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发表于 2002-6-1 18:11
HBeAg Seroconversion Associated with Favorable Long-Term Outcomes
By Brian Boyle, MD
Chronic active hepatitis B virus (HBV) infection is associated with continued HBV replication, as indicated by the presence of hepatitis B e antigen (HBeAg). Occasionally, seroconversion from HBeAg positive to negative with the development of antibody (anti-HBe) occurs spontaneously, and this is generally accompanied by normalization of liver transaminases and clinical remission of HBV infection.
A study recently published in Hepatology indicates that long-term outcomes are improved as well by this seroconversion. In the study, 283 patients with chronic HBV infection were followed up for at least 1 year after spontaneous HBeAg seroconversion to anti-HBe. The median follow-up period in these patients was 8.6 years following the seroconversion.
Of these patients, 189 (66.8%) showed sustained remission while 94 (33.2%) experienced alanine aminotransferase (ALT) elevation over twice the upper limit of normal at some point during the follow-up period. In the patients that experienced an ALT elevation, 12 (4.2%) of these were associated with HBeAg reversion, 68 (24%) with detectable serum HBV DNA but HBeAg negative, and 14 (4.9%) of undetermined causes.
Further, of the 269 patients who had no clinical or other evidence of cirrhosis at the seroconversion, 21 (7.8%) developed cirrhosis. Hepatocellular carcinoma (HCC) developed in 6 (2.2%) of the patients. The cumulative incidence and relative risk of cirrhosis and HCC were significantly higher in those patients who developed active hepatitis than in patients with sustained remission.
The authors conclude, "the results suggest that spontaneous HBeAg seroconversion confers favorable long-term outcomes. However, active hepatitis still may develop and lead to cirrhosis and HCC."
05/31/02
Reference
Y Hsu and others. Long-term outcome after spontaneous HBeAg seroconversion in patients with chronic hepatitis B. Hepatology 2002; 35:1522-1527.
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