Research Report
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World J Gastroenterol. Apr 21, 2014; 20(15): 4407-4413
Published online Apr 21, 2014. doi: 10.3748/wjg.v20.i15.4407
HBsAg levels in HBeAg-positive chronic hepatitis B patients with different immune conditions
Yi-Min Zhang, Yi-Da Yang, Hong-Yu Jia, Lin-Yan Zeng, Wei Yu, Ning Zhou, Lan-Juan Li
Yi-Min Zhang, Yi-Da Yang, Hong-Yu Jia, Lin-Yan Zeng, Wei Yu, Ning Zhou, Lan-Juan Li, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Author contributions: Zhang YM and Yang YD contributed equally to this paper; Li LJ designed the study; Jia HY, Zeng LY, Yu W and Zhou N collected the data; Zhang YM and Yang YD collected and analyzed the data and wrote the paper.
Supported by China National Science and Technology Major Project, No. 2012ZX10002004 and No. 2013ZX10002001; the Chinese High Tech Research and Development (863) Program, No. 2011AA020104; Zhejiang CTM Science and Technology Project, No. 2011ZB061
Correspondence to: Lan-Juan Li, MD, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Shangcheng District, Hangzhou 310003, Zhejiang Province, China. ljli@zju.edu.cn
Telephone: +86-571-87236755 Fax: +86-571-87236755
Received: July 6, 2013
Revised: December 31, 2013
Accepted: February 17, 2014
Published online: April 21, 2014
Processing time: 285 Days and 8.1 Hours
Abstract

AIM: To investigate hepatitis B surface antigen (HBsAg) levels in patients with HBeAg-positive chronic hepatitis B (CHB) and different immune conditions.

METHODS: HBeAg-positive CHB patients with different immune conditions were enrolled in this cross-sectional study. These patients were grouped according to the following criteria: immune-tolerant patients, IT group; patients with a mild immune response in the immune clearance phase, IC-Mild group; and patients with a dramatic immune response in the immune clearance phase and exhibiting acute on chronic liver failure (ACLF), ACLF group. All these patients had not previously received antiviral therapy and were enrolled at a pre-settled ratio of 2:2:1. Serum HBsAg levels and the correlation between serum HBsAg level and serum hepatitis B virus (HBV) DNA level were evaluated in these groups.

RESULTS: In total, 180 HBeAg-positive CHB patients [IT group (n = 72), IC-Mild group (n = 72), and ACLF group (n = 36)] were enrolled in this study. The median serum HBsAg levels varied among the groups (P < 0.001): IT, 4.86 log10 IU/mL; IC-Mild, 3.97 log10 IU/mL; and ACLF, 3.57 log10 IU/mL. Serum HBsAg level showed a moderate positive correlation with serum HBV-DNA level in the IC-Mild group (r = 0.60, P < 0.001), but exhibited a weaker correlation in the IT (r = 0.52, P < 0.001) and ACLF groups (r = 0.51, P = 0.001). The ratio of HBsAg/HBV DNA did not differ significantly among the IT, IC-Mild, and ACLF groups (medians: 0.56, 0.55, and 0.56, respectively; P = 0.179).

CONCLUSION: Serum HBsAg levels varied significantly in HBeAg-positive patients with different immune conditions. These findings may have important implications for understanding the immune clearance of HBV in HBeAg-positive CHB patients.

Keywords: Chronic hepatitis B; Hepatitis B surface antigen; Hepatitis B e antigen; Immune tolerance; Immune clearance; Acute on chronic liver failure

Core tip: This study showed that a dramatic immune response demonstrated that acute on chronic liver failure results in lower serum hepatitis B surface antigen levels compared with a mild immune response in patients in the immune clearance phase. These findings may have important implications for understanding the immune clearance of hepatitis B virus in these patients.