Prediction of early HBeAg seroconversion by decreased titers of HBeAg in the serum combined with increased grades of lobular inflammation in the liver
Sung Kwan Bae, Hiroshi Yatsuhashi, Satoru Hashimoto, Yasuhide Motoyoshi, Eisuke Ozawa, Shinya Nagaoka, Seigo Abiru, Atsumasa Komori, Kiyoshi Migita, Minoru Nakamura, Masahiro Ito, Yuzo Miyakawa, Hiromi Ishibashi
Med Sci Monit 2012; 18(12): CR698-705
Available online: 2012-12-01
Background: Hepatitis B e antigen (HBeAg) seroconversion is an important hallmark in the natural course of chronic hepatitis B. This study was designed to predict early HBeAg seroconversion within 1 year, by not only biochemical and virological markers, but also pathological parameters in patients with chronic hepatitis B.
Material/Methods: In a retrospective cohort study, 234 patients with HBeAg were reviewed for demographic, biochemical, virological and pathological data at the time of liver biopsy. Then, the patients who accomplished HBeAg seroconversion within 1 year thereafter were compared with those who did not, for sorting out factors predictive of early HBeAg seroconversion.
Results: Early HBeAg seroconversion occurred in 58 (24.8%) patients. In univariate analysis, factors predictive of early HBeAg seroconversion were: alanine aminotransferase (ALT) (p=0.002), IP-10 (p=0.029), HBsAg (p=0.003), HBeAg (p<0.001), HBV DNA (p=0.001), HBcrAg (p=0.001), core-promoter mutations (p=0.040), fibrosis (p=0.033) and lobular inflammation (p=0.002). In multivariate analysis, only serum HBeAg levels <100 Paul Ehrlich Institute (PEI) U/ml and grades of lobular inflammation ≥2 were independent factors for early HBeAg seroconversion (odds ratio 8.430 [95% confidence interval 4.173–17.032], p<0.001; and 4.330 [2.009–9.331], p<0.001; respectively).
Conclusions: HBeAg levels < 100 PEIU/ml combined with grades of lobular inflammation ≥2 are useful for predicting early HBeAg seroconversion. In patients without liver biopsies, high ALT levels (≥200 IU/L) can substitute for lobular inflammation (grades ≥2).
Keywords: Multivariate Analysis, Liver - virology, Inflammation - pathology, Hepatitis B, Chronic - virology, Hepatitis B e Antigens - blood, Demography, Child, Biopsy, Biological Markers - blood, Adult, Adolescent, Prognosis, ROC Curve, Risk Factors, Viral Load