Misawa Noriko, Matsumoto Akihiro, Tanaka Eiji, Rokuhara Akinori, Yoshizawa Kaname, Umemura Takeji, Maki Noboru, Kimura Tatsuji, Kiyosawa Kendo
Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
J Med Virol. 2006 Jan;78(1):68-73. doi: 10.1002/jmv.20505.
The characteristic differences between patients with and without loss of hepatitis B virus (HBV) DNA after achieving hepatitis B e antigen seroconversion were analyzed by comparing changes in HBV DNA and HBV core-related antigen levels during a period from 3 years before to 3 years after the seroconversion. Of the 24 seroconverters, 6 (inactive replication group) showed continuous loss of HBV DNA in serum after the seroconversion and the remaining 18 did not lose HBV DNA (active replication group). The HBV DNA level was similar between the two groups, while the HBV core-related antigen level was significantly lower in the active replication group than in the inactive replication group before the seroconversion. The levels of both HBV DNA and HBV core-related antigen decreased remarkably around the time of seroconversion in the inactive replication group, while these levels did not change or decreased slightly in the active replication group. After the seroconversion, the HBV DNA level was significantly higher in the active replication group than in the inactive replication group, while the HBV core-related antigen level was similarly low between the two groups. Because the serum level of HBV core-related antigen mainly reflects that of HBe antigen, the low level of HBV core-related antigen seen after seroconversion in both groups might have contributed to the occurrence of seroconversion. The precore and core promoter mutations which cause diminished excretion of hepatitis B e antigen were significantly more frequent in the active replication group than in the inactive replication group. It was therefore considered that the seroconversion was caused mainly by a decrease in viral replication in the inactive replication group, and mainly by a decrease in HBe antigen production in the active replication group.
通过比较乙肝e抗原血清学转换前3年至转换后3年期间乙肝病毒（HBV）DNA和HBV核心相关抗原水平的变化，分析了实现乙肝e抗原血清学转换后有或无HBV DNA丢失的患者之间的特征差异。在24例血清学转换者中，6例（非活动性复制组）在血清学转换后血清中HBV DNA持续丢失，其余18例未丢失HBV DNA（活动性复制组）。两组的HBV DNA水平相似，而在血清学转换前，活动性复制组的HBV核心相关抗原水平显著低于非活动性复制组。在非活动性复制组中，HBV DNA和HBV核心相关抗原水平在血清学转换时均显著下降，而在活动性复制组中这些水平未变化或略有下降。血清学转换后，活动性复制组的HBV DNA水平显著高于非活动性复制组，而两组的HBV核心相关抗原水平相似较低。由于血清中HBV核心相关抗原水平主要反映HBe抗原水平，两组血清学转换后出现的低水平HBV核心相关抗原可能促成了血清学转换的发生。导致乙肝e抗原分泌减少的前核心和核心启动子突变在活动性复制组中显著比非活动性复制组更频繁。因此认为，在非活动性复制组中血清学转换主要由病毒复制减少引起，而在活动性复制组中主要由HBe抗原产生减少引起。
