Ahn Sang Hoon, Park Young Nyun, Park Jun Yong, Chang Hye-Young, Lee Jung Min, Shin Ji Eun, Han Kwang-Hyub, Park Chanil, Moon Young Myoung, Chon Chae Yoon
Department of Internal Medicine, Yonsei University College of Medicine, C.P.O. Box 8044, Seoul, South Korea.
J Hepatol. 2005 Feb;42(2):188-94. doi: 10.1016/j.jhep.2004.10.026.
BACKGROUND/AIMS: During the natural course of hepatitis B virus (HBV) infection, the long-term clinical and histological outcomes following spontaneous hepatitis B surface antigen (HBsAg) seroclearance remain unclear.
Between 1984 and 2003, 49 (9.5%) out of 432 inactive HBsAg carriers had no detectable level of circulating HBsAg. Fifteen of 49 patients had undergone paired peritoneoscopic liver biopsies.
During a mean follow-up period of 19.6 months after HBsAg seroclearance, 5 of 49 (10.2%) patients were noted to have HCC. Liver cirrhosis (P=0.040), a history of perinatal infection (P=0.005) and long-standing duration (at least 30 years) of HBsAg positivity (P=0.002) were associated with a significantly higher risk of developing HCC. Despite HBsAg seroclearance, HBV DNA was detected in the liver tissues from all 15 patients who underwent paired liver biopsies. Necroinflammation was significantly ameliorated (P<0.0001). On the other hand, amelioration of the fibrosis score did not reach a statistically significant level (P=0.072). Interestingly, aggravation of liver fibrosis was evident in 2 patients (13.3%) including one who had rapidly progressed to overt cirrhosis.
In patients with spontaneous HBsAg seroclearance, necroinflammation was markedly improved and liver fibrosis was unchanged or regressed despite occult HBV infection. However, HCC developed in a minority of cases.
背景/目的：在乙型肝炎病毒（HBV）感染的自然病程中，自发性乙肝表面抗原（HBsAg）血清学清除后的长期临床和组织学转归仍不明确。
1984年至2003年期间，432例非活动性HBsAg携带者中有49例（9.5%）检测不到循环中的HBsAg水平。49例患者中有15例接受了配对的腹腔镜肝活检。
在HBsAg血清学清除后的平均随访期19.6个月内，49例患者中有5例（10.2%）发生了肝癌。肝硬化（P=0.040）、围产期感染史（P=0.005）和HBsAg阳性持续时间长（至少30年）（P=0.002）与发生肝癌的风险显著升高相关。尽管HBsAg血清学清除，但在接受配对肝活检的所有15例患者的肝组织中均检测到HBV DNA。坏死性炎症明显改善（P<0.0001）。另一方面，纤维化评分的改善未达到统计学显著水平（P=0.072）。有趣的是，2例患者（13.3%）出现肝纤维化加重，其中1例迅速进展为显性肝硬化。
在自发性HBsAg血清学清除的患者中，尽管存在隐匿性HBV感染，但坏死性炎症明显改善，肝纤维化无变化或有所消退。然而，少数病例会发生肝癌。
