HBsAg 携带者静止期肝炎的自发复发。
Spontaneous relapse of hepatitis in inactive HBsAg carriers.
机构信息
Liver Research Unit, Chang Gung Memorial Hospital and Chang Gung University, 199, Tung Hwa North Road, Taipei, 10591, Taiwan,
出版信息
Hepatol Int. 2007 Jun;1(2):311-5. doi: 10.1007/s12072-007-9002-9.
BACKGROUND/AIMS: The issue of spontaneous relapse of hepatitis in anti-HBe positive asymptomatic HBsAg carriers was rarely reported before and deserves further exploration.
METHODS
A total of 1241 anti-HBe positive asymptomatic adult HBsAg carriers were prospectively followed up. Of these, 661 (53%) were males, and the mean (+/-SD) age was 35.6 +/- 9.1 years. Relapse of hepatitis was defined as elevation of ALT more than twice the upper limit of normal accompanied by detectable serum HBV DNA by hybridization assays.
RESULTS
During a mean follow up of 12.3 years, hepatitis relapsed in 211 patients with an annual rate of 1.46%. The cumulative probabilities of hepatitis relapse were 10.2%, 17.4%, 19.3%, 20.2%, and 20.2%, respectively, after 5, 10, 15, 20, and 25 years of follow up. Multivariate analyses showed that the probability of hepatitis relapse correlated significantly with male sex (P < 0.0001) and age at entry (P = 0.007). The cumulative probability of hepatitis relapse after 20 years was 26.9% for males and only 12.5% for females, and was 13.1% for those of age <30 years at entry but increased to 29.4% for those of age 40-49 years at entry.
CONCLUSION
Hepatitis relapsed in about 20% of asymptomatic HBsAg carries during 25 years of follow up. Relapse of hepatitis occurred more frequently during earlier years of follow up. Males were more likely to have relapse of hepatitis than females. In addition, relapse of hepatitis was significantly less frequent in patients who were younger than 30 years at study entry, possibly implicating more favorable outcome of earlier HBeAg seroconversion.
背景/目的：抗 HBe 阳性无症状 HBsAg 携带者的自发性肝炎复发问题以前很少报道，值得进一步探讨。
方法
对 1241 例抗 HBe 阳性无症状成年 HBsAg 携带者进行前瞻性随访。其中男性 661 例（53%），平均（+/-SD）年龄为 35.6 +/- 9.1 岁。肝炎复发定义为 ALT 升高超过正常上限的两倍，并通过杂交检测可检测到血清 HBV DNA。
结果
在平均 12.3 年的随访中，211 例患者发生肝炎复发，年发生率为 1.46%。随访 5、10、15、20 和 25 年后，肝炎复发的累积概率分别为 10.2%、17.4%、19.3%、20.2%和 20.2%。多变量分析表明，肝炎复发的概率与性别（P < 0.0001）和入组时年龄（P = 0.007）显著相关。20 年后男性肝炎复发的累积概率为 26.9%，而女性仅为 12.5%，入组时年龄<30 岁的患者为 13.1%，但入组时年龄为 40-49 岁的患者增至 29.4%。
结论
在 25 年的随访中，约有 20%的无症状 HBsAg 携带者发生肝炎复发。肝炎复发在随访早期更为常见。男性比女性更容易发生肝炎复发。此外，在研究开始时年龄小于 30 岁的患者中，肝炎复发的频率明显较低，这可能表明 HBeAg 血清学转换较早的结果更为有利。
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