乙肝患者血清HBsAg与HBsAb双阳性的临床分析  

The clinical analysis of serum HBsAg and HBsAb double positive in hepatitis B patients

作　　者：朱锦宏[1] 吴红[1] 王春苗[2] 吴晓蔓[1] ZHU Jinhong;WU Hong;WANG Chunmiao;WU Xiaoman(Department of Clinical Laboratory, The Second Affiliated Hospital ofGuangzhou Medical University, Guangzhou 510260,China)

机构地区：[1]广州医科大学附属第二医院检验科,广州510260 [2]广东省人民医院检验科广东省医学科学院,广州510080

出　　处：《实用医学杂志》2019年第4期638-640,644,共4页The Journal of Practical Medicine

基　　金：广州市医药卫生科技项目(编号:20171A011298)

摘　　要：目的通过分析乙型病毒性肝炎(以下简称"乙肝")患者乙型肝炎病毒(HBV)血清标志物中乙型肝炎表面抗原(HBsAg)与乙型肝炎表面抗体(HBsAb)同时阳性罕见模式的病例,探讨其存在原因及临床价值。方法应用微粒子酶免疫化学发光分析法(MEIA)检测乙肝患者血清标志物(HBV-M);采用用荧光定量PCR方法检测HBV-DNA,采用PCR-高分辨率熔解曲线(PCR-HRM)分析技术检测HBV基因基本核心启动子(BCP)双变异nt1762A-T/nt1764G-A;比色法检测谷丙转氨酶和谷草转氨酶,并结合患者的临床特点进行综合分析。结果在15 600例乙肝患者中,HBsAg与HBsAb双阳性的检出率为2.3%,其阳性率在不同性别组及不同年龄组中差异无统计学意义(P> 0.05);在所有HBsAg与HBsAb双阳模式中,HBsAg、HBsAb、HBeAb、HB-cAb阳性模式比例最高,占57.9%;HBsAg与HBsAb双阳模式中HBeAg阳性组乙肝患者的HBV DNA阳性率高于HBeAg阴性组;而HBeAg阴性组BCP双变异nt1762A-T/nt1764G-A发生率较HBeAg阳性组高;两组差异具有统计学意义(P <0.05);慢性乙肝患者HBsAg与HBsAb双阳检出率均高于无症状携带者、乙肝后肝硬化、重型乙肝及乙肝肝癌(P <0.05)。结论 HBsAg与HBsAb双阳性出现,并不预示乙肝病毒传染性减弱,而提示病毒基因有可能出现变异,临床有必要通过检测血清HBV DNA来确定患者体内病毒是否处于复制状态,为此部分HBsAg与HBsAb双阳性患者的个性化治疗提供一定临床帮助。Objective Study of the rare hepatitis B virus patients model cases which both the hepatitis B surface antigen(HBsAg)and hepatitis B surface antibody(HBsAb)were positive, and discussion of its cause and the clinical value. Methods serum markers of hepatitis B virus(HBV-M)was detected by microparticle enzyme immunoassay chemiluminescence(MEIA);HBV-DNA was detected by fluores--cence quantitative PCR method,alanine aminotransferase and aspartate aminotransferase were detected by colorimetric,and all the data were combined with the clinical features of patients for comprehensive analysis. Results 1)HBsAg and HBsAb double positive detection rate was 2.3% in 15600 cases of hepatitis B patients,there was no significant difference in the positive rate of different sex groups and different age groups(P > 0.05);2)HBsAg,HBsAb,HBeAb,HBcAb positive mode accounted for the highest proportion in all HBsAg and HBsAb double positive cases,the percentage was 57.9%;3)the positive rate of HBV DNA in hepatitis B patients with HBeAg positive rate were higher than HBeAg negative group in all HBsAg and HBsAb double positive cases;and the incident rate of double variation nt1762A-T/nt1764G-A in HBeAg negative group was higher than that in HBeAg positive group. There were significant differences between two groups(P < 0.05);4)the detection rate of HBsAg and HBsAb double positive in patients with chronic hepatitis B were higher than those of asymptomatic carriers,liver cirrhosis,hepatitis B and hepatitis B hepatocellular carcinoma(P < 0.05). Conclusion The phenomenon of both positive HBsAg and HBsAb does not indicate the elimination of the hepatitis B virus infection,but it is likely suggested the mutation of the virus. It is necessary to prompt clinical detection of serum HBV DNA,so as to determine whether the virus in patients is in the replication status,and it also provide some help for clinical individualized treatment of HBsAg and HBsAb double positive patients.

关 键 词：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] R446.6[医药卫生—临床医学]