OBJECTIVETo investigate the correlation between spontaneous clearance of HBV DNA and the levels of Alanine Aminotransferase (ALT) in chronic hepatitis B (CHB) patients.

METHODSRetrospective review analysis was used in this research. A total of 177 CHB patients with HBV DNA>1x10(4) copies/ml and ALT>800 U/L were recruited in this study and were divided randomly into two groups, 84 patients in control group (received lamivudine therapy) while 96 cases in study group (without anti-viral therapy), the dynamic changes of HBV DNA and HBV markers in these two groups were compared.

RESULTSThe clinical data of CHB patients were retrospected and followed up in 24 weeks. The negative conversion cases of HBV DNA are 62 (87.3%) in study group and 56 cases (78.87%) in control group at week 24, the negative conversion cases of HBV DNA are 56 (78.9%) in study group and 60 (92.3%) cases in control at week 8. No significant difference (x2=0.058, P>0.05) existed between these two groups. Among 43 patients with HBV DNA is less than or equal to 6 log10 copies/ml, 41 (95.3%) patients converted negatively, while in 28 patients with HBV DNA is more than 6 log10 copies/ml, 21 (75.0%) patients converted negatively. The negative conversion rate of HBV DNA is more than 6 log10 copies/ml was lower than the other group at week 24. The difference between the two groups was significant (x2=0.024, P<0.05). 41 patients with hepatitis B e antigen (HBeAg) negative and 30 patients with HBeAg positive were included in antiviral group. The negative conversion cases of HBV DNA of the former are 36 (87.8%) and the latter are 26 (86.7%). No significant difference found between them (x2=1, P>0.05). HBeAg loss found in 10 patients of 30 HBeAg positive patients with 4 patients occurred as early as at the fourth week. A total of 62 patients HBV DNA converted negatively in antiviral group, but 5 patients were found HBV DNA rebounded (occurred in 24 to 72 weeks) with ALT rebound (47 to 140 U/L).

CONCLUSIONSThe tendency of spontaneous clearance of HBV DNA when ALT is more than 800 U/L is obvious, so anti-viral therapy should be administrated strictly. The negative conversion rate of HBV DNA has no relation with HBeAg but with the copies of HBV DNA replication.