HBV-DNA), and hepatitis B surface antigen (HBsAg) in patients with CHB.

METHODS

We selected 120 patients with CHB receiving treatment in Hangzhou Linping District First People’s Hospital from January 2020 to June 2024. Participants were allocated into the mild (F0-F1, n = 52) and moderate-to-severe groups (F2-F4, n = 68) following the rigorous LF staging criteria. HBcAb, HBV-DNA, and HBsAg concentrations were measured. Pearson correlations were employed to examine the correlations of HBcAb with HBV-DNA and HBsAg, whereas Spearman correlation analysis was conducted to identify the associations of the three with LF staging. Receiver operating characteristic (ROC) curves were further used to analyze the performance of these biomarkers in diagnosing LF stages. Furthermore, binary logistic regression analysis was conducted to determine the association of these three with LF progression in CHB.

RESULTS

Markedly increased HBcAb and notably decreased HBV-DNA and HBsAg were observed in moderate-to-severe cases vs their mild counterparts. A positive correlation was observed between HBV-DNA and HBsAg, whereas both markers were inversely associated with HBcAb. Moreover, LF staging exhibited a significant positive correlation with HBcAb and an inverse connection with HBV-DNA and HBsAg. The receiver operating characteristic analysis revealed area under the curve values of 0.715, 0.799, and 0.662 for HBcAb, HBV-DNA, and HBsAg in diagnosing LF staging, respectively. Combining these markers improved the area under the curve to 0.851. The final analysis identified HBcAb as promoting fibrosis advancement (odds ratio = 2.765), whereas HBV-DNA demonstrated protective properties (odds ratio = 0.247).

CONCLUSION

HBcAb is negatively correlated with HBV-DNA and HBsAg but positively associated with LF staging. All three markers are valuable in assessing LF staging, and their combined use presents the highest diagnostic efficacy. Importantly, a high HBcAb/low HBV-DNA profile markedly increased fibrosis progression risks in CHB-affected individuals.

Keywords: Hepatitis B core antibody; Hepatitis B virus DNA; Hepatitis B surface antigen; Chronic hepatitis B; Liver fibrosis staging

Core Tip: By combining three serum biomarkers, hepatitis B core antibody, hepatitis B virus-DNA, and hepatitis B surface antigen, this study proposes a cost-effective, non-invasive diagnostic approach for assessing chronic hepatitis B-related liver fibrosis (LF) staging, providing advantages in operational convenience and repeatability. The multi-parameter model demonstrated superior diagnostic performance without compromising either sensitivity or specificity. Further, a strong correlation of hepatitis B core antibody and hepatitis B virus-DNA with LF progression was determined. Altogether, a promising non-invasive serological tool for LF staging is proposed in this study, providing a cost-effective solution to improve clinical diagnostics and patient care.