Ni Yen-Hsuan, Chang Mei-Hwei, Chen Pei-Jer, Tsai Keh-Sung, Hsu Hong-Yuan, Chen Huey-Ling, Tsuei Daw-Jen, Chen Ding-Shinn
Department of Pediatrics, Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
Gastroenterology. 2007 Jun;132(7):2340-5. doi: 10.1053/j.gastro.2007.03.111. Epub 2007 Apr 11.
BACKGROUND & AIMS: This study investigated the viremia profiles in children with chronic hepatitis B virus (HBV) infection and spontaneous hepatitis B e antigen (HBeAg) seroconversion.
Fifty-eight children with chronic HBV infection met the following criteria: normal alanine aminotransferase (ALT) level at enrollment, followed up for more than 10 years, no antiviral treatment, and having undergone spontaneous HBeAg seroconversion during follow-up evaluation. They were grouped according to the post-HBeAg seroconversion HBV-DNA levels: (1) low viremia: transient or never 10(4) copies/mL or greater (n=35) (2) fluctuating high viremia: 10(4) copies/mL or greater at least twice at intervals more than 1 year apart (n=23). Abdominal sonography, ALT, and HBV-DNA levels were assessed annually. Another 14 nonseroconverted children served as controls. The precore mutant (nt1896) and genotypes were examined.
The initial HBV-DNA level of the 58 seroconverters was 10(8.4+/-1.0) copies/mL and decreased to 10(2.9+/-2.0) copies/mL at the end of follow-up period. Their mean ages at enrollment, at peak HBV-DNA, at peak ALT, at HBeAg seroconversion, and at final follow-up were 7.0 +/- 3.7, 13.4 +/- 5.8, 16.3 +/- 6.0, 17.2 +/- 5.8, and 23.7 +/- 4.1 years, respectively. The precore mutant appeared more often in the fluctuating-high-viremia group than in the low-viremia group (60.9% vs 22.9%, P=.004). HBV genotypes had no effect on the viremia profiles. After HBeAg seroconversion, none had persistent abnormal ALT levels.
Generally, these young seroconverters had decreased viral loads, normal ALT levels, and uneventful courses after HBeAg seroconversion. A longer follow-up period is necessary to elucidate the significance of HBeAg seroconversion occurring in childhood and young adulthood.
本研究调查了慢性乙型肝炎病毒（HBV）感染儿童及自发性乙型肝炎e抗原（HBeAg）血清学转换的病毒血症情况。
58例慢性HBV感染儿童符合以下标准：入组时丙氨酸氨基转移酶（ALT）水平正常，随访超过10年，未接受抗病毒治疗，且在随访评估期间发生自发性HBeAg血清学转换。根据HBeAg血清学转换后HBV-DNA水平将他们分组：（1）低病毒血症：短暂或从未达到10⁴拷贝/mL或更高（n = 35）；（2）波动高病毒血症：间隔超过1年至少两次达到10⁴拷贝/mL或更高（n = 23）。每年评估腹部超声、ALT和HBV-DNA水平。另外14例未发生血清学转换的儿童作为对照。检测前核心突变（nt1896）和基因型。
58例血清学转换者的初始HBV-DNA水平为10⁸·⁴⁺/₋₁·⁰拷贝/mL，随访结束时降至10²·⁹⁺/₋₂·⁰拷贝/mL。他们入组时、HBV-DNA峰值时、ALT峰值时、HBeAg血清学转换时及最终随访时的平均年龄分别为7.0±3.7、13.4±5.8、16.3±6.0、17.2±5.8和23.7±4.1岁。前核心突变在波动高病毒血症组比低病毒血症组更常见（60.9%对22.9%，P = 0.004）。HBV基因型对病毒血症情况无影响。HBeAg血清学转换后，无一例ALT水平持续异常。
总体而言，这些年轻的血清学转换者病毒载量降低，ALT水平正常，HBeAg血清学转换后病程平稳。需要更长的随访期来阐明儿童期和青年期发生HBeAg血清学转换的意义。
