title: Metabolic syndrome delays HBeAg seroclearance in Chinese patients with hepatitis B.
abstract: BACKGROUND
  Delayed hepatitis B e antigen (HBeAg) seroclearance increases the risk of cirrhosis and hepatocellular carcinoma (HCC). The effect of metabolic syndrome (MetS) on HBeAg seroclearance in chronic hepatitis B (CHB) patients remains unclear.
  
  
  OBJECTIVE
  To examine the effect of MetS on HBeAg seroclearance.
  
  
  METHODS
  A prospective cohort of 413 treatment-naïve HBeAg-positive CHB patients from 2005 to 2012 was studied. Clinical, virological and histological parameters were evaluated. The patients were classified into three groups according to the metabolic characteristics; normal, pre-MetS and MetS based on the International Diabetes Federation criteria. The primary outcome was age at HBeAg seroclearance.
  
  
  RESULTS
  The overall HBeAg seroclearance rate was 11.4% per annum during 19 351 patient-months of follow-up with no difference in HBeAg seroclearance rates between 162 treatment-free and 251 patients receiving nucleos(t)ide analogues. Patients with pre-MetS and MetS were older when HBeAg seroclearance occurred (44 ± 12 and 53 ± 7 years, respectively) than the normal patients (37 ± 9 years, all P < 0.01). Patients with pre-MetS and MetS had more advanced liver fibrosis (33.0% and 53.1%, respectively) than the normal patients (18.4%, all P < 0.05). By the age of 50, 59.3% of the metabolic normal patients, 42.1% of the pre-MetS and 18.7% of the MetS patients had achieved HBeAg seroclearance (all P < 0.05, except P = 0.07 for pre-MetS vs. MetS). In multivariate analysis, MetS and type II diabetes at baseline were predictors of delayed HBeAg seroclearance after adjusting for viral load, anti-viral therapy and necroinflammatiom.
  
  
  CONCLUSIONS
  Chinese patients with chronic hepatitis B and with pre-metabolic syndrome or metabolic syndrome have delayed HBeAg seroclearance.
authors.affiliation: State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong , Hong Kong, China.
authors.forename: J C
authors.initials: JC
authors.lastname: Hsiang
authors.forename: G L-H
authors.initials: GL
authors.lastname: Wong
authors.forename: H L-Y
authors.initials: HL
authors.lastname: Chan
authors.forename: A W-H
authors.initials: AW
authors.lastname: Chan
authors.forename: A M-L
authors.initials: AM
authors.lastname: Chim
authors.forename: V W-S
authors.initials: VW
authors.lastname: Wong
mesh_terms: D000328:Adult; D044466:Asian People; D015897:Comorbidity; D005260:Female; D006509:Hepatitis B / Q000276:immunology; D006513:Hepatitis B e Antigens / Q000097:blood*; D019694:Hepatitis B, Chronic / Q000097:blood* / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood* / Q000453:epidemiology / Q000276:immunology; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D006513:Hepatitis B e Antigens