| Background and aims: In recent years, with the development of detection technology, the detection of HBs Ag quantification has become a reality, HBs Ag not only as a marker of hepatitis B, but it also is used to predict the progression of chronic hepatitis B(CHB) disease and determine the antiviral efficacy and prognosis of this paper. Many studies show that intrahepatic closed circular DNA(ccc DNA) with HBs Ag has good correlation. The aim of this study is to investigate the levels of HBs Ag and HBVDNA and the correlations between HBs Ag and HBVDNA during natural history of chronic hepatitis B.At the same time, Nucleoside(acid) analog(NAs) is the main drug for the treatment of CHB, but the treatment time is long, the recurrence rate after NAs withdrawal is high.This paper also discusses the significance of HBs Ag quantitative value of NAs withdrawal.Methods: Two hundred and forty-five patients presenting as CHB were enrolled in the first study,who visited the infectious diseases department of the Second Hospital Affiliated to Chongqing Medical University form July 2014 to December 2015.The CHB patients never received any antiviral therapy. At the same time, thirty-three patients were choosed who had taked NAs long time and reached the HBe Ag sero conversion, continuous normal liver function and HBV DNA negative in the second study, the quantitative determination of HBs Ag, monitoring the HBs Ag、liver function、、HBVDNA at the time of 4 weeks, 12 weeks, 24 weeks, 36 weeks, 48 weeks after NAs withdrawal. Once diagnosed with hepatitis B recurrence, immediately start again with oral nucleoside analogues.luminescence method for quantitative detection of HBs Ag level by Roche electrochemical, real time fluorescence quantitative PCR detection of HBVDNA load. Multiple groups were compared using the Kruskal Wallis H test, between the two groups compared using the Mann Whitney U test, correlation analysis using Spearman test. Influence factors using logistic regression analysis. Bilateral P<0.05 as the difference was statistically significant.Results: The serum HBs Ag level and HBV DNA quantification of normal liver function group and abnormal liver function had significant differences(P < 0.001); serum HBs Ag and HBV DNA quantification in the group of HBe Ag positive were significantly higher than that of HBe Ag negative group, the differences were statistically significant(P < 0.001). Serum HBs Ag level and HBV DNA quantification in the baseline levels were positively correlated(r = 0.759, P < 0.001); HBe Ag positive group was significantly correlated(r = 0.519, P < 0.001), lower in HBe Ag negative group correlation(r = 0.380, P < 0.001), liver function abnormal group no correlation(P > 0.05). Serum HBs Ag titers were different in each phase of CHB(P < 0.001): IT(4.64 log10 IU/m L), IC(4.33 log10 IU/m L), ENH(3.91 log10 IU/m L), LR(2.81 log10 IU/m L). HBs Ag titers were highest in the IT phase and lowest in the LR phase. Serum HBs Ag titers showed a strong correlation with HBV viral load in the IT phase(r = 0.662, P <0.001). No correlation in the LR phase or in the ENH phase. Serum HBs Ag titers were different in each phase of CHB(P < 0.001): IT(4.64 log10 IU/m L), IC(4.33 log10 IU/m L), ENH(3.91 log10 IU/m L), LR(2.81 log10 IU/m L). HBs Ag titers were highest in the IT phase and lowest in the LR phase. Serum HBs Ag titers showed a strong correlation with HBV viral load in the IT phase(r = 0.662, P <0.001). No correlation in the IC phase or in the ENH phase(P > 0.05). The age of CHB patients was negatively correlated with baseline HBs Ag levels(-0.432 r=, P<0.001), and HBe Ag positive CHB patients were younger than HBe Ag negative CHB patients(P<0.001). In the natural history of chronic HBV infection, IT patients were younger than patients in group IC(P<0.001), IC group were younger than LR group or ENH group(P<0.05), LR group and ENH group had no significant difference in age(P>0.05). By Logistic regression analysis, there was no correlation between gender and the level of serum HBs Ag(P>0.05). No patient who had achieved HBs Ag levels <50IU/m L at the end of treatment experienced virological relapse, true negative predictive value of 100%;but 2 cases of the 4 patients whose HBs Ag levels ≥1000 IU/Ml(50%), had HBV relaspsed, really positive predictive value of 50%. Serum HBs Ag 1000IU/m L at the time of NAs withdrawal is the risk of a recurrence of the truncated value, patients whose HBs Ag >1000IU/m L at the time of NAs withdrawal relapse rate was significantly higher than that HBs Ag <1000IU/m L.The dynamic change of HBs Ag in the non-recurrence group was a small fluctuation range and a slow downward trend, while the HBs Ag of the recurrence group was significantly increased more than 2.5 times higher. 3 cases of the 5 patients whose HBs Ag levels <1 IU/m L at the time of NAs withdrawal had HBs Ag seroconversion(60%).Conclusions: Serum HBs Ag levels of CHB patients were positively correlated with HBVDNA load at baseline, and the correlation was most significant in the immune tolerance phase. During the natural history of CHB, serum HBs Ag levels were different from IT, IC, ENH to LR, and there was a gradual decline. During the natural history of CHB, the correlation between serum HBs Ag levels and HBVDNA load were different in CHB patients. There was a certain correlation between the age of CHB patients and the level of HBs Ag, younger patients’ HBs Ag level is relatively high. The recurrence rate of the patients whose serum HBs Ag<50 IU / ml at the time of discontinuation of NAS is very low, we recommend that these patients may stop NAS; In the group whose serum HBs Ag ≥1000 IU / ml at the time of discontinuation of NAS, their recurrence rate was high, these patients can not stop NAs; The patients whose serum HBs Ag ranged from 50 IU/m L to 1000IU/m L have certain risk of recurrence after cessation of NAs, they need close follow-up after stopping NAs. Compared with the HBs Ag quantitative at the time of discontinuation of NAS, if the serum HBs Ag level increased more than 2 times, the patients may have clinical recurrence. The CHB patients withdrawal HBs Ag quantitative <10 IU/m L may appear HBs Ag seroconversion in the future. |
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