Changes In HBsAg Quantification After HBV DNA Below The Lowest Limit Of Detection In Patients With Chronic Hepatitis B Treated With Nucleos(t)ide Analogues

Objective:To investigate the changes in HBsAg quantification and the influencing factors after HBV DNA obtaining virological response in patients with chronic hepatitis B treated with nucleos(t)ide analogues.Methods:A retrospective study was conducted,and case data of patients with chronic hepatitis B who were admitted to the department of infectious diseases of our hospital and received antiviral treatment with nucleos(t)ide analogues from January2016 to August 2019 were collected.Patients who took the drugs regularly and had HBsAg quantitative detection results after the HBV DNA was below the detection threshold were included in this study.The information of the patients'medical records included the patients'age,gender,family history,antiviral treatment time,history of other liver diseases(mainly for drinking history and fatty liver),history of interferon treatment,history of nucleos(t)ide analogues therapy,antiviral drugs,examination results related to liver function,hepatitis B serologic testing,hepatitis B surface antigen(HBsAg)quantification,initial HBV DNA and epigastrium color ultrasound.SPSS 22.0 was used for statistical analysis.Chi-square test was used to compare the rate of counting data,and univariate and multivariate binary logistic regression analysis were successively applied.P<0.05 indicates that the difference is statistically significant.Results:1.A total of 770 HBsAg quantitative results were obtained from 321 patients.In 2 years,3nd year,4th year,5th year and 5 years more after treatment,the HBsAg<20 IU/mL ratios were 2.2%,4.9%,3.3%,9%,and 10.9%(?~2=12.97,P=0.007),respectively;HBsAg<200 IU/mL ratios were 15.0%,15.9%,17.0%,21.9%,and 26.1%(?~2=24.28,P<0.001),respectively;HBsAg<500IU/mL ratios were 34.4%,30.5%,36.0%,44.0%,and 32.6%(?~2=24.42,P<0.001),respectively;HBsAg<1000 IU/mL ratios were47.0%,52.4%,49.0%,62.5%,65.2%(?~2=29.60,P<0.001),respectively;HBsAg<1500 IU/mL ratios were 63.2%,67.0%,62.7%,75.3%,78.0%(?~2=19.96,P=0.001),respectively;the differences were statistically significant.2.In 2 years of treatment,the ratio of HBsAg<1500 IU/mL in HBeAg negative patients was 67.0%,which was higher than36.1%of that in HBeAg-positive patients(?~2=12.76,P=0.000);the ratio of HBsAg<1000 IU/m L in HBeAg-negative patients was 45.1%,which was higher than 22.2%of that in HBeAg-positive patients(?~2=10.85,P=0.001),and the differences were statistically significant.At the third year after the treatment,the ratio of HBsAg<1500 IU/mL in HBeAg-negative patients was 72.3%,which was higher than 37.8%of that in HBeAg-positive patients(?~2=6.51,P=0.011);the ratio of HBsAg<1000 IU/mL in HBeAg-negative patients was55.5%,which was higher than 27.0%of that in HBeAg positive patients(?~2=5.59,P=0.018),and the differences were statistically significant.At the fourth year after the treatment,the ratio of HBsAg<200 IU/m L in HBeAg-negative patients was 23.6%,which was higher than 2.9%of that in HBeAg-positive patients(P=0.024),and the difference was statistically significant.3.Among the 321 patients,199 patients had 2 or more follow-up HBsAg quantitative test results after HBV DNA being negative,and 89(44.7%)cases had a downward trend in HBsAg,and 37(18.6%)cases had an upward trend in HBsAg,and 73(36.7%)cases had fluctuated HBsAg.4.Multivariate logistic analysis of the meaningful indicators identified by Chi-square test and univariate logistic analysis showed that:the initial HBV DNA quantification,ALT level,and antiviral treatment time were independent influencing factors for determining whether HBsAg was<20IU/mL;the history of interferon treatment,initial HBV DNA quantification,antiviral treatment time and albumin quantification were independent influencing factors for determining whether HBsAg was<200IU/mL;the age,history of other liver diseases,initial HBV DNA quantification,and antiviral treatment time were independent influencing factors for determining whether HBsAg was<500 IU/m L;the age,gender,HBeAg status,direct bilirubin,albumin quantification,globulin,antiviral treatment time,and with or without cirrhosis were independent influencing factors for determining whether HBsAg was<1000IU/mL;the HBeAg status,initial HBV DNA quantification,globulin,antiviral treatment time,and with or without cirrhosis were independent influencing factors for determining whether HBsAg is<1500IU/mL.Conclusions:1.After antiviral treatment and the HBV DNA below the lowest limit of detection,with the extension of treatment time,HBsAg quantification showed a decline for most patients.2.Multivariate analysis of HBsAg quantitative influencing factors at different thresholds shows that after virological response to HBsAg treatment of chronic hepatitis B,The independent influencing factor of HBsAg quantification is mainly the time of antiviral treatment;secondly,there may be the initial HBV DNA quantification level?...