慢性乙型肝炎严重急性发作后的长期乙型肝炎表面抗原谱和

StephenW

慢性乙型肝炎严重急性发作后的长期乙型肝炎表面抗原谱和血清清除
许嘉贤 1 , 冯绍峰 1 , 张嘉诚 1 2 , 麦龙怡 1 3 , 濑户伟琪 1 2 3 , 袁文丰 1 3
隶属关系
隶属关系

    1
    香港大学玛丽医院内科，中国香港特别行政区。
    2
    香港大学深圳医院内科，中国深圳。
    3
    香港大学肝脏研究国家重点实验室，中国香港特别行政区。

    PMID: 36317514 DOI: 10.5009/gnl220122

免费文章
抽象的

背景/目的：乙型肝炎表面抗原 (HBsAg) 血清清除在慢性乙型肝炎 (CHB) 感染中并不常见。在慢性乙型肝炎急性发作 (AFOCHB) 期间，丙氨酸氨基转移酶升高反映了对病毒清除的免疫反应增加。我们假设重度 AFOCHB 与更大的 HBsAg (qHBsAg) 定量下降和 HBsAg 血清清除率相关。

方法：将 75 例丙氨酸氨基转移酶高于正常上限 10 倍的重度 AFOCHB 患者按年龄和性别按 1:2 的比例与对照组配对。 qHBsAg 水平在发作时和每年（对于病例和对照）测量，直到最后一次随访。

结果：重度 AFOCHB 患者和对照组的中位随访时间分别为 8.8 年和 10.5 年。重度 AFOCHB 组 HBsAg 血清清除的累积率高于对照组（11.8% vs 5.0%，p=0.04），尽管前者的基线中位数 qHBsAg 有较高的趋势（3,127 IU/mL vs 1,178 IU /mL，p = 0.076)。与对照组相比，重度 AFOCHB 组每年 qHBsAg 降低幅度更大（-242.4 IU/mL/yr vs -47.3 IU/mL/yr，p=0.002）。年龄增加 (p=0.049)、基线 qHBsAg 降低 (p=0.002) 和严重 AFOCHB (p=0.014) 与 HBsAg 血清清除独立相关。然而，严重 AFOCHB 组的肝细胞癌累积率显着高于对照组（15.8% vs 1.9%，p<0.001）。

结论：重度 AFOCHB 与更高的 HBsAg 血清清除率和 qHBsAg 下降相关。然而，它与更高的肝细胞癌发病率有关。

关键词：功能性固化；乙型肝炎发作;乙型肝炎表面抗原。

StephenW

Long-term Hepatitis B Surface Antigen Profile and Seroclearance after Severe Acute Flares of Chronic Hepatitis B
Ka-Yin Hui  1 , James Fung  1 , Ka-Shing Cheung  1   2 , Lung-Yi Mak  1   3 , Wai-Kay Seto  1   2   3 , Man-Fung Yuen  1   3
Affiliations
Affiliations

    1
    Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China.
    2
    Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
    3
    State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong SAR, China.

    PMID: 36317514 DOI: 10.5009/gnl220122

Free article
Abstract

Background/aims: Hepatitis B surface antigen (HBsAg) seroclearance remains uncommon in chronic hepatitis B (CHB) infection. During acute flares of CHB (AFOCHB), alanine aminotransferase elevation reflects a mounting immune response toward viral clearance. We hypothesized that severe AFOCHB is associated with a greater quantitative HBsAg (qHBsAg) decline and HBsAg seroclearance rate.

Methods: A total of 75 patients with severe AFOCHB with alanine aminotransferase 10× the upper limit of normal were matched to a control group by age and sex in a 1:2 ratio. qHBsAg levels were measured at the time of flare and annually (for both cases and controls) until the last follow-up.

Results: The median follow-up times for patients with severe AFOCHB and controls were 8.8 and 10.5 years, respectively. The cumulative rate of HBsAg seroclearance was higher in the severe AFOCHB group than in the control group (11.8% vs 5.0%, p=0.04) despite the former group having a trend of a higher baseline median qHBsAg (3,127 IU/mL vs 1,178 IU/mL, p=0.076). Compared with the control group, the severe AFOCHB group had a greater annual qHBsAg reduction (-242.4 IU/mL/yr vs -47.3 IU/mL/yr, p=0.002). Increasing age (p=0.049), lower baseline qHBsAg (p=0.002), and severe AFOCHB (p=0.014) were independently associated with HBsAg seroclearance. However, the cumulative rate of hepatocellular carcinoma was significantly higher in the severe AFOCHB group than in the control group (15.8% vs 1.9%, p<0.001).

Conclusions: Severe AFOCHB was associated with a greater incidence of HBsAg seroclearance and qHBsAg decline. However, it was associated with a higher incidence of hepatocellular carcinoma.

Keywords: Functional cure; Hepatitis B flare; Hepatitis B surface antigen.

StephenW

https://www.gutnliver.org/journa ... i=10.5009/gnl220122