Gastroenterology and Liver Clinic, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Modena, Italy.
J Hepatol. 2010 May;52(5):768-70. doi: 10.1016/j.jhep.2010.01.018. Epub 2010 Feb 18.
Clearance of Hepatitis B Surface Antigen and Risk of Hepatocellular Carcinoma in a cohort Chronically Infected with Hepatitis B Virus. Simonetti J, Bulkow L, McMahon BJ, Homan C, Snowball M, Negus S, Williams J, Livingston SE. Hepatology. 2009 Nov 30. [Epub ahead of print]. Copyright 2009. Reprinted with permission of John Wiley and Sons, Inc. Abstract: Some individuals who are chronically infected with hepatitis B virus (HBV) eventually lose hepatitis B surface antigen (HBsAg). Hepatocellular carcinoma (HCC) has been demonstrated to occur in a few patients after loss of HBsAg. Neither factors associated with loss of HBsAg nor the incidence of HCC thereafter have been clearly elucidated. We performed a prospective population-based cohort study in 1271 Alaska native persons with chronic HBV infection followed for an average of 19.6 years to determine factors associated with loss of HBsAg and risk of developing HCC thereafter. HBsAg loss occurred in 158 persons for a rate of HBsAg clearance of 0.7%/year. Older age, but not sex, was associated with clearance of HBsAg, and loss of HBsAg was not associated with any particular HBV genotypes (A-D, and F) found in this population. Participants were followed for an average of 108.9 months after HBsAg loss. Six patients, two with cirrhosis and four without, developed HCC a mean of 7.3 years after HBsAg clearance (range, 2.0-15.5 years). The incidence of HCC after clearance of HBsAg was 36.8 per 100,000 per year (95% CI 13.5-80.0) which was significantly lower than the rate in those who remained HBsAg-positive (195.7 cases per 100,000 person-years of follow-up [95% CI 141.1-264.5; P<0.001). After loss of HBsAg, HBV DNA was detected in the sera of 28 (18%) of those who cleared a median of 3.6 years after clearance.
HCC can occur in persons with chronic hepatitis B who have lost HBsAg, even in the absence of cirrhosis. These persons should still be followed with periodic liver ultrasound to detect HCC early.
清除乙型肝炎表面抗原和乙型肝炎病毒慢性感染者发生肝细胞癌的风险。西蒙内蒂 J、布尔科 L、麦克马洪 BJ、霍曼 C、斯莫尔 M、内格斯 S、威廉姆斯 J、利文斯顿 SE。《肝脏病学》。2009 年 11 月 30 日。[电子版提前出版]。版权所有 2009.经 John Wiley and Sons, Inc. 许可重印。摘要：一些乙型肝炎病毒（HBV）慢性感染者最终会失去乙型肝炎表面抗原（HBsAg）。已经证明，在 HBsAg 丢失后，少数患者会发生肝细胞癌（HCC）。与 HBsAg 丢失相关的因素以及此后 HCC 的发生率均未明确阐明。我们对 1271 名慢性 HBV 感染的阿拉斯加原住民进行了一项前瞻性人群队列研究，平均随访 19.6 年，以确定与 HBsAg 丢失相关的因素以及此后发生 HCC 的风险。158 人发生了 HBsAg 丢失，HBsAg 清除率为 0.7%/年。年龄较大而非性别与 HBsAg 清除相关，而在该人群中发现的任何特定的 HBV 基因型（A-D 和 F）均与 HBsAg 丢失无关。HBsAg 丢失后，参与者平均随访 108.9 个月。6 例患者，2 例有肝硬化，4 例无肝硬化，在 HBsAg 清除后平均 7.3 年（范围，2.0-15.5 年）发生 HCC。HBsAg 清除后 HCC 的发生率为 36.8/100,000 人/年（95%CI 13.5-80.0），明显低于 HBsAg 阳性者（195.7 例/100,000 人年随访[95%CI 141.1-264.5；P<0.001）。HBsAg 丢失后，28 例（18%）清除者的血清中仍可检测到 HBV DNA，中位时间为清除后 3.6 年。
即使没有肝硬化，HBsAg 丢失的慢性乙型肝炎患者也可能发生 HCC。这些人仍应定期进行肝脏超声检查，以早期发现 HCC。
