正确理解抗-HBc的临床意义

谢靖; Robert G. GISH; 贾继东

doi:10.12449/JCH251006

正确理解抗-HBc的临床意义

DOI: 10.12449/JCH251006

1.
北京和睦家医院消化中心，北京 100016
2.
Hepatitis B Foundation，Doylestown，PA 18901，USA
3.
首都医科大学附属北京友谊医院肝病中心/北京市肝硬化转化医学重点实验室，北京 100050

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：谢靖提出综述框架，负责文献检索与初稿撰写；贾继东和Robert G. Gish共同参与综述的构思与设计；贾继东负责稿件的关键修改及最终定稿；Robert G. Gish负责总体指导、监督，提出专家意见并批准最终版本。

详细信息

通信作者:
贾继东， jia_jd@ccmu.edu.cn （ORCID： 0000-0002-4673-8890）

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出版历程
- 收稿日期: 2025-07-21
- 录用日期: 2025-09-09
- 出版日期: 2025-10-25

Unveiling the clinical impact of hepatitis B core antibody

1.
Digestive Disease Center，Beijing United Family Hospital，Beijing 100016，China
2.
Hepatitis B Foundation，Doylestown，PA 18901，USA
3.
Liver Research Center，Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis，Beijing Friendship Hospital，Capital Medical University，Beijing 100050，China

More Information

Corresponding author: JIA Jidong， jia_jd@ccmu.edu.cn （ORCID： 0000-0002-4673-8890）

摘要

摘要: 抗-HBc是既往HBV暴露及潜在病毒持续存在的重要标志物。在急性HBV感染过程中，HBsAg出现后不久，最早出现的抗体为免疫球蛋白M型抗-HBc（抗-HBc-IgM），通常持续6～12个月，随后出现免疫球蛋白G型抗-HBc（抗-HBc-IgG）。在慢性感染者发生肝炎急性发作时，抗-HBc-IgM亦可能再次出现，但其滴度较急性感染者低。孤立性抗-HBc阳性可见于既往HBV感染已自愈/功能性治愈或隐匿性感染者，在化疗、免疫治疗、输血或器官移植时，仍存在HBV再激活或传播风险。因此，准确识别抗-HBc的临床价值对于HBV感染的全面评估和个体化管理具有重要意义。
- 乙型肝炎核心抗体 /
- 乙型肝炎病毒筛查 /
- 再感染
Abstract: Hepatitis B core antibody （anti-HBc） is an important marker of prior HBV exposure and potential viral persistence. During acute HBV infection， anti-HBc IgM is the earliest antibody to appear shortly after HBsAg， usually lasting for 6 — 12 months， followed by anti-HBc IgG. In patients with chronic infection experiencing acute hepatitis flares， anti-HBc IgM may reappear， though typically at lower titers than in acute infection. “Isolated anti-HBc positivity” may indicate resolved/functional cure of prior HBV infection or occult HBV infection， and there is still a risk of HBV reactivation or transmission during chemotherapy， immunotherapy， blood transfusion， or organ transplantation. Therefore， accurate recognition of the clinical significance of anti-HBc is essential for comprehensive evaluation and individualized management of HBV infection.
- Hepatitis B Core Antibody /
- Hepatitis B Virus Screening /
- Reinfection

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图 1 解读HBsAg、抗-HBs和抗-HBc检测结果

Figure 1. Interpreting HBsAg， anti-HBs， and anti-HBc test results

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表 1 美国胃肠病学会对HBsAg阴性/抗-HBc阳性患者HBV再激活风险的分类

Table 1. American Gastroenterological Association classification of reactivation risk in HBsAg-negative/anti-HBc-positive patients

再激活风险等级	估计再激活发生率	相关治疗药物类型
高风险	>10%	B细胞清除药物，如利妥昔单抗（Rituximab）、奥法妥木单抗（Ofatumumab）； TNF-α抑制剂，如依那西普（Etanercept）、阿达木单抗（Adalimumab）、赛妥珠单抗（Certolizumab）、英夫利昔单抗（Infliximab）；其他细胞因子抑制剂和整合素抑制剂，如阿巴西普（Abatacept）、乌司奴单抗（Ustekinumab）、那他珠单抗（Natalizumab）、维得利珠单抗（Vedolizumab）；酪氨酸激酶抑制剂，如伊马替尼（Imatinib）、尼洛替尼（Nilotinib）；蒽环类药物，如多柔比星（Doxorubicin）、表柔比星（Epirubicin）
中风险	1%～10%	中/大剂量糖皮质激素治疗≥4周
低风险	<1%	传统免疫抑制剂，如硫唑嘌呤（Azathioprine）、6-巯基嘌呤（6-Mercaptopurine）、甲氨蝶呤（Methotrexate）；关节腔注射激素；糖皮质激素治疗≤1周；低剂量糖皮质激素治疗≥4周

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表 2 乙型肝炎血清学标志物解释

Table 2. Interpretation of HBV biomarkers

血清标志物				临床解释	注释
HBsAg	抗-HBs	抗-HBc-IgG	抗-HBc-IgM	临床解释	注释
-	-	-	-	未感染过HBV；未接种或疫苗接种不足	建议接种疫苗以降低感染风险
+	-	+	+	急性乙型肝炎或慢性乙型肝炎急性发作	短期内定期评估ALT变化，6个月后复查乙型肝炎相关血清标志物
+	-	+	-	慢性乙型肝炎	评估是否需要抗病毒治疗
-	+	-	-	疫苗接种后获得免疫力	抗体滴度≥100 IU/L为理想水平
-	+	+	-	HBV既往感染者，免疫控制不充分；抗-HBs滴度<10 IU/L；在免疫抑制状态下有HBV再激活风险；在肝脏或骨髓移植中可能传播HBV	观察随访患者；在化疗、免疫抑制治疗或ALT异常时需检测HBV DNA；传播风险低，限于特殊临床情境
-	-	+	-	既往感染HBV并已恢复HBV；再激活风险低	观察随访患者；在接受化疗或免疫抑制时，可能需进行HBV DNA检测；在正常情况下几乎无传播风险

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