Lok A S, Lai C L, Wu P C, Leung E K, Lam T S
Gastroenterology. 1987 Jun;92(6):1839-43. doi: 10.1016/0016-5085(87)90613-5.
Five hundred twelve (373 men, 139 women) patients, aged 1-75 yr, with chronic hepatitis B virus infection seen during a 5-yr period were analyzed. Of these, 43.8% were hepatitis B e antigen (HBeAg)-positive, 49.2% were positive for hepatitis B e antibody, and 7% were negative for both HBeAg and hepatitis B e antibody at presentation. The cumulative probability of clearing HBeAg at the end of the first, second, and third years was 17%, 30%, and 34%, respectively. The probability of clearing HBeAg increased with the age of the patients. Reversion to HBeAg occurred in 7.8% of patients who were HBeAg-negative at presentation and 32.3% of HBeAg-positive patients who cleared HBeAg. In 70.6% of these patients, serum hepatitis B virus-deoxyribonucleic acid was persistently positive or became detectable at the time of HBeAg reversion. Most reversions occurred during the "e-window" phase. The reversions were transient in 31.8% of the cases. Recognition of the dynamics of these serologic changes is important in the evaluation of therapeutic regimens aimed at suppression of HBV replication and call for controlled trials with adequate duration of follow-up. Biochemical exacerbation of liver disease accompanied 38.7% of HBeAg to hepatitis B e antibody seroconversions and 34.8% of reversions. Such exacerbations may be mistaken for acute attacks of hepatitis B in patients not previously recognized to be hepatitis B surface antigen carriers and, in the absence of serial serologic data, are indistinguishable from superimposed non-A, non-B hepatitis.
对512例（373例男性，139例女性）年龄在1至75岁之间、在5年期间就诊的慢性乙型肝炎病毒感染患者进行了分析。其中，43.8%为乙型肝炎e抗原（HBeAg）阳性，49.2%为乙型肝炎e抗体阳性，7%在就诊时HBeAg和乙型肝炎e抗体均为阴性。在第1年、第2年和第3年末清除HBeAg的累积概率分别为17%、30%和34%。清除HBeAg的概率随患者年龄增加而升高。就诊时HBeAg阴性的患者中有7.8%发生HBeAg血清学逆转，清除HBeAg的HBeAg阳性患者中有32.3%发生逆转。在这些患者中，70.6%的患者血清乙型肝炎病毒脱氧核糖核酸持续阳性或在HBeAg逆转时可检测到。大多数逆转发生在“e抗原窗”期。31.8%的病例逆转是短暂的。认识这些血清学变化的动态对于评估旨在抑制HBV复制的治疗方案很重要，并且需要进行足够随访期的对照试验。38.7%的HBeAg向乙型肝炎e抗体血清学转换和34.8%的逆转伴有肝病的生化恶化。这种恶化在以前未被识别为乙型肝炎表面抗原携带者的患者中可能被误诊为乙型肝炎急性发作，并且在没有系列血清学数据的情况下，与重叠的非甲非乙型肝炎无法区分。
