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目的慢性乙型肝炎e抗原(HBeAg)血清转换后乙型肝炎复发的预测因素之前罕有报道,值得进一步研究。方法研究对象是133例发生HBeAg血清转换的HBeAg阳性无症状携带者。乙型肝炎复发的判定标准为丙氨酸氨基转移酶(ALT)升高>2倍正常上限(ULN),伴有杂交法可检测到血清HBV DNA。结果研究对象中,男75例,女58例,平均年龄(28.2±6.9)岁。其中108例的HBV DNA为基因B型,25例为基因C型。HBeAg阳性阶段ALT水平<2ULN、2~5ULN、>5ULN的例数分别为49、40、44。HBeAg发生血清转换的平均随访时间为(4.6±3.7)年。HBeAg血清转换后平均随访(5.8±4.6)年中,26例患者出现乙型肝炎复发,每年的复发率为3.3%。多变量分析表明乙型肝炎复发与下列因素明显相关:基因C型(P=0.003),男性(P=0.03),HBeAg阳性阶段ALT水平>5ULN(P=0.02),发生HBeAg血清转换的年龄≥40岁(P=0.002)。结论在基线水平,基因C型和男性是乙型肝炎复发的独立预测因素。另外,如果需要更强的免疫介导肝细胞溶解或更长的免疫清除期方能清除病毒时,乙型肝炎再发的可能性就会相应增加。
Aims Predictors of hepatitis B recurrence after seroconversion of chronic hepatitis B e antigen (HBeAg) were rarely reported and deserved further study. Methods The subjects were HBeAg-positive asymptomatic carriers of 133 HBeAg-seroconverted patients. Hepatitis B relapse is based on a> 2-fold upper limit of normal (ULN) increase in alanine aminotransferase (ALT) with serum HBV DNA detectable by hybridization. Results The subjects were 75 males and 58 females, with an average age of (28.2 ± 6.9) years. 108 cases of HBV DNA genotype B, 25 cases of genotype C HBeAg positive stage ALT levels <2ULN, 2 ~ 5ULN,> 5ULN cases were 49,40,44. The mean follow-up of HBeAg seroconversion was (4.6 ± 3.7) years. After a mean follow-up of 5.8 ± 4.6 years after HBeAg seroconversion, 26 patients developed recurrent hepatitis B, with a recurrence rate of 3.3% per year. Multivariate analysis showed that relapse of hepatitis B was significantly associated with the following factors: genotype C (P = 0.003), male (P = 0.03), ALT level> 5 ULN in HBeAg positive stage (P = 0.02), age at which HBeAg seroconversion occurred ≥ 40 years old (P = 0.002). Conclusions At baseline, genotype C and males are independent predictors of hepatitis B recurrence. In addition, there is a corresponding increase in the likelihood of hepatitis B relapse if stronger immune-mediated hepatololysis or longer immunodeviations are required to clear the virus.