Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan.
Research Center for Genes, Environment, and Human Health, and Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
J Pediatr. 2014 Oct;165(4):767-72.e1. doi: 10.1016/j.jpeds.2014.06.059. Epub 2014 Aug 8.
To investigate the factors predicting spontaneous clearance of hepatitis B surface antigen (HBsAg) in a long-term, prospectively followed cohort from childhood into adult life.
Children with chronic hepatitis B virus (HBV) infection without treatment were followed longitudinally every 6 months. At each visit, liver profiles and HBV markers were assessed. Hepatitis B vaccination history and the maternal HBV markers also were studied.
A total of 349 children (205 male) were followed for 20.6 ± 4.4 years with initial ages of 8.4 ± 3.9 years; 42 (12.0%) cleared HBsAg spontaneously. The HBsAg titers decayed with age, with an average annual clearance rate of 0.58%. Children had a lower annual HBsAg decay rate if their mothers are HBsAg carriers (P < .001). Hepatitis B e antigen-seroconversion is a favorable predictor for spontaneous HBsAg clearance (P = .04). Those with HBsAg titer ≤1000 IU/mL at enrollment during childhood have a higher rate of HBsAg clearance (hazard ratio = 5.23; P < .001). Using HBsAg titer ≤1000 IU/mL to predict HBsAg clearance, the sensitivity is 38.1%, specificity is 90.6%, positive predictive value is 35.6%, and negative predictive value is 91.4%.
During long-term follow-up, spontaneous HBsAg clearance is most likely to occur in a patient born to a non-HBsAg-carrier mother, is a hepatitis B e antigen-seroconverter, and had an initial HBsAg level ≤1000 IU/mL.
在一项长期前瞻性队列研究中，从儿童期到成年期，调查预测乙型肝炎表面抗原（HBsAg）自发清除的因素。
未接受治疗的慢性乙型肝炎病毒（HBV）感染儿童进行纵向随访，每 6 个月一次。每次就诊时，评估肝脏指标和 HBV 标志物。还研究了乙型肝炎疫苗接种史和母亲的 HBV 标志物。
共有 349 名儿童（205 名男性）接受了 20.6±4.4 年的随访，初始年龄为 8.4±3.9 岁；42 名（12.0%）自发清除了 HBsAg。HBsAg 滴度随年龄下降，平均每年清除率为 0.58%。如果母亲是 HBsAg 携带者，儿童的 HBsAg 每年衰减率较低（P<0.001）。乙型肝炎 e 抗原血清学转换是 HBsAg 自发清除的有利预测指标（P=0.04）。在儿童时期入组时 HBsAg 滴度≤1000 IU/mL 的儿童，HBsAg 清除率较高（危险比=5.23；P<0.001）。使用 HBsAg 滴度≤1000 IU/mL 来预测 HBsAg 清除，其灵敏度为 38.1%，特异性为 90.6%，阳性预测值为 35.6%，阴性预测值为 91.4%。
在长期随访中，最有可能在非 HBsAg 携带者母亲所生的患者中发生 HBsAg 自发清除，且乙型肝炎 e 抗原血清学转换和初始 HBsAg 水平≤1000 IU/mL。
