乙型肝炎病例HBsAg与HBsAb双阳性模式分析  

The analysis for HBsAg and anti-HBs double positive serology pattern

作　　者：周鸿良[1] 杨莉俊[1] 费敏英[1] 陈小静[1] 

机构地区：[1]浙江省杭州市萧山区第一人民医院检验科,杭州311201

出　　处：《中国卫生检验杂志》2010年第11期2911-2912,2914,共3页Chinese Journal of Health Laboratory Technology

摘　　要：目的:探讨乙型肝炎患者HBsAg与HBsAb同时阳性少见模式产生的原因与临床意义。方法:筛选有完善的病史资料、及多次不同时段复查结果的HBsAg与HBsAb同时阳性病例209例纳入统计分析。分析HBsAg与HBsAb同时阳性患者的临床诊断、HBVM(乙肝血清标志物)模式分布、HBV-DNA的阳性率、肝功能状况、治疗用药情况。结果:HB-sAg与HBsAb同时阳性病例HBVM模式分布以①②③⑤为主占54.5%。HBsAg与HBsAb同时阳性组与对照组②的HBsAb的滴度差异具有显著性,与对照组①在HBV-DNA阳性率和肝功能异常率方面无显著性差异。诊断为慢性乙肝的患者占HBsAg与HBsAb同时阳性病例的78.5%。结论:HBsAb的产生在HBsAg与HBsAb同时阳性患者中并非预示乙肝病情的恢复。HBV病毒的变异受多种因素影响。乙肝病情反复不逾,以及持续的治疗可能会引起HBV(乙型肝炎)病毒S区基因突变的累积,从而造成HBsAg与HBsAb同时阳性现象。Objective：Investigate the causes and clinical significances regarding the rare model of double positive of HBsAg and HBsAb in hepatitis B patients.Methods： There were 209 patients included in this study,all with consistent and complete documentations in medical records showing multiple positive results of both HBsAg and HBsAb at various time points.Analysis include clinical diagnosis,HBVM（HBV serum markers） distribution,the rate of HBV-DNA positive units,liver function and evaluation of medication treatment.Results： The HBVM（HBV serum markers） distribution showed that 54.5% of total patients with double positive of HBsAg and HBsAb may be categorized into the model ①②③ and ⑤.There is a significant difference in HBsAb titer between the group of double positive patients and control group 2.However,there is no significant difference in positive rate of HBV-DNA and rate of liver dysfunction between the group of double positive patients and control group 1.78.5% of double positive patients were diagnosed with chronic hepatitis B.Conclusion： The appearance of HBsAb in patients who were double positive to HBsAg and HBsAb may not predict the recovery from hepatitis B.HBV virus mutation is affected by various factors.Reappearance of hepatitis B viruses,along with continuous medical treatment could lead to multiple mutations of HBV（hepatitis B） virus S gene.This may result in the double detection of HBsAg and HBsAb in hepatitis B patients.

关 键 词：乙型肝炎病毒 病毒变异 乙肝表面抗原 乙肝表面抗体 少见模式 免疫压力 

分 类 号：R512.62[医药卫生—内科学]