中国慢性乙型肝炎HBsAg 血清清除

tonychant

文题：HBsAg seroclearance in chronic hepatitis B in the Chinese: virological, histological, and clinical aspects. 作者：Yuen MF, Wong DK, Sablon E, Tse E, Ng IO, Yuan HJ, Siu CW, Sander TJ, Bourne EJ, Hall JG, Condreay LD, Lai CL. 杂志全名：Hepatology 年份，卷（期）: 起止页码：2004 ;39(6 ):1694-701 PMID: 15185311 英文摘要： Few studies have examined Chinese patients with chronic hepatitis B who exhibit hepatitis B surface antigen (HBsAg) seroclearance. We comprehensively studied the biochemical, virological, histological, and clinical aspects of 92 patients with HBsAg seroclearance (median follow-up, 126 months). Ninety-two HBsAg-positive controls matched for age, sex, and duration of follow-up were also recruited. Liver biochemistry, serum hepatitis B virus (HBV) DNA levels, and development of clinical complications were monitored. Intrahepatic total and covalently closed circular (ccc) HBV DNA were measured quantitatively in 16 patients. HBV genotype was determined in 30 patients. The mean age at HBsAg seroclearance was 48.8 (+ 13.81) years. There was a significant improvement in serum alanine aminotransferase levels after HBsAg seroclearance (p<0.0001). Patients with genotype B had a higher chance of HBsAg seroclearance than those with genotype C (P =.014). Ninety-eight percent of patients had undetectable serum HBV DNA. Thirty-seven percent of patients had low titer of intrahepatic HBV DNA, mainly in the form of cccDNA (71%-100%). All 14 patients with liver biopsies had near normal histology. There was no difference in the risk of development of hepatocellular carcinoma (HCC) between patients with and without HBsAg seroclearance. However, the mean age of HBsAg seroclearance was significantly older in patients with HCC than in patients without HCC (P =.016). In conclusion, patients with HBsAg seroclearance had favorable biochemical, virological, and histological parameters. Intrahepatic HBV DNA level was low and predominantly in the form of cccDNA. However, HCC could still develop, particularly in patients with cirrhosis who had HBsAg seroclearance at an older age. 中文译文： 中国慢性乙型肝炎HBsAg 血清清除；病毒学，组织学与临床方面 [摘要] 背景与目的; 很少有研究调查中国HBsAg 血清清除的慢性乙型肝炎患者. 方法; 我们研究包括92例HBsAg 血清清除患者的生化，病毒学，组织学与临床方面，中位随访时间126个月。收集92例HBsAg阳性年龄，性别与随访时间匹配的为对照组。肝生化，血清HBV DNA水平以及临床并发症进展被监测。16例肝内总的与ccc HBV DNA 被检测，30例HBV基因型被确定。 结果; HBsAg 血清清除患者的平均年龄为48.8±13.81岁，在HBsAg 血清清除后ALT水平有显著改善(p<0.0001).基因型B患者HBsAg 血清清除高于基因型C者(p=0.014)，98%的患者血清HBV DNA水平无法发现，在37%的患者有低滴定量的肝内HBV DNA，主要以cccDNA形式(71%-100%). 全部的14例肝活检患者组织学接近正常，有或无HBsAg 血清清除者肝癌发生风险没有差异，然而，有肝癌者HBsAg 血清清除平均年龄显著大于无肝癌者(P = 0.016).. 结论； HBsAg 血清清除患者有良好的生化，病毒学以及组织学参数，肝内HBV DNA水平低且主要为cccDNA形式，然而，仍然发展成肝癌特别是在年长HBsAg 血清清除的肝硬化患者。

大排长

一旦肝脏硬化，如果追求表面抗原转阴，可能反而是肝癌的可能性。

通常表面抗原转阴还是好事。