| Summary: | 碩士 === 國立臺灣大學 === 臨床醫學研究所 === 102 === Backgrounds and Aims
Clearance of hepatitis B surface antigen (HBsAg) is the desirable outcome of chronic hepatitis B virus (HBV) infection. Little is known about the natural history of surface antigen decay from childhood to adult life. We investigate the factors predicting spontaneous HBsAg clearance in this long-term prospectively followed cohort from childhood into adult life.
Materials and Methods
Chronic HBV-infected children without treatment were followed longitudinally every 6 months. At each visit, liver functions profiles and HBV markers were checked. Hepatitis B vaccination history and the maternal HBV markers were also studied.
Results
A total of 349 children (205 males) were followed for 20.6±4.4 years with initial ages of 8.4±3.9 years. Forty-two patients (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 < 0.001). Hepatitis B e antigen (HBeAg)-seroconversion is a favorable predictor for spontaneous HBsAg clearance (P = 0.04). Those with HBsAg titer ≦1,000IU/mL at enrollment during childhood have a higher rate of HBsAg clearance (HR = 5.23 ; P < 0.001). Using HBsAg titer ≦1,000IU/mL to predict HBsAg clearance, the sensitivity is 38.1%, specificity 90.6%, positive predictive value 35.6% and negative predictive value 91.4%.
Conclusions
During long-term follow-up, patient who has a non HBsAg-carrier mother, is an HBeAg seroconverter, and with initial HBsAg level ≦1,000IU/mL is favorable for spontaneous HBsAg clearance.
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