CID：高HBV水平可导致急性乙型肝炎发展为慢性感染

High Levels of HBV after the Onset Lead to Chronic Infection in Patients with Acute Hepatitis B.
Abstract
Background. Some patients with acute HBV infection develop chronic infection. However, the method for identifying them has not been established. Methods. We followed 215 Japanese patients with acute HBV infection until the clearance of HBsAg or the development of chronic infection. Levels of HBsAg and HBV DNA were serially monitored from the onset. Results. Of the 215 patients, 113 (52.5%) possessed HBV genotype A, 26 (12.0%) genotype B, and 73 (34.0%) genotype C. Twenty-one of the 215 (9.8%) developed chronic infection, with the persistence of HBsAg for>6 months. The rate of chronicity of genotype A, B, and C was 12.4%, 3.8%, and 8.2%. Of the 21 patients, only six (2.8%) patients, including five with genotype A, failed to clear HBsAg within 12 months. Levels of HBsAg at 12 weeks and HBV DNA at 4 weeks were useful for distinguishing the patients who became chronic from those who did not (P <.001 and P<.001, respectively). Likewise, the levels of HBsAg at 12 weeks and HBV DNA at 8 weeks were useful for discriminating between the patients who lost HBsAg within 12 months and those who did not (P<.01 and P<.05, respectively). Conclusions. In acute HBV infection, clearance of HBV may happen between 6 and 12 months from the onset. Only those who fail to clear HBV within 12 months from the onset may really develop chronic infection.