AASLD 2013:自发e抗原血清学转换与无后续抗病毒治表面抗原转

StephenW

自发乙肝e抗原血清学转换是与无后续抗病毒治疗乙型肝炎表面抗原转阴率较高
TITLE: Spontaneous hepatitis B e-antigen seroconversion without subsequent antiviral therapy is associated with higher rates of hepatitis B surface antigen seroclearance
AUTHORS (FIRST NAME, LAST NAME): James Fung1, Danny Wong1, Wai-Kay Seto1, Ching-Lung Lai1, Man-Fung Yuen1
Institutional Author(s):
INSTITUTIONS (ALL): 1. Medicine, University of Hong Kong, Hong Kong, China.
ABSTRACT BODY: Background: In chronic hepatitis B (CHB), the implications of hepatitis B e-antigen (HBeAg) seroconversion on subsequent hepatitis B surface antigen (HBsAg) seroclearance has not been documented.

Methods: The Chronic Hepatitis B E-Seroconversion Study (C.H.E.S.S.) cohort follows up a large population of CHB patients with documented HBeAg seroclearance. Patients are followed-up at 3-6 monthly intervals with routine liver biochemistry and viral serological tests.

Results: A total of 803 patients with documented HBeAg seroconversion were included, with a median HBeAg seroconversion age of 34 years. The median follow-up length was 123 months after HBeAg seroclearance, with a total of 9250 patient-years. Of these, 502 (62.5%) were male. The cumulative rate of HBsAg seroclearance after HBeAg seroconversion was 0.2%, 1.4%, 3%, and 15% after 1, 5, 10, and 20 years respectively, without any gender differences (p=0.756). The median time to HBsAg seroclearance after HBeAg seroconversion was 139 months. 448 (55.8%) remained treatment-naïve after spontaneous HBeAg seroconversion (group 1), 204 (25.4%) had treatment-induced HBeAg seroconversion (group 2), and 151 (18.8%) required antiviral treatment after spontaneous HBeAg seroconversion. The HBsAg seroclearance rate observed in groups 1, 2, and 3 at 10 years were 4.3%, 2.6%, and 0% respectively, and at 20 years were 24%, 7.2%, and 0% respectively (p<0.001) (see figure). No HBsAg seroclearance was observed for group 3. The age of spontaneous HBeAg seroconversion was lower in group 1 compared with group 3 (32 vs 39 years respectively, p<0.001).

Conclusion: In CHB, early spontaneous HBeAg seroconversion is associated with lesser chance of active HBeAg-negative disease and higher chance of HBsAg seroclearance. HBsAg seroclearance is rare for those who spontaneously undergo HBeAg seroconversion with subsequent reactivation requiring antiviral therapy.

StephenW

背景：在慢性乙型肝炎（ CHB ） ，乙肝e抗原（HBeAg ）血清转换在随后的B型肝炎表面抗原（HBsAg）的影响转阴并没有被记录在案。

方法：慢性乙肝e血清转换研究队列（国际象棋）如下一个人口众多的慢性乙型肝炎患者的HBeAg转阴记载。患者随访3-6个月的时间间隔与常规肝功能和病毒血清学试验。

结果：共803例HBeAg血清转换记录都包括在内，与HBeAg血清转换中位数年龄34岁。中位随访长度为123个月后， e抗原转阴，共9250病人年。其中，502名（62.5 ％）是男性。累计乙肝表面抗原转阴后HBeAg血清转换率分别为0.2 ％， 1.4％， 3 ％和15 ％后， 1 ，5 ，10 ，和20年的分别，没有任何性别差异（p = 0.756 ） 。乙肝表面抗原转阴后HBeAg血清转换的平均时间为139个月。 448 （55.8％）维持治疗初治后自发性HBeAg血清学转换（第1组） ， 204 （25.4％）有治疗引起的HBeAg血清转换（第2组） ， 151 （18.8％）自发性HBeAg血清学转换后需要抗病毒治疗。乙肝表面抗原的血清清除率组1，组2中观察到的，和3分别为4.3％ ， 2.6％和0 ％ ，分别在10年， 20年时分别为24％ ，7.2％ ，和0 ％ （P <0.001 ）（见如图）。观察3组无乙肝表面抗原转阴。自发性HBeAg血清转换的年龄明显低于第1组相比，第3组（分别为32和39岁， P < 0.001 ） 。

结论：慢性乙型肝炎，早期自发性HBeAg血清转换的机会较小活跃HBeAg阴性的疾病，乙肝表面抗原转阴的几率较高。乙肝表面抗原转阴是罕见的那些人自发地进行后续的重新需要抗病毒治疗的HBeAg血清学转换。