Long-term outcome after spontaneous HBeAg seroconversion in patients with chronic hepatitis B
Long-term outcome after spontaneous HBeAg seroconversion in patients with chronic hepatitis B
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DOI：
10.1053/jhep.2002.33638
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发表时间：
2002-06-01
期刊：
影响因子：
13.5
通讯作者：
Liaw, YF
中科院分区：
文献类型：
--
作者：
Hsu, YS;Chien, RN;Liaw, YF
在慢性B肝炎病毒（HBV）感染过程中，B e抗原（HBeAg）血清转化为抗-HBe抗体（抗-HBe）往往与肝脏生化指标正常化和临床缓解相一致，但有关自发血清转化后的长期结局的数据。仍然稀缺。排除合并其他病毒感染的患者，对283例慢性HBV感染患者在HBeAg自发血清转换为抗-HBe后至少随访1年。随访研究包括临床、生化和病毒学评价，以及超声和甲胎蛋白测定筛查肝细胞癌（HCC）。中位随访期为8.6年283例患者HBeAg血清转换后（范围，1至18.4年），189持续缓解率为66.8%，其余94（33.2%）出现丙氨酸氨基转移酶AIM升高超过正常上限的两倍：12例（4.2%）与HBeAg逆转相关，68例（24%）血清HBV DNA可检测但HBeAg阴性，14例（4.9%）原因不明。在269例HBeAg血清转换时无肝硬化证据的患者中，21例（7.8%）发展为肝硬化，活动性肝炎患者的累积发病率和相对危险度显著高于持续缓解患者（P <0.05）。283例患者中有6例（2.2%）发生了肝癌，HBeAg血清转换后发生活动性肝炎的患者的累积发病率也明显较高（P <0.005）。总之，结果表明，自发性HBeAg血清转换赋予有利的长期结果。然而，活动性肝炎仍然可能发展并导致肝硬化和HCC。
During the course of chronic hepatitis B virus (HBV) infection, hepatitis B e antigen (HBeAg) seroconversion to its antibody (anti-HBe) often coincides with normalization of liver biochemical test and clinical remission, but data regarding long-term outcome after spontaneous seroconversion. are still scarce. Excluding patients with other virus(es) concurrent infection, 283 patients with chronic HBV infection were followed up for at least 1 year after spontaneous HBeAg seroconversion to anti-HBe. Follow-up studies included clinical, biochemical, and virologic evaluation and hepatocellalar carcinoma (HCC) screening with ultrasonography and a-fetoprotein assay. Daring a median follow-up period of 8.6 years (range, 1 to 18.4 years) after HBeAg seroconversion in 283 patients, 189 (66.8%) showed sustained remission, whereas the remaining 94 (33.2%) experienced alanine aminotransferase (AIM elevation over twice the upper limit of normal: 12 (4.2%) associated with HBeAg reversion, 68 (24%) with detectable serum HBV DNA but HBeAg negative, and 14 (4.9%) of undetermined causes. Of the 269 patients without evidence of cirrhosis at the time of HBeAg seroconversion, 21 (7.8%) developed cirrhosis with a cumulative incidence and relative risk significantly higher in patients developing active hepatitis than in patients with sustained remission (P < .05). HCC developed in 6 (2.2%) of the 283 patients, also with a significantly higher cumulative incidence in patients developing active hepatitis after HBeAg seroconversion (P < .005). In conclusion, the results suggest that spontaneous HBeAg seroconversion confers favorable long term outcomes. However, active hepatitis still may develop and lead to cirrhosis and HCC.