Factors Affecting the Natural Decay of Hepatitis B Surface Antigen in Children with Chronic Hepatitis B Virus Infection during Long-term Follow-up

• Main Authors: Yu-Chun Chiu, 邱郁淳
• Other Authors: 張美惠
• Format: Others
• Language: zh-TW
• Published: 2014
• Online Access: http://ndltd.ncl.edu.tw/handle/86399899447746967412

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.