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[A 16-year clinical observation on 217 chronic HBsAg carriers]
Fu-shan Li1, Long-hua Chen, Xi-feng Tang
1Department of Radio-therapy, Nanfang Hospital, First Military Medical University, Guangzhou (510515). LFS88@Fimmu.com
Insights
Asymptomatic carriers of Hepatitis B surface antigen (HBsAg) can progress to chronic hepatitis B (CHB), liver cirrhosis (LC), and liver cancer (HCC). Early detection and management are crucial for preventing advanced liver disease progression.
Area of Science:
- Hepatology
- Virology
- Oncology
Context:
- Chronic Hepatitis B (CHB) affects millions globally.
- Asymptomatic carriers (AsC) represent a significant reservoir for HBV transmission.
- Understanding the natural history of HBV infection is vital for public health strategies.
Purpose:
- To investigate the clinical progression of asymptomatic HBsAg carriers (AsC).
- To identify the clinical rules governing the development of CHB to liver cirrhosis (LC) and hepatocellular carcinoma (HCC).
- To explore effective methods for interrupting this disease progression.
Summary:
- A 16-year observational study followed 217 AsCs.
- 9.68% achieved HBsAg negative conversion, while 57.14% remained asymptomatic.
- 73 cases progressed to chronic liver disease, with rates of 1.04% to LC and 0.40% to HCC annually.
- Fifteen patients died from liver disease, primarily HCC.
Impact:
- Hepatocellular carcinoma (HCC) develops from liver fibrosis or cirrhosis.
- Patients with liver fibrosis/cirrhosis are at high risk for HCC.
- HCC is a major cause of mortality in chronic liver disease patients.
- Integrative medicine approaches suggest 'blood stasis' correlates with disease progression.
Objective:
By means of observing the clinical development of asymptomatic chronic HBsAg carriers (AsC) to explore the clinical rule of development of chronic hepatitis B (CHB) to liver cirrhosis (LC) to hepatocellular carcinoma (HCC) and to seek effective method for blocking the procedure.
Methods:
AsCs were selected from health examination according to the diagnostic standard from the National Program for Prevention and Treatment of Viral Hepatitis, by periodical or non-periodical conventional examination of liver diseases, mixed infection of HCV was excluded. A 16-year systematic observation on clinical process of HBV infection series was completed.
Results:
In the 217 AsCs observed, 21 cases (9.68%) with the HBsAg negatively converted, the average year negative conversion rate being 0.58%, among them, 13/21 cases (61.9%) had production of anti-HBs antigen; 20 cases were clinically cured; 1 case transferred to HCC; 124 cases (57.14%) remained asymptomatic carriers; 73 transferred to chronic liver disease, showing a tendency of gradually developing from CHB to LC to HCC, the year transferring rate from AsC to LC and HCC being 1.04% and 0.40%, respectively. Fifteen patients died of liver diseases, in which one died of severe CHB, 3 of LC and 11 of HCC.
Conclusion:
Different clinical end-results may reveal in AsCs according to their age and regulation on immune response to HBV. Few of the HCC and LC patients were HBeAg (e+) positive, they often reveal HBeAg (e-) negative or anti-HBe positive. HCC always develops on the basis of liver fibrosis or cirrhosis, which are the prophase of HCC, and patients with liver fibrosis or cirrhosis are the high risk group of developing HCC. HCC is not only the terminal pathologic stage of hepatopathy, but also one of the most important factors that causes death of chronic hepatopathy. From the viewpoint of integrative medicine in typing hepatopathy to observe the clinical speciality of AsC developing to CHB, LC and HCC, it is considered that the degree of blood stasis is in accordance with the development of hepatopathy.