慢性乙型肝炎病毒感染自然史中HBsAg和HBsAb共存血清学模式分析

目的分析慢性乙肝病毒感染者HBsAg和HBsAb共存模式中血清学指标、HBV-DNA和肝酶等指标与自然病程的关系,探讨其临床意义。方法回顾性分析2016年重庆医科大学附属第一医院HBsAg和HBsAb双阳性患者的血清学指标、HBV-DNA和ALT、GGT检测结果,并对其感染的自然病程进行分析。结果 2016年该院HBsAg和HBsAb双阳性患者共520例,占全部HBV感染者的2.80%,占总送检标本数的0.42%。可分期的184例双阳性患者中,免疫耐受期47例(25.54%),免疫清除期17例(9.24%),低复制期108例(58.70%),再活动期12例(6.52%),HBsAg、HBsAg/HBsAb比值、HBV-DNA、ALT和GGT水平差异均有统计学意义(P<0.05),低复制期患者HBsAg/HBsAb比值均低于其他患者(P<0.05)。不同分期患者HBsAb、年龄和性别比较差异无统计学意义(P>0.05),且HBsAb水平均较低。284例资料完整HBsAg和HBsAb共存病例中HBV-DNA阳性136例,占47.89%。HBsAg浓度与HBV-DNA载量成正相关(r=0.295,P<0.05),HBsAb浓度与HBV-DNA载量之间没有显著相关性(r=0.04,P>0.05)。结论 HBsAg和HBsAb共存患者并不少见,与性别无关,可发生在各个年龄阶段,以低复制期患者为最多。HBsAg和HBsAb共存患者中HBsAb多以低浓度形式存在,且浓度与自然病程无关。HBsAb的出现并非代表患者体内病毒复制停止,在诊断及治疗HBsAg和HBsAb共存模式的乙肝病毒感染者时仍需结合HBV-DNA载量来判断感染状态。

Coexistence of HBsAg and HBsAb in patients with chronic hepatitis B virus infection

Abstract: Objective To analyze the relationship between serological markers, HBV-DNA, liver enzyme and natural history of chronic HBV carriers with the co-existence of HBsAg and HBsAb, and explore the clinical significance. Methods The basic information, serological markers of virus, HBV-DNA, ALT and GGT of patients with positive HBsAg and HBsAb as well as their natural history of HBV infection in the First Affiliated Hospital of Chongqing Medical University in 2016 were retrospectively analyzed. Results There were 520 patients with positive HBsAg and HBsAb in our hospital in 2016, accounting for 2.80% of all HBsAg-positive patients, and 0.42% of those tested for their HBV serological status, respectively. Among the 184 patients with co-existence of HBsAg and HBsAb, 47 (25.54%) were in immune tolerance phase, 17 (9.24%) were in immune clearance phase, 108 (58.70%) were in slow replication phase and 12 (6.52%) were in reactivation phase. There were significant differences in the levels of HBsAg, HBsAg/HBsAb, HBV-DNA, ALT and GGT among the 4 phases (P<0.05). The ratio of HBsAg/HBsAb in slow replication phase was comparatively lower than in the other 3 phases (P<0.05). No significant differences were observed in the level of HBsAb, age and gender among 4 phases (P>0.05), in which the concentration of HBsAb was low. Among the 284 patients with co-existence of HBsAg and HBsAb, 136 (47.89%) were HBV-DNA positive. The concentration of HBsAg was positively correlated with HBV-DNA loads (r=0.295, P<0.05), while that of HBsAb was not significantly (r= 0.04, P>0.05). Conclusion The coexistence of HBsAg and HBsAb in chronic HBV carriers is common and independent of gender and age, observed more often in slow replication phase. The concentration of HBsAb in such case is low and unrelated to the natural history of chronic hepatitis B. Since the presence of HBsAb does not mean that HBV had ceased to replicate, HBV-DNA should still be used as a clinical indicator for diagnosis and treatment of HBV infection with coexistence of HBsAg and HBsAb.