摘要
目的探讨抗-HBc阳性的肝损伤患者临床特征。方法收集2013年8月至2014年8月上海市交通大学医学院附属瑞金医院感染科收治的肝损伤待查,并且抗-HBc阳性、HBsAg阴性的212例患者资料。根据是否为肝硬化,分为肝硬化组(60例)、非肝硬化组(152例);另将该60例肝硬化组与同期收治的60例乙型肝炎后肝硬化组进行比较。分别统计其一般资料、生物化学及免疫学等指标。多组均数比较采用单因素方差分析,两组比较的非参数统计采用Wilcoxon秩和检验。结果HBV DNA阳性1例,阳性率为0.5%。致肝损伤病因主要为:隐源性肝硬化60例,占28.3%,药物性肝炎45例,占21.2%,不明原因肝损伤33例,占15.6%,急性戊型肝炎28例,占13.2%,自身免疫性肝炎15例,占7.1%。肝硬化组与非肝硬化组的T淋巴细胞亚群、抗-HBs及抗-HBe定量、红细胞计数、血小板计数、前白蛋白、白蛋白、ALT、AST、国际标准化比值、透明质酸、胶原蛋白-Ⅲ、胶原蛋白-Ⅳ差异均有统计学意义(均P<0.05)。乙型肝炎后肝硬化组与HBV抗-HBc阳性肝硬化组间的CD3+CD4+及CD3+CD8+T淋巴细胞计数、白细胞计数、ALT、AST、TBil、白蛋白差异均有统计学(均P<0.05)。结论抗-HBc阳性少数患者仍有HBV复制,具有传染性。HBV抗-HBc阳性、HBsAg阴性可能与部分隐源性肝硬化、原发性肝癌发病相关。抗-HBc阳性人群易并发药物性肝炎、自身免疫性肝炎等与免疫机制相关疾患。肝硬化患者较非肝硬化患者更易诱发免疫耐受和病情慢性化。抗-HBc定量或可作为预测HBV感染后疾病转归的指标。抗-HBc阳性肝硬化组较乙型肝炎后肝硬化组病情轻。
Objective To investigate the clinical features of hepatitis B core antibody (anti-HBc) positive patients with liver injury. Methods A total of 212 anti-HBc positive and HBsAg negative patients who were primarily diagnosed with liver injury from August 2013 to August 2014 at Ruijin Hospital were collected for this study.The patients were divided into cirrhosis group (n=60) and non-cirrhosis group (n=152) according to the status of cirrhosis.The 60 cases with cirrhosis were further compared with 60 cases with post-hepatitis B cirrhosis.The general information, biochemistry and immunology data were assessed.ANOVA was used to compare multiple groups of means, and Wilcoxon rank-sum test was used for non-parametric comparisons of the two groups. Results Only one case was positive for HBV DNA with the positivity rate of 0.5%.The causes for liver injury were as follows, 60 cases with cryptogenic cirrhosis, which accounted for 28.3%;45 cases with drug-induced hepatitis, which accounted for 21.2%;33 cases with unexplained liver injury, which accounted for 15.6%;28 cases with acute hepatitis E, which accounted for 13.2% and 15 cases with autoimmune hepatitis, which accounted for 7.1%.There were significant differences of T cell subpopulation, hepatitis B surface antibody (HBsAg) and hepatitis B e antibody (anti-HBe) quantitative level, red blood cells (RBC), platelet counts (PLT), prealbumin, albumin, alamine aminotransferase (ALT), aspartate transaminase (AST), international normalized ratio (INR), hyaluronic acid (HA), collagen Ⅲ (COL-Ⅲ) and collagen Ⅳ (COL-Ⅳ) between the cirrhosis group and non-cirrhosis group (all P<0.05).The CD3+ CD4+ and CD3+ CD8+ counts, white blood cells (WBC), ALT, AST, total bilirubin (TBil) and albumin in anti-HBc-positive cirrhosis group were statistically different from those in post-hepatitis B cirrhosis group (all P<0.05). Conclusions Some patients with positive anti-HBc still have HBV replication and infectivity.HBV anti-HBc positivity and HBsAg negativity may be associated with some cryptogenic cirrhosis and primary liver cancer.Patients with positive anti-HBc are prone to be complicated with drug-induced hepatitis, autoimmune hepatitis, and other liver damage related to immune mechanisms.Patients with cirrhosis have a higher risk to induce immune tolerance and progress to chronic disease than non-cirrhotic patients.Quantitative anti-HBc might be used as an indicator to predict disease progression after HBV infection.Disease condition in cirrhotic group with positive anti-HBc and negative HBsAg is less severe than that in post-hepatitis B cirrhosis group.
作者
周宁
张月荣
史冬梅
项晓刚
谢青
李玉民
Zhou Ning;Zhang Yuerong;Shi Dongmei;Xiang Xiaogang;Xie Qing;Li Yumin(Department of Infection,the First People's Hospital of Lanzhou,730050 Lanzhou,China)
出处
《中华传染病杂志》
CAS
CSCD
2018年第12期725-729,共5页
Chinese Journal of Infectious Diseases
基金
兰州市科技局科技计划项目(2015-2-5).
关键词
肝硬化
乙型肝炎病毒感染
抗-HBC阳性
三抗体阳性
乙型肝炎病毒复制
Liver cirrhosis
Hepatitis B virus infection
Anti-HBc positive
Three antibodies positive
Hepatitis B virus replication
作者简介
通信作者:李玉民,Email:liym@lzu.edu.cn.
