在急性乙型肝炎患者发病后HBV水平高导致慢性感染

StephenW

High Levels of HBV after the Onset Lead to Chronic Infection in Patients with Acute Hepatitis B


    Hiroshi Yotsuyanagi1,7,
    Kiyoaki Ito2,5,7,
    Norie Yamada1,3,4,
    Hideaki Takahashi3,
    Chiaki Okuse3,
    Kiyomi Yasuda4,
    Michihiro Suzuki3,
    Kyoji Moriya1,
    Masashi Mizokami2,
    Yuzo Miyakawa6, and
    Kazuhiko Koike1

+ Author Affiliations

    1Department of Internal Medicine, Graduate School of Medicine, University of Tokyo, Bunkyo, Tokyo, Japan
    2The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Ichikawa, Japan
    3Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
    4Department of Internal Medicine, Center for Liver Diseases, Kiyokawa Hospital, Suginami, Tokyo, Japan
    5Department of Microbiology and Immunology, Aichi Medical University School of Medicine and
    6Miyakawa Memorial Research Foundation, Minato, Tokyo, Japan

    Corresponding Address requests for reprints to: Hiroshi Yotsuyanagi, MD, Graduate Institute of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo 113-8655, Japan. e-mail: [email protected]; phone: 81-3-5800-8801, fax: 81-3-5800-8804.

    ↵7 H.Y. and K.I equally contributed to this work

Abstract

Background. Some patients with acute HBV infection develop chronic infection. However, the method for identifying them has not been established.

Methods. We followed 215 Japanese patients with acute HBV infection until the clearance of HBsAg or the development of chronic infection. Levels of HBsAg and HBV DNA were serially monitored from the onset.

Results. Of the 215 patients, 113 (52.5%) possessed HBV genotype A, 26 (12.0%) genotype B, and 73 (34.0%) genotype C. Twenty-one of the 215 (9.8%) developed chronic infection, with the persistence of HBsAg for>6 months. The rate of chronicity of genotype A, B, and C was 12.4%, 3.8%, and 8.2%. Of the 21 patients, only six (2.8%) patients, including five with genotype A, failed to clear HBsAg within 12 months. Levels of HBsAg at 12 weeks and HBV DNA at 4 weeks were useful for distinguishing the patients who became chronic from those who did not (P <.001 and P<.001, respectively). Likewise, the levels of HBsAg at 12 weeks and HBV DNA at 8 weeks were useful for discriminating between the patients who lost HBsAg within 12 months and those who did not (P<.01 and P<.05, respectively).

Conclusions. In acute HBV infection, clearance of HBV may happen between 6 and 12 months from the onset. Only those who fail to clear HBV within 12 months from the onset may really develop chronic infection.

    Received February 14, 2013.
    Accepted May 9, 2013.

    © The Author 2013. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: [email protected].

StephenW

背景。有些患者急性HBV感染发展成慢性感染。然而，该方法尚未确立吞吐量它们。

方法。我们随访了215名日本患者急性HBV感染，直到清除HBsAg或慢性感染的发展。串行监控从发病的HBsAg和HBV DNA的水平。

的结果。在215例患者中，有113（52.5％）HBV基因型A，26（12.0％），B型，和73（34.0％），C基因型25-215（9.8％）发展为慢性感染之一，拥有持久乙肝表面抗原> 6个月。基因型A，B和C的慢性化率是12.4％，3.8％和8.2％。 21例患者中，只有6例患者（2.8％），其中包括5个基因型，在12个月内未能清除HBsAg的。在第4周在12周和HBV DNA的HBsAg水平有助于区分那些谁没有谁成为慢性患者（P <0.001，P <0.001）。同样，8周时乙肝表面抗原在第12周和HBV DNA水平区分谁失去了HBsAg的12个月内，这些患者是有用的，谁没有（P <0.01，P <0.05）。

结论。在急性HBV感染，乙肝病毒的清除可能从一开始的6个月和12个月之间发生。只有那些不能清除乙肝病毒在12个月内从发病可能真的发展成慢性感染。

sddp1

成年感染hbv慢性化的比例很小。我们的大多数不幸在于幼年时期的感染。

StephenW

回复 sddp1 的帖子

这项研究证明成年感染hbv慢性化的比例很小 ,还可能需要超过6个月清除病毒.