The Natural Outcome Of Inactive HBV Carrier State

Objective:To investigate related predictors of the different natural outcome of inactive HBV carrier stateand improve the natural history of chronic HBV infection.Methods:This study is a retrospective cohort study, collecting117cases from January2013to January2014in Affiliated Hospital of Yan’an University who were diagnosed as inactive HBsAg carrierstate. The main follow-up included the basic information of the inactive HBsAg carrier state andhepatitis B virus marker, hepatitis B virus deoxyribonucleic acid, albumin ALT, AST, ALP, GGT inthe whole process. The clinical end point was made from different clinical outcome. UsingSPSS20.0carry out statistical analysis, wielding survival analysis by the Kaplan-Meier method toanalyze different clinical outcome and drawing out the survival curve graphics,Log-rank test wasperformed on the graphics, multivariate analysis applied Cox proportional hazard regression model.Results:1. Clinical follow-up time was1to9years, average and median follow-up time was4years.Until the end of follow-up, there was9cases (7.69%) of spontaneous HBsAg loss,4casesproducing anti-HBs,15cases (12.8%) of HBeAg negative CHB, of which5cases progressing intothe “HBeAg-negative CHB” phase of the natural history of hepatitis B virus (HBV) infection,10cases having antiviral indications confirmed by liver biopsy.2. The baseline HBsAg level in different age groups of the inactive HBV carrier state hassignificant difference（F=17.859，P=0.016）, HBsAg at the end point had significant difference （F=8.43，P=0.031）.3. HBsAg titers in each age group of the inactive HBV carrier state decreased with time andthere was significant difference between the <30years old group and the30~39age group（t=2.937,2.125P=0.006,0.038）, no significant difference between the40~49years old groupand the≥50years old group（t=1.681,1.421P=0.098,0.165）.4. There was negative correlation between age and baseline HBsAg level in inactive HBsAgcarrier state (r=-0.615P<0.001).5. Compared to the inactive HBV carrier state, the group of spontaneous HBsAg loss wasyounger, with lower baseline HBsAg and higher alkaline phosphatase (ALP). Kaplan-Meieranalysis showed that the lower the baseline HBsAg, the greater proportion of spontaneous HBsAgloss (Log-rank test χ2=4.442, P=0.035). Compared with women, men are more likely tospontaneous HBsAg loss (Log-rank test χ2=4.785, P=0.029).6. Compared to the inactive HBV carrier state, the group progressed to HBeAg-negative CHBwere with morewomen, higer HBsAg and serunl HBV DNA levels at the end point(Log-rank testχ2=18.359,77.513P<0.001,0.001). Kaplan-Meier analysis showed that the higherHBsAg and serunl HBV DNA levels at the end point, the higher progression to HBeAgnegative CHB. Drinking increased the progression to HBeAg negative CHB(Log-rank testχ2=4.555，P=0.033).7. Cox regression indicated that age, baseline HBsAg was independent predictors ofHBsAg seroconversion in inactive HBsAg carrier state,the relative risk ratio was0.896(95%CI0.830-0.968，P=0.005)、0.989(95%CI0.980-0.997，P=0.010) and gender,HBV DNA levels at the end point was independent predictors of inactive HBsAg carrierstate progressed to HBeAg-negative CHB, the relative risk ratio was11.075(95％CI1.839-66.681，P=0.009),4.173(95％CI2.453-7.099，P<0.001). Conclusion:1. The inactive HBsAg carrier state shouldbe followed up regularly, the follow-up shouldbe closer in monitoring biochemical, viruses and other indicators, if necessary, liver biopsy isantiviral treatment indications.2. Baseline HBsAg and age in the inactive HBsAg carrier state was negatively correlated,HBsAg titers decreased over time with HBV DNA not detecting in the serum for several years.3. The prognosis of the inactive HBsAg carrier state affected by age, sex, baseline HBsAg,HBVDNA changes, drinking, et al. Age, baseline HBsAg was independent predictor ofHBsAg seroconversion in inactive HBsAg carrier state, and gender, HBV DNA levels atthe end point was independent predictor of inactive HBsAg carrier state progressed toHBeAg-negative CHB.