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HBsAg与抗-HBs同时阳性的慢性乙型肝炎患者临床特点分析
An investigation of clinical features of HBsAg and anti-HBs positive patients with chronic hepatitis B
文章发布日期:2016年09月28日  来源:  作者:宋金云,王建芳,吴旭平,等  点击次数:2346次  下载次数:339次

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【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>0.05);HBeAg阴性组中,HBsAg与抗-HBs双阳性组HBV DNA定量>1×105 IU/ml的比例与对照组比较,差异有统计学意义(χ2=10.740,P<0.05)。对HBV S区进行测序分析发现,测序的80例HBsAg与抗-HBs双阳性患者中有27例患者的HBV S区发生变异,突变率33.7%,且S区变异位点主要有P29L、S61L、P62L、I126T/S、Q129N、M133K、F134L、G145R/K、L175S和L186H等。结论HBsAg与抗-HBs同时阳性者在乙型肝炎患者中有一定比例,其主要原因可能是病毒株变异所致。这种情况并不代表疾病好转,且抗-HBs出现并不一定能完全有效清除HBsAg,病毒DNA往往存在持续复制,需引起重视。
【Abstract】:ObjectiveTo investigate the phenomenon of coexistence of HBsAg and anti-HBs and its clinical features, as well as related causes. MethodsA 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. ResultsThere 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 P29L, S61L, P62L, I126T/S, Q129N, M133K, F134L, G145R/K, L175S, and L186H. ConclusionThe patients with positive HBsAg 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 HBsAg clearance. There may be persistent replication of viral DNA, which needs to be taken seriously.
【关键字】:肝炎病毒, 乙型; 肝炎表面抗原, 乙型; 肝炎抗体, 乙型; 抗原变异
【Key words】:hepatitis B virus; hepatitis B surface antigens; hepatitis B antibodies; antigenic variation
【引证本文】:宋金云, 王建芳, 吴旭平, 等. HBsAg与抗-HBs同时阳性的慢性乙型肝炎患者临床特点分析[J]. 临床肝胆病杂志, 2016, 32(11): 2092-2095.

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