HBsAg与抗-HBs同时阳性的慢性乙型肝炎患者临床特点分析

宋金云; 王建芳; 吴旭平; 黄玲

doi:10.3969/j.issn.1001-5256.2016.11.016

HBsAg与抗-HBs同时阳性的慢性乙型肝炎患者临床特点分析

DOI: 10.3969/j.issn.1001-5256.2016.11.016

东南大学附属第二医院临床科研中心

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中图分类号: R512.62
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出版历程
- 出版日期: 2016-11-20

An investigation of clinical features of HBsAg and anti-HBs positive patients with chronic hepatitis B

摘要

摘要: 目的分析HBsAg与抗-HBs同时阳性的现象及其临床特点,并探讨其产生的原因。方法收集2011年2月-2014年2月东南大学附属第二医院体检者2260例,其中被诊断为慢性乙型肝炎的患者830例。采用化学发光微粒子免疫分析法筛选HBsAg与抗-HBs同时阳性的患者188例,分为HBeAg阳性组（n=101）和HBeAg阴性组（n=87）。同时选取200例HBsAg阳性、抗-HBs阴性者作为对照,其中HBeAg阳性组80例,HBeAg阴性组120例。检测HBV血清学标志物、肝功能、病毒载量并结合临床进行分析。计数资料组间比较采用χ2检验。结果 HBV血清学标志物在HBsAg与抗-HBs双阳性情况下共有5种模式,其中以HBsAg、抗-HBs、HBeAg及抗-HBc阳性,且抗-HBe阴性多见,占47.9%（90/188）,肝功能指标总异常率为69.1%（130/188）,HBV DNA总阳性率为56.9%（107/188）。HBeAg阳性的2组HBV DNA均存在高水平复制,其中HBsAg与抗-HBs双阳性组HBV DNA阳性率与对照组比较,差异无统计学意义（χ2=2.632,P>0.0...
- 肝炎病毒,乙型 /
- 肝炎表面抗原,乙型 /
- 肝炎抗体,乙型 /
- 抗原变异
Abstract: Objective To investigate the phenomenon of coexistence of HBsAg and anti- HBs and its clinical features,as well as related causes. Methods A total of 2260 persons who underwent physical examination in The Second Affiliated Hospital of Southeast University from February 2011 to February 2014 were enrolled,among whom 830 were diagnosed with chronic hepatitis B. Chemiluminescence microparticle immunoassay was used to screen out 188 patients with coexistence of HBsAg and anti- HBs,and these patients were divided into HBeAg positive group( 101 patients) and HBeAg negative group( 87 patients). Another 200 patients with positive HBsAg and negative anti-HBs were enrolled as controls,among whom 80 were in the HBeAg- positive group and 120 were in the HBeAg- negative group. HBV serological markers,liver function,and viral load were measured and analyzed with reference to clinical manifestations. The chi- square test was used for comparison of categorical data between groups. Results There were five patterns of HBV serological markers in patients with positive HBsAg and anti- HBs,among which positive HBsAg,anti- HBs,HBeAg,and anti- HBc and negative anti- HBe were the most common and accounted for 47. 9%( 90 /188). The overall abnormal rate of liver function parameters was 69. 1%( 130 /188),and the positive rate of HBV DNA was 56. 9%( 107 /188). The two groups with positive HBeAg had a high level of HBV DNA replication,and there was no significant difference in the positive rate of HBV DNA between positive HBsAg and anti- HBs group and control group( P > 0. 05).In the groups with negative HBeAg,there was a significant difference in the proportion of patients with HBV DNA quantitation of > 1 × 105 IU / ml between positive HBsAg and anti- HBs group and control group( P < 0. 05). The sequencing of the S region of HBV showed that among the 80 patients with positive HBsAg and anti- HBs,27 had variations in this region,and the mutation rate reached 33. 7%. The major variation sites in S region included P29 L,S61L,P62 L,I126T / S,Q129 N,M133K,F134 L,G145R / K,L175 S,and L186 H. Conclusion The patients with positive HBsA g and anti- HBs account for a certain proportion in patients with hepatitis B,and the major reason may be variation of viral strains. This situation does not indicate the improvement in disease,and the appearance of anti- HBs may not achieve complete and effective HBsA g clearance. There may be persistent replication of viral DNA,which needs to be taken seriously.
- hepatitis B virus /
- hepatitis B surface antigens /
- hepatitis B antibodies /
- antigenic variation

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参考文献(20)

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