Prospective Study
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World J Gastroenterol. Jul 21, 2014; 20(27): 9178-9184
Published online Jul 21, 2014. doi: 10.3748/wjg.v20.i27.9178
Hepatitis B surface antigen levels during natural history of chronic hepatitis B: A Chinese perspective study
Lin-Yan Zeng, Jiang-Shan Lian, Jian-Yang Chen, Hong-Yu Jia, Yi-Min Zhang, Dai-Rong Xiang, Liang Yu, Jian-Hua Hu, Ying-Feng Lu, Lin Zheng, Lan-Juan Li, Yi-Da Yang
Lin-Yan Zeng, Jiang-Shan Lian, Jian-Yang Chen, Hong-Yu Jia, Yi-Min Zhang, Dai-Rong Xiang, Liang Yu, Jian-Hua Hu, Ying-Feng Lu, Lin Zheng, Lan-Juan Li, Yi-Da Yang, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Author contributions: Zeng LY and Lian JS performed the majority of experiments; Chen JY, Jia HY, Zhang YM, Xiang DR, Yu L, Hu JH, Lu YF provided analytical tools and revised the manuscript; Zheng L, Li LJ and Yang YD designed the study; Lian JS and Yang YD wrote the manuscript.
Supported by National Key Program for Infectious Diseases of China to Yang YD, No. 2013ZX10002001; and the 12th Five-Year Significant New Drugs Creation Plan of the Ministry of Science and Technology of China to Li LJ, No. 2011ZX09302-003-03
Correspondence to: Yi-Da Yang, Professor, State Key Laboratory for Diagnosis and Treatment of Infectious Disease, the First Affiliated Hospital of Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. yangyida65@163.com
Telephone: +86-571-87236755 Fax: +86-571-87236755
Received: November 17, 2013
Revised: March 12, 2014
Accepted: April 21, 2014
Published online: July 21, 2014
Processing time: 246 Days and 5 Hours
Abstract

AIM: To determine the baseline hepatitis B surface antigen (HBsAg) levels during the different phases of chronic hepatitis B (CHB) patients in China.

METHODS: Six hundred and twenty-three hepatitis B virus or un-infected patients not receiving antiviral therapy were analyzed in a cross-sectional study. The CHB patients were classified into five phases: immune-tolerant (IT, n = 108), immune-clearance (IC, n = 161), hepatitis B e antigen negative hepatitis (ENH, n = 149), low-replicative (LR, n = 135), and liver cirrhosis (LC, n = 70). HBsAg was quantified (Abbott ARCHITECT assay) and correlated with hepatitis B virus (HBV) DNA, and serum alanine aminotransferase/aspartate aminotransferase (ALT/AST) in each phase of CHB was also determined.

RESULTS: Median HBsAg titers were different in each phase of CHB (P < 0.001): IT (4.85 log10 IU/mL), IC (4.36 log10 IU/mL), ENH (2.95 log10 IU/mL), LR (3.18 log10 IU/mL) and LC (2.69 log10 IU/mL). HBsAg titers were highest in the IT phase and lowest in the LC phase. Serum HBsAg titers showed a strong correlation with HBV viral load in the IC phase (r = 0.683, P < 0.001). No correlation between serum HBsAg level and ALT/AST was observed.

CONCLUSION: The mean baseline HBsAg levels differ significantly during the five phases of CHB, providing evidence on the natural history of HBV infection. HBsAg quantification may predict the effects of immune-modulator or oral nucleos(t)ide analogue therapy.

Keywords: Hepatitis B surface antigen quantification; Chronic hepatitis B; Natural history; Perspective

Core tip: The quantification of serum hepatitis B surface antigen (HBsAg) has been recently advocated as a favorable marker of disease activity in chronic hepatitis B (CHB). Knowledge of HBsAg in the natural history of chronic hepatitis B is important for the management of the disease, but there is a lack of corresponding data on the base level of HBsAg in the natural history of CHB in China. Hence, the aim of this cross-sectional study was to evaluate the levels of HBsAg in consecutive phases of the natural history of hepatitis B virus-infection without the influence of antiviral treatment before, including the patients’ progression to liver cirrhosis.