The Diagnostic Value Of Serum Immunoglobulin A Levels In The Patients With Different Clinical Types Of Chronic Hepatitis B Infection

Background and AimsLiver fibrosis and cirrhosis are major causes of morbidity and mortality in chronic hepatitis B (CHB) patients. Although antiviral therapy has greatly reduced the risk of fibrosis and cirrhosis, some patients may eventually develop advanced fibrosis and cirrhosis. Knowledge of the stages of liver fibrosis is essential in patients with viral hepatitis B to assess the progression and prognosis of the disease, particularly when determining whether to use antiviral treatment. Serum immunoglobulins (Igs) are frequently elevated in patients with chronic liver disease, but currently there is a lack of sufficient data on serum Igs in patients with chronic hepatitis B virus (CHB) infection. This study aimed to evaluate serum IgA, IgG and IgM levels in patients with HBV-related cirrhosis and to analyze, if altered, immunoglobulin levels that were associated with cirrhosis progress.Material and Methods1 MaterialThis study was approved by the Ethics Committee of the First Affiliated Hospital of Zhejiang University College of Medicine. Informed consent was obtained from each participant. Patients with chronic HBV infection (n=174) who were referred to the Liver Diseases Clinic between July 2012 and December 2014 were enrolled. Among them, 104 were diagnosed with HBV-related cirrhosis and the remaining 70 with chronic hepatitis B (CHB). Healthy controls included 55 volunteers with no history of liver diseases, alcohol consumption less than 20 g/day and normal liver biochemistry. There were no age or gender based exclusions.2 Methods1) Biochemical parameters including serum creatinine, albumin, total protein, total bilirubin, blood urea nitrogen (BUN), gamma-glutamyl transferase (GGT), aspartate aminotransferase (AST) and alanine aminotransferase (ALT), Immunoglobulin determination of IgA, IgG and IgM levels were measured using an automatic analyzer (Hitachi 7600; Tokyo, Japan).2) International normalized ratio (INR) was determined using a Sysmex CA-1500 blood coagulation analyzer (Sysmex Corp, Japan).3) Platelet and hemoglobin levels were determined using a Sysmex XE-2100 automated hematology analyzer (Sysmex Corp, Japan), as part of a complete blood count.4) Virological assessments:HBsAg and HBeAg were tested by using chemiluminescent microparticle immunoassay kits(Abbot Laboratories, USA).5) Serum HBV-DNA was quantified by ABI7500 using fluorescence quantitative polymerase chain reaction test(ABI,USA)6) Statistic alanalysis:SPSS 17.0 statistic software.Results1) Baseline characteristics of participants. Recruited to the study were 174 chronic HBV-infected patients (104 cirrhotic and 70 non-cirrhotic) as well additional 55 healthy controls. The mean age on admission was 51.5 years (range 22-72 years; SD 12.8 years). Compared with non-cirrhotic patients, the patients with cirrhosis tended to be older, more likely to have severe liver disease, lower levels of albumin, platelets and hemoglobin and higher blood urea nitrogen and creatinine.2) Comparison of immunoglobulin levels between cirrhotic and non-cirrhotic patients and Healthy controls.The serum IgA and IgG levels in the cirrhotic patients were significantly higher than that of the Healthy controls and non-cirrhotic patients (both P<0.05). The IgA and IgG levels were also higher in non-cirrhotic patients than healthy controls (both PO.05). IgM levels in the cirrhotic patients were significantly higher than that of the healthy controls (PO.05), but there was no significant difference comparing non-cirrhotic patients. There was also no significant difference in serum IgM levels between non-cirrhotic patients and healthy controls.3) Comparison of immunoglobulin levels between the compensated and decompensated cirrhosis patients.All cirrhotic patients were further divided into compensated and decompensated groups. Serum IgA in decompensated patients was significantly higher than that found in compensated patients (P=0.002). However, no significant differences were found in serum IgM (P=0.833) or IgG levels (P=0.204) between two groups.4) Relative risk factors for liver cirrhosis. Univariate logistic regression analysis demonstrated that patients with high serum IgA and IgQ low platelets, low albumin, and old age were significantly associated with cirrhosis. Multivariate logistic regression analysis showed that serum IgA, albumin, and platelets were independent risk factors for cirrhosis. The area under the IgA in AUC is the largest.ConclusionThe results from the present study show that serum IgA levels were elevated in HBV related cirrhosis patients; furthermore, even higher levels of IgA were detected in decompensated cirrhosis patients than that of the compensated ones. Serum IgA may serve as an independent marker, conveniently indicating cirrhosis in patients with CHB.