Clearance of HBsAg in seven patients with chronic hepatitis B
Clearance of HBsAg in seven patients with chronic hepatitis B
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7 例慢性乙型肝炎患者 HBsAg 清除率
作者：
H. Adachi;S. Kaneko;E. Matsushita;Y. Inagaki;M. Unoura;Kenichi Kobayashi
本文调查了自发清除HBsAg的慢性B型肝炎患者的自然史。对我院351例慢性B型肝炎患者进行了3年以上的观察。其中7例患者在随访期间变为HBsAg阴性。HBsAg在ALT急性升高后6个月内（范围= 11至169天，平均= 70天）消失。在3名患者中发现ALT水平高达500 IU，而在其他4名患者中未发现这种升高。HBsAg消失后，所有患者的ALT水平均恢复正常。除了一个例外，所有患者血清转化为HBsAg抗体，然而，B型肝炎病毒DNA在5例患者的血清中仍然使用聚合酶链反应检测。当使用6名患者血清的1：200稀释度时，对HBcAg的抗体抑制百分比滴度逐渐下降至小于70%。其中4名患者发生活动性肝病：2名患有慢性活动性肝炎，2名患有肝硬化。这4例患者中有3例随后发生肝细胞癌。这些结果表明，即使在转氨酶活性正常化和HBsAg清除后，患者仍可能患有慢性肝炎并发症。因此，即使在没有HBsAg的情况下，特别是如果血清中B型肝炎病毒DNA持续存在，也应将B型肝炎病毒视为与肝细胞癌相关的可能因素。
The natural history of chronic hepatitis B patients who spontaneously cleared serum HBsAg was investigated. A total of 351 patients with chronic hepatitis B were observed in our hospital for at least 3 yr. Seven of these patients became HBsAg negative during the follow‐up period. HBsAg disappeared within 6 mo (range = 11 to 169 days, mean = 70 days) after acute elevation of ALT. ALT levels as high as 500 IU were found in three patients, whereas such elevation was not demonstrated in the other four patients. After the disappearance of HBsAg, ALT levels returned to normal in all patients. With one exception, all patients seroconverted to antibody to HBsAg; however, hepatitis B virus DNA remained detectable in serum using the polymerase chain reaction in five patients. The titer of percent inhibition of antibody to HBcAg gradually decreased to less than 70% when a 1:200 dilution of the serum of six patients was used. Four of the patients had active liver disease develop: two had chronic active hepatitis and two had cirrhosis. Three of these four patients subsequently had hepatocellular carcinoma develop. These findings suggest that patients may suffer complications of chronic hepatitis even after normalization of transaminase activities and after the clearance of HBsAg. Thus hepatitis B virus should be considered as a possible factor associated with hepatocellular carcinoma even in the absence of HBsAg, particularly if serum hepatitis B virus DNA persists.