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    • br Materials and methods br Results

    2021-09-10


    Materials and methods
    Results
    Discussion Serum HBsAg is not only an important serological marker for the screening and diagnosis of HBV infection but also an important indicator for the treatment of hepatitis B [15]. Jaroszewicz et al. [4] and Nguyen et al. [8] reported that the HBsAg levels of patients with HBV infection in Asia and Europe were different at different stages of the disease and that the patient's serum HBsAg level played a role in auxiliary diagnosis with respect to understanding the natural history of HBV infection [7]. Previously, some individuals in the HBV-infected population were reported to be characterized by a sustained low level of HBsAg LMK 235 (< 10 IU/mL), suggesting that the effective detection of low-level serum HBsAg had important clinical and epidemiological significance [24], [32], [33]. In this study, the clinical characteristics of 276 patients with HBV infection and low-level HBsAg were investigated, and the clinical data from these patients were analysed. The results showed that the population with low-level HBsAg consisted primarily of patients who were chronic ASCs. A comparison of these patients with 1032 cases of chronic ASCs with high-level HBsAg expression revealed no significant differences in gender composition or ALT levels (Table 1, P > 0.05), whereas age, HBV serological marker patterns, HBV DNA load (log10 IU/mL), HBV-DNA positive rate (%), distribution of HBV genotype, and HBV serotype showed significant differences between the two groups (P < 0.05) (Table 1, Table 3). The patients were older in the low-level HBsAg group (55.09 ± 16.45 years) than in the high-level HBsAg group (43.63 ± 10.95 years), suggesting that the formation of low-level HBsAg was closely related to viral clearance, which was consistent with the changing trend in the natural history of the HBsAg concentration reported by Jaroszewicz et al. [4] and Nguyen et al. [8]. The HBsAg/anti-HBe/anti-HBc serological pattern was observed in 97.1% of the cases in the low-level HBsAg group, and the low replication and low positive rate of HBV DNA in this group were similar to the values reported in the literature for these parameters [32], [33]. Thus, chronic asymptomatic HBV infection, older age distribution (mean age of 55.09 years), HBsAg/anti-HBe/anti-HBc positive rate (97.1%), low replication of HBV DNA (1.32 ± 1.60 log10 IU/mL), low HBV-DNA positive rate (45.65%), genotype B (82.54%), and serotype adw (84.13%) were the main characteristics of the ASC population with low-level HBsAg. There are differences in the content and proportion of subviral particles at different stages of HBV infection. Pfefferkorn et al. [41] found that the content of L-HBsAg and M-HBsAg and the proportion of the total HBsAg in ASCs were lower than those of other stages of HBV infection (acute infections, HBeAg-negative CHB, HbeAg-positive phase). LHBs is more abundant on virions and filamentous SVPs than on spherical SVPs. Thus, a decline in the ratio of virions versus spherical SVPs could contribute to the observed relative decrease of LHBs in low viraemic phases of infection (i.e., the IC phase), but the effect is likely very small because even in highly viraemic patients, the amount of small SVP exceeds that of virions by at least 1:1000. Additionally, Chai et al. [42] reported that when the expression of HBsAg was low, a small amount of HBsAg protein is preferentially used to form virus particles. This opinion has been confirmed in a study by Garcia et al. [43]. A possible reason for these two viewpoints was that the HBV infection stages of the two studies were different. Until now, there have been no reports of the distribution of L-HBSAg, M-HBSAg, S-HBSAg and the proportion of subviral particles versus viral particles in the serum of HBV ASCs with low-level HBsAg. Research in this area has been listed as the next research plan of our research team. In the alignment analysis of HBV gene sequences, we encountered difficulty in comparing results from different references, which led to issues in the assessment of results from individual studies. Overall, choosing appropriate HBV reference sequences is critical for such analyses [34], [44]. The reference sequences established in this paper considered not only the nature of the research object itself (ASCs) but also regional differences (Table 4) to ensure the establishment of reference sequences that are representative and comparable to the study population. Thus, the results based on these reference sequences are reliable and authoritative.