Hepatitis B surface antigen (
HBsAg) levels are used to evaluate and monitor clinical phases of
chronic hepatitis B infection but their clinical significance is unclear in the late complications,
cirrhosis of the liver and
hepatocellular carcinoma. This study aimed to evaluate
HBsAg levels across the whole natural history of
hepatitis B virus infection, including late complications. This retrospective, cross-sectional study enrolled 838 treatment-naive patients diagnosed with
chronic hepatitis B infection at First Affiliated Hospital of Fujian Medical University between 2009 and 2012. Patients were classified into six groups: immunotolerance, immunoclearance, low replicative, negative
hepatitis e (
HBeAg) phases,
liver cirrhosis, and
hepatocellular carcinoma. Main outcome measures were serum
HBsAg,
HBeAg, HBV
DNA, total
bilirubin,
albumin,
alanine and
aspartate aminotransferase, and quantitative correlation of
HBsAg with HBV
DNA.
HBsAg levels declined significantly between clinical phases of
infection (all P < 0.001) and were significantly lower in decompensated than in compensated
cirrhosis (2.90 vs. 3.30, P < 0.001) but not significantly different between early versus advanced
hepatocellular carcinoma. Significant positive correlations were observed between serum
HBsAg and HBV
DNA at immunoclearance and
HBeAg negative phases, compensated and decompensated
liver cirrhosis and advanced but not early
hepatocellular carcinoma (all P < 0.001).
HBsAg and HBV
DNA were significantly higher in
HBeAg positive patients with advanced
hepatocellular carcinoma (P < 0.001).
HBsAg levels differ significantly between
chronic hepatitis B infection phases, decreasing progressively from
chronic infection to
cirrhosis and
hepatocellular carcinoma. Significant correlations are found between serum
HBsAg and HBV
DNA.