张雨婷 叶栋 李欣予 高岭 潘孝本 陈公英

[摘要] 目的 探討成人急性乙肝血清基线HBsAg定量水平、动态变化及临床意义。 方法 对89例AHB患者及101例CHB-AE患者的基线HBsAg定量、HBV-DNA载量、HBcAb-IgM及相关临床资料进行回顾性分析。 结果 ①AHB患者基线log10 HBsAg定量为3.46（2.81，3.84）IU/mL;CHB-AE患者log10 HBsAg定量为3.61（3.12，4.13）IU/mL，AHB患者基线log10 HBsAg定量水平显著低于CHB-AE患者，两组差异有统计学意义（P<0.05）;AHB与CHB-AE患者基线log10 HBV-DNA水平分别为4.54（3.73，5.59）IU/mL及6.87（5.79，7.59）IU/mL;HBcAb-IgM水平分别为20.62（16.54，26.33）IU/mL及 0.24（0.13，0.48）IU/mL，两组比较，差异均有统计学意义（P<0.05）。②动态观察HBsAg定量变化，完成1个月随访的AHB log10 HBsAg定量为0.50（-1.30，1.75）IU/mL，27.1%患者出现HBsAg转阴;3个月随访后，89.0% AHB患者出现HBsAg转阴;6个月随访后，所有患者均HBsAg转阴。③基线1/log10 HBsAg水平≥0.204 IU/mL 时，诊断AHB的敏感度为74.0%;基线1/log10 HBV-DNA水平≥0.581 IU/mL时，诊断AHB的敏感度为84.7%;基线HBcAb-IgM水平≥0.925 mIU/mL时，诊断AHB的敏感度为98.6%。 结论 AHB患者血清基线log10 HBsAg为3.46（2.81，3.84）IU/mL，显著低于CHB-AE患者;随访1个月时约1/4患者HBsAg阴转;随访3个月时超过4/5患者HBsAg阴转;随访6个月，全部患者HBsAg阴转。低HBsAg定量、低HBV-DNA载量及高HBcAb-IgM水平有助于AHB、CHB-AE两组患者的鉴别诊断。

[关键词] 急性乙型肝炎;HBsAg定量水平;动态变化;临床意义

[中图分类号] R512.6          [文献标识码] A          [文章编号] 1673-9701（2021）12-0001-04

Baseline HBsAg quantitative level，dynamic changes and clinical significance of adult acute hepatitis B

ZHANG Yuting1   YE Dong1   LI Xinyu2   GAO Ling3   PAN Xiaoben2   CHEN Gongying1， 3

1.The Fourth School of Clinical Medicine， Zhejiang Chinese Medical University， Hangzhou   310053， China; 2.Hangzhou Normal University， Hangzhou   310036， China; 3.Department of Infectious Diseases， the Affiliated Hospital of Hangzhou Normal University， Hangzhou   310015， China

[Abstract] Objective To explore the baseline serum HBsAg quantitative level， dynamic changes and clinical significance of adult acute hepatitis B. Methods The baseline HBsAg quantitative level， HBV-DNA load， HBcAb-IgM and related clinical data of 89 AHB patients and 101 CHB-AE patients were retrospectively analyzed. Results ①The baseline log10 HBsAg quantitative level in AHB patients was 3.46（2.81， 3.84） IU/mL; the log10 HBsAg quantitative level in CHB-AE patients was 3.61（3.12，4.13） IU/mL， and the baseline log10 HBsAg quantitative level in AHB patients was significantly lower than that of CHB-AE patients. There was a significant statistical difference between the two groups（P<0.05）; the baseline log10 HBV-DNA levels in AHB and CHB-AE patients were 4.54（3.73， 5.59）IU/mL and 6.87 （5.79， 7.59） IU/mL respectively; the HBcAb-IgM levels were 20.62 （16.54， 26.33） IU/mL and 0.24 （0.13，0.48）IU/mL， respectively， and there were significant statistical differences between the two groups（P<0.05）. ②The changes of HBsAg quantitative levels were dynamically observed. The AHB log10 HBsAg quantitative level at one-month follow-up visit was 0.50（-1.30， 1.75） IU/mL， with 27.1% of the patients showing HBsAg-negative; at three months of follow-up visit， 89.0% of AHB patients showed HBsAg-negative; at six months of follow-up visit，all patients turned HBsAg-negative.③When the baseline 1/log10 HBsAg level was≥0.204 IU/mL， the sensitivity of diagnosing AHB was 74%; when the baseline 1/log10 HBV-DNA level was ≥0.581 IU/mL，the sensitivity of diagnosing AHB was 84.7%; when the baseline HBcAb-IgM level was≥0.925 mIU/mL， the sensitivity of diagnosing AHB was 98.6%. Conclusion The baseline log10 HBsAg in AHB patients is 3.46 （2.81， 3.84）IU/mL， which is significantly lower than that in CHB-AE patients. About 1/4 of patients turn HBsAg-negative during the follow-up visit after one month.More than 4/5 patients turn HBsAg-negative during the follow-up visit for three months; during the follow-up visit after six months， all patients turn HBsAg-negative. Low HBsAg quantitative levels， low HBV-DNA load， and high HBcAb-IgM levels are helpful for the differential diagnosis of patients with AHB and CHB-AE.

[Key words] Acute hepatitis B; HBsAg quantitative level; Dynamic changes; Clinical significance

乙型肝炎病毒（Hepatitis B virus，HBV）感染是临床上常见的传染病之一，2015年，WHO曾估计全世界高达2.57亿人感染HBV[1]。乙肝表面抗原（Hepatitis B surface antigen，HBsAg）在HBV病毒生命周期中的合成是复杂的，其过程通常发生在内质网中。进入肝细胞后，病毒离子脱去其蛋白质外壳，其基因组以稳定的全双链共价闭合环状HBV DNA（cccDNA）的形式进入细胞核，并作为病毒基因转录的模板。HBsAg由mRNA翻译而来，其转录模板是活性cccDNA，反映感染肝细胞的数量，可作为评价感染细胞数量的替代标志物[2]。在临床领域，HBsAg长期以来一直作为乙型肝炎病毒感染的定性诊断标志物。随着近年来HBsAg定量成为一种简单且可重复的工具，定量HBsAg在作为HBV感染自然史和抗HBV治疗过程中的预测标志物具有一定的临床意义。本研究探讨急性乙型肝炎（Acute hepatitis B，AHB）患者发作期及随访过程中血清HBsAg的定量动态变化，并分析鉴别急性乙型肝炎及慢性乙型肝炎急性发作（Chronic hepatitis B-acute exacerbation，CHB-AE）两组患者的影响因素及临床意义，现报道如下。

1 资料与方法

1.1 一般资料

研究对象为杭州市第二人民医院及杭州市西溪医院2014年1月至2020年7月收治的成人AHB及CHB-AE患者（其中AHB患者89例，CHB-AE患者101例）共计190例。……