乙肝表面抗原和表面抗体双阳性慢性乙肝患者流行病学特征及临床预后  

Epidemiological characteristics and clinical prognosis of 305 chronic hepatitis B patients with HBsAg and HBsAb coexistence

作　　者：梁慧筠 梁敏锋[3] 裘宇容[1] LIANG Hui⁃jun;LIANG Min⁃feng;QIU Yu⁃rong(The First School of Clinical Medicine,Southern Medical University,Guangzhou,Guangdong 510515;Nanhai District People's Hospital of Foshan,Foshan,Guangdong 528225;The First People's Hospital of Foshan,Foshan,Guangdong 528000,China)

机构地区：[1]南方医科大学第一临床医学院,广东广州510515 [2]佛山市南海区人民医院检验科,广东佛山528225 [3]佛山市第一人民医院感染科,广东佛山528000

出　　处：《热带医学杂志》2022年第6期751-755,共5页Journal of Tropical Medicine

基　　金：广州市产学研协同创新重大专项校地协同创新项目(201604040003)

摘　　要：目的探讨乙肝表面抗原(HBsAg)和表面抗体(HBsAb)双阳性患者的流行病学特征及临床预后。方法统计2017年1月-2020年7月在佛山市南海区人民医院就诊的乙肝病毒感染患者10076例,并持续记录其中305例HBsAg和HBsAb双阳性慢性乙肝患者的临床及随访资料,分析其流行病学特征和临床预后。结果HBsAg和HBsAb双阳性发生率在乙肝感染患者中占3.00%。在305例HBsAg和HBsAb双阳性患者中,男女比例为1.38∶1,年龄中位数47(36~62)岁。HBsAg、HBsAb、乙肝e抗原(HBeAg)及乙肝核心抗体(HBcAb)阳性模式占43.93%(134/305),HBsAg、HBsAb、乙肝e抗体(HBeAb)、HBcAb阳性模式占42.95%(131/305)。丙氨酸氨基转移酶(ALT)和/或天门冬氨酸氨基转移酶(AST)异常率为41.64%,HBV DNA阳性率为54.43%,甲胎蛋白(AFP)异常率为19.02%。HBsAg和HBsAb双阳性患者以低浓度HBsAb(10.00~99.99 mIU/mL)为主,占83.93%(256/305)。至随访结束,305例HBsAg和HBsAb双阳性患者中68例(22.30%)诊断为严重肝病,其中33例(10.82%)为肝癌,30例(9.84%)为肝硬化,5例(1.64%)为肝衰竭。根据HBsAg和HBsAb双阳性患者是否发生严重肝病,分为严重肝病组(n=68)和普通肝病组(n=237)进行单因素分析,发现两组HBsAg、HBsAb、HBeAb定量值及年龄差异无统计学意义(P>0.05);严重肝病组中男性,AST、ALT、AFP异常,HBV DNA载量≥104IU/mL的发生率高于普通肝病组,差异均有统计学意义(P<0.05)。结论持续HBsAg和HBsAb双阳性患者发生严重肝病比例高,此血清学模式可能提示疾病的预后转归不良,临床应重视对此类患者的治疗和管理。Objective To investigate the clinical prognosis and epidemiological characteristics of the patients with hepatitis B surface antigen(HBsAg)and hepatitis B surface antibody(HBsAb)coexistence.Methods Perform statistical analysis was performed on 10076 cases that were infected by hepatitis B virus(HBV)and had treatment in Nanhai District People’s Hospital of Foshan from January 2017 to July 2020.The epidemiological characteristics and clinical prognosis of 305 cases with HBsAg and HBsAb coexistence were analyzed.Results The prevalence of coexistent HBsAg and HBsAb in patients with HBV infection was 3.00%.Among 305 patients with HBsAg and HBsAb coexistence,the male to female ratio was 1.38∶1,and the median age was 47(36-62)years old,43.93%(134/305)for HBsAg,HBsAb,hepatitis B e antigen(HBeAg)and hepatitis B core antibody(HBcAb)positive patterns,42.95%(131/305)for HBsAg,HBsAb,anti-HBe antibody(HBeAb)and HBcAb positive patterns.Alanine aminotransferase(ALT)and/or aspartate aminotransferase(AST)abnormal rate was 41.64%,HBV DNA positive rate was 54.43%,alpha fetoprotein(AFP)abnormal rate was 19.02%.Lower concentrations(10.00-99.99 mIU/mL)of HBsAb were predominant,accounting for 83.93%(256/305).By the end of follow-up,68(22.30%)in the 305 HBsAg and HBsAb double-positive patients were diagnosed with severe liver diseases,including 33(10.82%)cases liver cancer,30(9.84%)cases liver cirrhosis,and 5(1.64%)cases hepatic failure.According to whether severe liver disease occurred or not in HBsAg and HBsAb double-positive patients,the patients were divided into the severe liver disease group(n=68)and the common liver disease group(n=237)for univariate analysis.It was found that quantitative value of HBsAg,HBsAb,HBeAb and age between the two groups were not significantly different(P>0.05).Proportion of male,the incidence of abnormal AST,ALT,AFP,HBV DNA load≥104IU/mL in severe liver disease group were statistically higher than those in common liver disease group(P<0.05).Conclusions The proportion of patients with severe liver d

关 键 词：慢性乙型肝炎 乙肝表面抗原 乙肝表面抗体 

分 类 号：R512.62[医药卫生—内科学]