兒童慢性B型肝炎病毒感染自然病程影響因子之長程研究：病毒量及病毒全長基因變化之探討(1/3)
Date Issued
2005
Date
2005
Author(s)
張美惠
DOI
932314B002101
Abstract
Aim/Background: In the natural history of chronic hepatitis B virus (HBV) infection, the acute
exacerbation or alanine aminotransferase (ALT) flare-up episodes can lead to progression of liver
damage, and even liver failure. Long term prospective study to explore the role of HBV viral load
in the exact mechanism of acute exacerbation and its subsequent hepatitis B e antigen (HBeAg)
seroconversion is very important but lacking particularly in children and young adults. Subjects
and Methods: Totally 460 children with chronic HBV infection were long-term followed up for
liver function profiles and HBV serum markers every 6 months. We recruited 72 children who
were enrolled at the age <15 years, followed-up for more than 10 years, and without treatment.
Fifty-nine of them were tepatitis B e antigen (HBeAg) seroconverted during follow-up, while 13
remained HBeAg sero-positive. We measured serum HBV DNA levels by real time PCR before,
at, and after ALT flare-up was detected. Then we correlated viral levels with subsequent HBeAg
seroconversion, gender, age, genotype, and histological findings. Results: The temporal profiles
of HBV DNA, ALT, and HBeAg seroconversion can be divided into three major patterns among
these 72 patients: (1) Plateau of HBV DNA before ALT flare-up (>2x UNL) and decreasing viral
load (>102 copies/ml) (n=62). After one or several episodes of ALT flare-up, the viral load started to
decrease sharply. (2) Increased viral load (>102 copies/ml) before ALT flare-up (n=5). (3)
Decreased viral load (>102 copies/ml) before ALT flare-up (n=4). One patient was unclassified.
The mean HBV DNA titer was much higher in the pre-HBeAg seroconversion phase than that in the
3
post-HBeAg seroconversion phase. While those of ALT flare-up are higher in the pre- HBeAg
seroconversion phase, the frequencies of HBV DNA fluctuations are not different between those
two phases. Conclusion: HBV viral load would not decline until they finally underwent HBeAg
seroconversion in the majority of HBV carrier children and young adults. Several episodes of ALT
flare-up were common in the natural course, yet they were not commonly accompanied by a surge
of HBV DNA level. Most Factor(s) other than the surge of viral load may plays the key role in the
initiation process of HBeAg seroconversion.
Subjects
hepatitis B virus
hepatitis B e antigen
HBV DNA
real time PCR
SDGs
Publisher
臺北市：國立臺灣大學醫學院小兒科
Type
report
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