The Clinical Characteristics Of HBeAg-negative Chronic Hepatitis B And The Clinical Significance Of The Associated HBV Mutations

ObjectiveTo study the clinical features of HBeAg-negative chronic hepatitis B, and theclinical significance of hepatitis B virus (HBV) precore G 1896A mutation and basalcore promoter (BCP) A1762T/G1764A double mutations.MethodsThe retrospective study was performed in the 684 in-patients with chronichepatitis B. The patients were divided into two groups according to the HBeAg statusand the HBeAg positive group was control group. Sera from 40 HBeAg negativeand 20 HBeAg positive patients were collected. G1896A mutation andA1762T/G1764A double mutations were detected by PCR-RFLP.ResultsOf the 684 patients with chronic hepatitis B, 334 were HBeAg negative (48.8%).The average ages of the patients with HBeAg-negative chronic hepatitis B were elderthan those with HBeAg-positive chronic hepatitis B. The total duration of the patientswith HBeAg-negative chronic hepatitis B was longer than those with HBeAg-positivechronic hepatitis B. Male counted for a predominant number in this group. Theprevalence rate of cirrhosis, HCC and hepatitis gravis in HBeAg-negative group washigher, compared with HBeAg-positive group (P＜0.05). Jaundice and hepatic facewere more common in HBeAg-negative group (P＜0.05). As a whole, the ALT levelsof HBeAg-negative group were lower than those of HBeAg-positive group, but theTBIL levels of HBeAg-negative group were higher and the HBV DNA levels ofHBeAg-negative group were lower (P＜0.05). As a whole, the histologicalinflammation grading in HBeAg-negative group was lower than in HBeAg-positivegroup, and the histological fibrosis staging in HBeAg-negative group was higher thanin HBeAg-positive group (P＜0.05). HBV DNA levels were correlated with ALT levels in the patients with HBeAg-negative chronic hepatitis B, and HBV DNA levels werecorrelated with histological inflammation grading in the patients withHBeAg-negative chronic hepatitis B (P＜0.05).G1896A, A1762T/G 1764A double mutations and G1896A and A1762T/G1764Aunited mutations were more common in HBeAg-negative group than inHBeAg-positive group (P＜0.05). In the patients with HBeAg-negative chronichepatitis B, the ALT levels were higher in the group with G1896A mutation than inthe group without G1896A mutation, and the AST levels were higher in the groupwith united mutations than in the group without united mutations, and HBV DNAlevels were higher in the group with G1896A mutation and in the group withA1762T/G1764A double mutations than in the group without mutation (P＜0.05).The patients with these mutations tended to he severe.ConclusionHBeAg-negative chronic hepatitis B is a specific clinical type different fromHBeAg-positive chronic hepatitis B. G1896A mutation and A1762T/G1764A doublemutations may have high replication activity and he associated with the severity ofHBeAg-negative chronic hepatitis B.