Different models of HBeAg seroconversion predicated by on-treatment ALT and HBV DNA profiles

作者：You, Hong^*; Ma, Hong; Liu, Tianhui; Cong, Min; Wang, Ping; Ou, Xiaojuan; Wang, Xiaoming; Ren, Jiangbo; Li, Hongyi; Wang, Baoen; Jia, Jidong

来源：Journal of Viral Hepatitis, 2009, 16(12): 876-882.

DOI：10.1111/j.1365-2893.2009.01145.x

• chronic hepatitis B
• HBeAg seroconversion

Pretreatment alanine transaminase (ALT) elevation may be used as a predictor for higher hepatitis B e antigen (HBeAg) seroconversion in chronic hepatitis B patients. However, the role of dynamic changes of on-treatment ALT for seroconversion is unknown. A total of 170 naive HBeAg-positive chronic hepatitis B patients were treated with a nucleoside/nucleotide analogues (NA), either lamivudine, adefovir, entecavir, or telbivudine, for at least 2 years and followed up for 1 more year. Clinical characteristics were detected and analysed at baseline and at 3-month intervals. On-treatment ALT predicted HBeAg seroconversion more accurately than baseline ALT. Among the patients with on-treatment ALT < 1 x UNL, 1-< 2 x UNL, 2-< 5 x UNL and > 5 x UNL, HBeAg seroconversion was 11.4, 5.4, 24.4 and 65.0% (odds ratio = 1.0, 0.4, 2.5 and 14.4, respectively), respectively. Moreover, two models/types of seroconversion were observed. Type I was characterized by rapidly decreased ALT and HBV DNA during the first 3-month interval, but with high HBeAg reversion rate (50%) after consolidation treatment. Type II was a slow decreased DNA procedure accompanied by significant elevated ALT with less reversion (23%). Receiver operating characteristic curve analysis showed a 1.9-fold increased ALT ratio (present visit ALT: previous visit ALT) accompanied by at least a 0.8 log decreased HBV DNA may be used to classify these two seroconversion types. We conclude that on-treatment elevated ALT levels is a better predictor for seroconversion after NAs treatment, and HBV DNA profiles may help to identify different models of seroconversion.

• 出版日期2009-12
• 单位首都医科大学