- 现金
- 268 元
- 精华
- 0
- 帖子
- 27
- 注册时间
- 2005-5-19
- 最后登录
- 2009-3-14
|
人类对乙肝的认识是在不断的深入。以前的知识在不断的更新。现在的认识是乙肝病毒极难清除。即使表面抗原转阴了,仍可能有病毒。
看这篇英文文章:
Predictors and Long-term Outcomes Associated with Hepatitis B Surface Antigen (HBsAg) Clearance
Even among hepatitis B patients who achieve other markers of disease remission or "cure," seroclearance of hepatitis B surface antigen (HBsAg) is a rare event.
Two studies presented at the recent 58th Annual Meeting of the American Association for the Study of Liver Diseases in Boston (November 2-6, 2007) looked at predictors of HBsAg clearance and long-term outcomes in patients with chronic hepatitis B.
Study 1
In the first study, researchers in Hong Kong conducted a large-scale longitudinal study investigating virological, histological, and clinical aspects -- including the risk of development of hepatocellular carcinoma (HCC) -- in patients with HBsAg seroclearance.
The study included 298 patients (211 male and 87 female; median age at presentation 43 years) with HBsAg seroclearance. Participants were followed up every 3-6 months for clinical assessment. Intrahepatic HBV DNA and covalently closed circular DNA (cccDNA) were measured by real-time PCR. Serum HBV DNA was measured by the Artus HBV RG Test. Liver stiffness was assessed using transient elastography (FibroScan).
Results
• The median age at the time of HBsAg seroclearance was 49.6 years.
• The total median follow-up duration was 108.9 months and the median follow-up duration after HBsAg seroclearance was 36.4 months.
• Liver biopsies were performed on 29 patients a median 48.6 months after HBsAg seroclearance.
• All patients had detectable intrahepatic HBV DNA (median 1.68 copies/cell).
• cccDNA was detectable in 23 patients (79.3%; median 0.03 copies/cell).
• Of the 29 patients who underwent liver biopsies, 9 had sera available within 1 year and 16 patients had samples between 5 and 10 years after HBsAg seroclearance for HBV DNA analysis.
• All 9 patients of the former patients had undetectable HBV DNA (<1.1 IU/mL) within 1 year of HBsAg seroclearance.
• 4 of 16 of the latter group (25%) had detectable HBV DNA levels between 5 and 10 years after HBsAg seroclearance (median 2.37 IU/mL).
• Of the 26 patients with adequate liver tissue samples for histological examination, 4 had mild fibrosis (stage F1) and 5 had minimal necroinflammation.
• FibroScan was performed on 76 and 78 patients who had HBsAg seroclearance at age <50 and > 50 years, respectively.
• Significant fibrosis (liver stiffness > 8.1 kPa) was observed only in 7.9% (6 of 76) patients with HBsAg seroclearance at age < 50 compared to 29.5% (23 of 78) with HBsAg seroclearance at age > 50 (P = 0.001).
• 7 patients developed HCC at a median age of 69 years.
• Kaplan-Meier analysis showed that the risk of HCC development in patients with HBsAg seroclearance at age < 50 was significantly less than those with seroclearance at age > 50 (P = 0.004).
Based on these findings, the investigators concluded, "Although serum HBV DNA was detectable in only a small proportion of patients with HBsAg seroclearance, intrahepatic HBV DNA was still present in all patients. Nevertheless, patients who cleared HBsAg at age < 50 had significantly less fibrosis and lower chance of HCC development than those with HBsAg seroclearance at > 50 years."
[ 本帖最后由 imhealthok 于 2009-2-21 15:22 编辑 ] |
|