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目的探讨乙型肝炎表面抗原(hepatitis B surface antigen,HBsAg)和乙型肝炎表面抗体(hepatitis B surface antibody,抗-HBs)双阳性慢性乙型肝炎(chronic hepatitis B,CHB)患者的临床和病毒学特点。方法 2015年8月~2016年3月中国医科大学附属盛京医院感染科收治的CHB患者为研究对象,乙型肝炎病毒血清标志物采用化学发光微粒子免疫法检测,HBV DNA采用实时荧光定量PCR检测。结果1 058例CHB患者中,HBsAg/抗-HBs双阳性患者24例(24/1 058,2.27%)。在24例HBsAg/抗-HBs双阳性CHB患者中,19例(19/24,79.17%)HBsAg>100IU/ml,22例(22/24,91.67%)抗-HBs在10~100mIU/ml;HBV DNA阳性21例(87.50%),HBV DNA、HBsAg和丙氨酸氨基转移酶(ALT)水平在不同抗-HBs滴度的组间比较差异均无统计学意义。有2例肝功能正常的HBsAg/抗-HBs双阳性患者在随访中自发肝功异常、HBV DNA和HBsAg转阴,抗-HBs持续阳性。结论 HBsAg/抗-HBs双阳性CHB患者仍可能存在病毒复制,可发生肝炎活动及疾病进展。
Objective To investigate the clinical and virological characteristics of hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (anti-HBs) patients with chronic hepatitis B (CHB) Features. Methods From August 2015 to March 2016, CHB patients admitted to Department of Infectious Diseases, Shengjing Hospital, China Medical University were selected as study objects. Serum markers of hepatitis B virus were detected by chemiluminescence microparticle immunoassay. HBV DNA was detected by real-time fluorescence quantitative PCR . Results Among 1 058 cases of CHB, 24 cases were positive for HBsAg / anti-HBs double positive (24/1 058, 2.27%). Among the 24 HBsAg / anti-HBs double positive CHB patients, 19 (19/24, 79.17%) had HBsAg> 100 IU / ml and 22 (22/24, 91.67%) had anti-HBs at 10-100 mIU / 21 cases (87.50%) had positive HBV DNA, HBV DNA, HBsAg and alanine aminotransferase (ALT) levels had no significant difference among different anti-HBs titers. Two cases of HBsAg / anti-HBs double positive patients with normal liver function had spontaneous liver abnormalities at follow-up, negative HBV DNA and HBsAg, and persistent anti-HBs. Conclusion HBsAg / anti-HBs double positive CHB patients may still exist virus replication, hepatitis activity and disease progression may occur.