Fattovich G, Rugge M, Brollo L, Pontisso P, Noventa F, Guido M, Alberti A, Realdi G
Hepatology. 1986 Mar-Apr;6(2):167-72. doi: 10.1002/hep.1840060203.
Seventy consecutive HBsAg- and HBeAg-positive patients with biopsy-proven chronic hepatitis were followed prospectively with serial determinations of SGPT levels and hepatitis B virus serum markers including HBsAg, HBeAg, anti-HBe and hepatitis B virus DNA. During a period of 1 to 11 years (mean +/- S.D.: 5.0 +/- 2.3 years), 28 patients remained persistently HBeAg positive, most with continuing biochemical and histologic activity, while 41 cases seroconverted to anti-HBe. One patient became HBeAg and anti-HBe negative. After seroconversion, 87.8% of the cases showed sustained normalization of SGPT, and clearance of hepatitis B virus DNA from serum and histologic improvement was documented in 79% of the cases who had a control liver biopsy, while 15.8% developed cirrhosis. In two patients (4.9%), the disease remained active despite seroconversion, and both cases had evidence of continuing hepatitis B virus replication. Finally, reactivation of liver damage and of hepatitis B virus replication was observed in three additional patients (7.3%) who had transiently normalized SGPT after seroconversion. All 70 patients were analyzed for hepatitis delta virus markers, and only two persistently HBeAg-positive cases were found positive for antibody to hepatitis delta virus in serum, one also having hepatitis delta antigen in the liver. These findings indicate that, in chronic hepatitis type B, termination of virus replication is associated in most patients with biochemical and histologic regression of inflammatory activity. After anti-HBe seroconversion has occurred, virus replication and liver disease may persist or reactivate in a small proportion of patients thus giving origin to the well-recognized group of anti-HBe positive, hepatitis B virus DNA-positive chronic hepatitis type B.
对70例经活检证实为慢性肝炎且乙肝表面抗原（HBsAg）和乙肝e抗原（HBeAg）阳性的患者进行了前瞻性随访，连续测定谷丙转氨酶（SGPT）水平以及乙肝病毒血清学标志物，包括HBsAg、HBeAg、乙肝e抗体（anti - HBe）和乙肝病毒DNA。在1至11年的时间段内（平均±标准差：5.0±2.3年），28例患者持续HBeAg阳性，多数伴有持续的生化和组织学活动，而41例发生血清学转换为anti - HBe。1例患者HBeAg和anti - HBe均转为阴性。血清学转换后，87.8%的病例SGPT持续正常，79%经对照肝活检的病例血清中乙肝病毒DNA清除且组织学改善，而15.8%发展为肝硬化。2例患者（4.9%）尽管发生了血清学转换但疾病仍活跃，且两例均有乙肝病毒持续复制的证据。最后，在另外3例（7.3%）血清学转换后SGPT曾短暂正常的患者中观察到肝损伤和乙肝病毒复制的重新激活。对所有70例患者进行了丁型肝炎病毒标志物分析，仅2例持续HBeAg阳性病例血清中丁型肝炎病毒抗体呈阳性，其中1例肝脏中也有丁型肝炎抗原。这些发现表明，在慢性乙型肝炎中，大多数患者病毒复制的终止与炎症活动的生化和组织学消退相关。发生anti - HBe血清学转换后，一小部分患者病毒复制和肝病可能持续或重新激活，从而形成了公认的anti - HBe阳性、乙肝病毒DNA阳性的慢性乙型肝炎群体。
