title: Clinical significance of serum HBsAg levels and association with liver histology in HBeAg positive chronic hepatitis B.
abstract: BACKGROUND
  Despite its recognized role as a prognostic marker for antiviral treatment, the clinical significance of serum hepatitis B surface antigen (HBsAg) level in the immune-clearance stage of chronic hepatitis B remains unclear.
  
  
  OBJECTIVE
  To characterize how HBsAg level and various clinical and virological factors are related and analyze the correlation of HBsAg with liver histology.
  
  
  METHODS
  A total of 198 treatment-naïve HBeAg-positive chronic hepatitis B patients were enrolled. Serum HBV DNA and HBsAg were determined quantitatively. Mutations of precore or basal core promoter (BCP) were also determined. Finally, liver necroinflammation grading and fibrosis stage were evaluated by Knodell score and Ishak score, respectively.
  
  
  RESULTS
  Lower HBsAg levels were found in patients with genotype C HBV infection, or in the presence of precore or mutations, or Knodell necroinflammation grading ≥ 7, or advanced fibrosis (Ishak stage 4-6). HBsAg level displayed a strong correlation with HBV DNA (r = 0.727, P < 0.001) and also exhibited a positive correlation with intrahepatic HBcAg expression in either cytoplasm (r = 0.420, P < 0.001) or nucleus (r = 0.401, P < 0.001). Examining the correlation with advanced liver fibrosis revealed that HBsAg level is a significant factor in univariate analysis and is the only independent factor in multivariate analysis (Coefficient: -0.975, P = 0.039, OR: 0.377, 95% CI: 0.149-0.953).
  
  
  CONCLUSIONS
  HBsAg level varied with different clinical or virological categories. Lower baseline levels of HBsAg might reflect the status of advanced liver fibrosis in HBeAg positive chronic hepatitis B patients.
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, Taiwan.
authors.forename: Pin-Nan
authors.initials: PN
authors.lastname: Cheng
authors.forename: Hung-Wen
authors.initials: HW
authors.lastname: Tsai
authors.forename: Yen-Cheng
authors.initials: YC
authors.lastname: Chiu
authors.forename: Cheng-Hsun
authors.initials: CH
authors.lastname: Ho
authors.forename: I-Chin
authors.initials: IC
authors.lastname: Wu
authors.forename: Ting-Tsung
authors.initials: TT
authors.lastname: Chang
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000276:immunology / Q000627:therapeutic use; D004279:DNA, Viral / Q000097:blood / Q000276:immunology; D005260:Female; D006512:Hepatitis B Core Antigens / Q000097:blood* / Q000276:immunology; D006514:Hepatitis B Surface Antigens / Q000097:blood* / Q000276:immunology; D006513:Hepatitis B e Antigens / Q000097:blood* / Q000276:immunology; D006515:Hepatitis B virus / Q000187:drug effects / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000097:blood* / Q000188:drug therapy / Q000276:immunology / Q000473:pathology*; D022781:Hepatocytes / Q000187:drug effects / Q000276:immunology / Q000473:pathology / Q000821:virology; D006801:Humans; D007249:Inflammation / Q000276:immunology / Q000473:pathology / Q000821:virology; D008099:Liver / Q000187:drug effects / Q000276:immunology / Q000473:pathology* / Q000821:virology; D008103:Liver Cirrhosis / Q000276:immunology / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D009154:Mutation / Q000235:genetics / Q000276:immunology
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens