Clinical research studyAJM OnlineLong-Term Outcome after Hepatitis B Surface Antigen Seroclearance in Patients with Chronic Hepatitis B
Section snippets
Patients
From 1972 to 2002, a total of 5055 chronic HBsAg carriers, who were known to be seropositive for HBsAg for at least 6 months, were studied at Toranomon Hospital in Tokyo, Japan. After a mean follow-up period of 4 years (range 0.5-30 years), 231 patients were noted to have delayed HBsAg seroclearance, which is defined as persistent absence of HBsAg antigenemia by radioimmunoassay for at least 1 year and until the last examination. We excluded from the study all patients with: concurrent
Changes of Liver Biochemistry After HBsAg Seroclearance
Table 1 shows the characteristics of the 231 patients who had seroclearance of HBsAg. These patients were classified into a liver cirrhosis group or a non-liver cirrhosis group by ultrasonographic findings. A total of 67 patients showed a finding of liver cirrhosis. Histologic evidence of liver cirrhosis before HBsAg seroclearance was seen in 47 patients.
The alanine aminotransferase test showed that 203 of 231 patients (87.9%) had normal alanine aminotransferase levels 1 year after
Discussion
The results of this study indicate that patients with HBsAg clearance have a good prognosis. None of the patients with liver cirrhosis who had lost serum HBsAg progressed to decompensated liver cirrhosis. Moreover, no patients without liver cirrhosis with HBsAg clearance progressed to liver cirrhosis and/or hepatocellular carcinoma. Our findings agree with the published data by Chen et al16 (Table 4). However, 2 of 67 patients with liver cirrhosis at the time of HBsAg clearance had
Conclusion
The prognosis after HBsAg clearance was excellent except in patients with liver cirrhosis. However, patients with liver cirrhosis should be closely monitored for predictable complications.
Acknowledgment
The authors acknowledge the editorial assistance of Thomas Hughes.
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The present work was supported in part by grants-in-aid from Okinaka Memorial Institute for Medical Research and Japanese Ministry of Health, Labor, and Welfare.