聚合酶链反应检测HBV DNA的临床意义

应用ＰＣＲ对１７１例肝病血清检测结果，ＨＢＶＤＮＡ阳性率５９．１％，ＥｌｉＳＡ检测ＨＢｓＡｇ阳性率４３．２７％，二者比较有显著性差异（Ｐ〈０．０１），ＨＢｓＡｇ（＋）／ＨＢｅＡｇ（＋）组ＨＢＶＤＮＡ阳性率７９．５％，而ＨＢｓＡｇ（＋）抗－ＨＢｅ（＋）组主５７．９％，ＨＢｓＡｇ（－）／抗－ＨＢｓ（＋）组，ＨＢＶＤＮＡ阳性率３６．８％。     

PCR检测献血员乙肝感染状况

目的对部分献血员中乙型肝炎感染状况进行调查．方法用ＰＣＲ法对检查合格的２９０份献血血样进行ＨＢＶ＿ＤＮＡ检测．结果本组２９０份血样中ＨＢｓＡｇ，ＨＢｅＡｇ全部呈阴性．１６７例ＨＢＶＭ阳性；其中８０例单项抗ＨＢｓ阳性，５０例单项抗ＨＢｃ阳性，１９例抗ＨＢｓ和ＨＢｃ两项阳性，１２例抗ＨＢｅ和抗ＨＢｃ两项阳性；６例抗ＨＢｓ，抗ＨＢｅ和抗ＨＢｃ三项阳性，而ＨＢＶ－ＤＮＡ的阳性率在各组中分别为８８％（７／８０），２６０％（１３／５０），１０５％（２／１９），７５０％（９／１２），３３３％（２／６）．１２３例ＨＢＶＭ阴性，ＨＢＶ－ＤＮＡ的阳性率为１６％（２／１２３）．２９０例中ＨＢＶ－ＤＮＡ的总检出率为１２１％（３５／２９０）．结论合法献血员中存在着乙肝病毒感染者．     

国产基因工程干扰素α1治疗慢性乙型肝炎的临床研究

２２５例慢性乙型肝炎分三组治疗，Ａ和Ｂ组７４例配对随机用干扰素α１及安慰剂双盲对照观察，Ｃ组１５１例为干扰素α１４０微克连用三个月，ＨＢｅＡｇ、ＨＢＶ－ＤＮＡ、ＨＢｅＡｇ和ＨＢＶ－ＤＮＡ双转阴率及抗ＨＢｅ转阳率分别为４０．５％、５７．１％、３９．３％及２９．７％，与对照组差异有非常显著性（Ｐ＜０．０１）。扩大治疗组结果与Ａ组相似，均明显优于对照组。治疗组随访半年和一年ＨＢｅＡｇ及ＨＢＶ－ＤＮＡ转阴率与治疗结束时相似，表明有较持久的效果。     

HBV慢性无症状携带者临床,肝活检,血清标志物的三年随访动态观察

对４６６例ＨＢＶ慢性无症状携带者（ＡＳＣ）进行了为期３年的临床、肝活检及血清标志物的动态观察研究。在此期间，４６６例中有４６例出现临床显性发病，约占样本的１０％，可能与饮酒量过多、乱用药物、精神紧张等因素有关。１４例行第２次肝穿刺，提示：原肝组织正常者几年内相当稳定，病理很少变化，原有病理改变者不易恢复。ＡＳＣＨＢｓＡｇ每年转阴率为１．６３％，抗－ＨＢｓ年转阳率为０．３４％，ＨＢｅＡｇ年转阴率为３．８５％，抗－ＨＢｅ年转阳率为２．７４％，抗－ＨＢｃ无１例阴转。     

中草药及复方治疗250例慢性乙型肝炎疗效观察

自１９９２年１０月以来，我们用中草药及复方治疗慢性乙型性肝炎２５０例，对ＨＢｓＡｇ、ＨＢｅＡｇ、抗－ＨＢｃ转阴，抗－ＨＢｓ、抗－ＨＢｅ转阳取得了较好的疗效，现报道如下。１对象与方法１．１对象慢性乙型肝炎２５０例，均符合全国传染病学术会议（宜昌）制定的诊断标准。ＨＢｓＡｇ、ＨＢｅＡｇ、抗－ＨＢｃ均阳性，其中慢性迁延性肝炎２０８例，男１３９例，女６０例，１５～２５岁６４例，２６～３５岁７４例，３６～６０岁７０例；慢性活动性肝炎４２例，男２８例，女１４例，１５～２５岁３例，２６～３５岁２０例，３６～６…     

多重和套式聚合酶链反应检测血液,腹膜透析患者血清中HBV D…

利用免疫学和聚合反应（ＰＣＲ）方法，对３５例血液透析（血透），１４例腹膜透析（腹透）患者的８４份血清进行了检测。血透组抗－ＨＣＶ阳性率８２．９％，ＨＣＶ ＲＮＡ ＰＣＲ阳性率５１．４％；腹透组抗－ＨＣＶ阳性率仅７．１％，ＨＣＶ ＲＮＡ ＰＣＲ均阴性。ＨＢｓＡｇ和（或）ＨＢｅＡｇ在二组的阳性率分别为２５．７％和２１．４％；ＨＢＶＤＮＡＰＣＲ阳性率分别为４５．７％和６４．２％。透析患者ＨＣＶ和ＨＢＶ感     

多聚酶链式反应在慢性乙型肝炎血清学标志物检测中的应用

作者应用多聚酶链式反应检测９５例慢性乙型肝炎患者的血清标本，ＨＢｓＡｇ、ＨＢｅＡｇ、抗－ＨＢｃ阳性组，ＨＢｓＡｇ、抗－ＨＢｅ、抗－ＨＢｃ阳性组，ＨＢｓＡｇ、抗－ＨＢｃ阳性组，抗－ＨＢｓ阳性组，抗－ＨＢｅ，抗－ＨＢｃ阳性组其ＨＢＶＤＮＡ阳性率分别为９６．５５％（２８／２９例），７８．９５％（１５／１９例），４０％（８／２０），２０％（２／１０例），１０％（１／１０例），并提出乙型肝炎病毒复制和传染性     

HFRS疫苗对慢性乙肝血清学标志的影响

用肾综合征出血热（ＨＦＲＳ）疫苗治疗慢性乙肝患者８４例，重点观察其对乙肝血清学村志（ＨＢＶＭ）的影响，治疗前患者血清ＨＢｓＡｇ、ＨＢｅＡｇ抗－ＨＢＣ阳性，治疗３、６、１２个月时其中ＨＢｅＡｇ阴转率分别为３４．５％、３８．１％、２８．６％，ＨＢＶ－ＤＮＡ分别为２９．０％、３３．３％、２２．７％。结果显示，ＨＦＲＳ疫苗治疗慢性乙肝有一定疗效，能抑制ＨＢＶ复制，对ＨＢＶＭ有明显阴转作用。     

TTV感染与原发性肝癌关系的病例对照研究

目的：了解ＴＴＶ与ＨＰＣ的关系。方法：对８２例ＰＨＣ、４０例非肝癌恶性肿瘤病人（对照组１）、４０例正常人（对照组２）进行病例对照研究。结果：ＰＨＣ组中．ＨＢｓＡｇ、ＨＢｅＡｇ、ＨＢＶ－ＤＮＡ,、ＨＢＶ－Ｍ的阳性率分别为７５．６％,５１．２％、１９．５％、２８．９％、８２．９％。显著高于两组照组,ＴＴＶ－ＤＮＡ阳性率２６．８％（２２／８２）也显著高于两对照组。ＨＢＶＣ感染率（８２．９％（）显著高于Ｔ     

拉米夫定治疗2年时乙肝病毒的YMDD变异情况

观察核苷类似物拉米夫定治疗慢性乙肝病人２年时ＹＭＤＤ变异情况及其与血清ＨＢＶＤＮＡ，ＡＬＴ水平等指标的关系。第一阶段（１－１２周）为随机、双盲、安慰剂对照研究，７２名ＨＢｓＡｇ．ＨＢｅＡｇ阳性至少６个月，ＨＢＶ－ＤＮＡ阳性的慢性乙肝患者分别口服拉米夫定１００ｍｇ／ｄ（ｎ＝５４）或安慰剂（ｎ＝１８）；第二阶段（１３－１０４周）所有患者均服用拉米夫定 １００ｇ／ｄ。５２周和 １０４周检查病毒的 ＹＭＤＤ变异．其总变异率分别为 １３．７％（８／５８）和 ３９．７％（２３／５８）。１０４周时变异组血清 ＨＢＶＤＮＡ，ＡＬＴ水平高于无变异组（３９４．９±７２７．９比 １６．３±５０．９，Ｐ＝０．００４８；６２．７±５７．９比２６ ４±２７．５，Ｐ＝０．００３），ＨＢＶＤＮＡ阴转率低于未变异组（１７．４％比４８．６％，Ｐ＜０．０５）；服用拉米夫定的慢性乙肝患者的ＹＭＤＤ发生率与服药时间长短有关，血清ＨＢＶＤＮＡ及ＡＬＴ水平与ＹＭＤＤ相关。     

534例乙型肝炎病毒携带者随访结果分析

目的 观察乙型肝炎病毒(HBV)携带者转归。方法 对HBV携带者的血清乙肝病毒标志物、肝脏功能和临床情况进行定期随访。结果 HBeAg阳性携带者中,HBsAg自然阴转率17.2％,年阴转率2.53％,高于抗HBe阳性组的6.4％和0.91％(P<0.05);HBeAg自然阴转率、年转阴率分别为26.6％、3.9％。随访期间,有27.3％HBeAg阳性者、19.4％抗-HBe阳性者发展为不同类型的肝炎(P<0.O5)。结论 HBeAg阳性HBV携带者中,HBsAg和HBeAg均有自然转阴倾向,在长期携带过程中部分患者可发生各种临床类型的肝炎,抗-HBe阳性携带者临床类型较重,少数携带者可发展为肝硬化或肝癌。     

Serological and tissue markers of HBV infection in chronic active hepatitis patients and in healthy carriers of HBsAg

Summary We studied serological and tissue markers of Hepatitis B virus (HBV) infection in seven healthy carriers of HBsAg and in 58 patients with chronic active hepatitis (CAH), of whom 20 were HBsAg positive and 38 HBsAg negative. Surface antigen was found as the only marker of HBV infection in the liver tissue of all healthy carriers and HBsAg positive in 40% of the CAH patients. Core antigen was detected only in CAH patients: 7/20 HBsAg positive (in two alone and in five together with HBsAg) and 5/38 HBsAg negative (four with circulating anti-HBs and anti-HBc and one with only anti-HBc). All the healthy carriers of the surface antigen presented HBsAg in the liver as the only marker of HBV. Furthermore, all healthy carriers were found to be anti-HBe positive, whereas in the 16 HBsAg positive CAH patients examined for the e system, HBeAg and anti-HBe were found with the same frequency (43.7%). Of the 33 HBsAg negative CAH patients examined, anti-HBe was present in four who also had circulating anti-HBc and anti-HBs. In HBsAg positive CAH patients core antigen was found in the liver tissue of 4/7 HBeAg positive cases and in 2/7 anti-HBe positive, while surface antigen was detected in 3/7 HBeAg positive, 5/7 anti-HBe positive and in the two HBeAg/anti-HBe negative individuals. In HBsAg negative CAH patients, surface antigen was never found in the liver tissue; core antigen was detected, however, in five who had circulating anti-HBc (one in the presence and four in the absence of anti-HBe). In conclusion, from these data it would appear that the various serological patterns of HBV infection, particularly as concerns the presence of antibodies and presence or absence of HBsAg, are not invariably able to predict whether or not HBV antigens are present in liver tissue or, in other words, if active replication does occur.

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Serologische und Gewebe-Marker für die HBV-Infektion bei Patienten mit chronisch aktiver Hepatitis und gesunden Trägern von HBsAg

Zusammenfassung Wir haben serologische und Gewebe-Marker für die Hepatitis-B-Virus (HBV) Infektion bei sieben gesunden Trägern von HBsAg und 58 Patienten mit chronisch aktiver Hepatitis (CAH) geprüft, von denen 20 HBsAg positiv und 38 HBsAg negativ waren. Es zeigte sich, daß das Oberflächenantigen als einziger Marker der HBV-Infektion im Lebergewebe aller gesunden Träger positiv war und bei 40% der CAH-Patienten nachgewiesen werden konnte. Das Core Antigen wurde nur bei CAH-Patienten entdeckt: bei 7/20 HBsAg positiven Fällen (davon zweimal allein und fünfmal zusammen mit HBsAg) und bei 5/38 HBsAg negativen Kranken (viermal zusammen mit zirkulierendem anti-HBs und anti-HBc und einmal nur mit anti-HBc). Alle gesunden Oberflächenantigen-Träger wiesen in der Leber ausschließlich HBsAg als HBV-Marker auf. Es zeigte sich außerdem, daß alle gesunden Carrier anti-HBe positiv waren; dagegen konnten bei den 16 HBsAg positiven CAH-Patienten, die bezüglich des e Systems überprüft wurden, HBeAg und anti-HBe gleich häufig nachgewiesen werden (43,7%). Anti-HBe fand sich bei vier der 33 HBsAg negativen Patienten mit chronisch aktiver Hepatitis, sie wiesen gleichzeitig zirkulierendes anti-HBc und anti-HBs auf. Im Lebergewebe der HBsAg positiven CAH-Patienten wurde das Core Antigen bei 4/7 HBeAg positiven und bei 2/7 anti-HBe positiven Fällen gefunden; das Oberflächenantigen ließ sich bei 3/7 HBeAg positiven, bei 5/7 anti-HBe positiven und bei zwei HBeAg/anti-HBe negativen Kranken nachweisen. Bei HBsAg negativen Patienten mit chronisch aktiver Hepatitis wurde das Oberflächenantigen niemals im Lebergewebe gefunden. Hingegen entdeckten wir Core Antigen bei fünf Fällen, die zirkulierendes anti-HBc aufwiesen (in einem Fall gleichzeitig mit und viermal ohne den Nachweis von anti-HBe). Aus diesen Befunden könnte man schließen, daß die verschiedenen serologischen Muster der HBV-Infektion, insbesondere die Anwesenheit von Antikörpern und Vorhandensein oder Fehlen von HBsAg, nicht ausnahmslos geeignet sind, eine Voraussage zu treffen, ob sich HBV-Antigene im Lebergewebe befinden, das heißt, ob eine aktive Virusreplikation stattfindet.

     

Hepatitis B virus DNA in chronic HBsAg carriers: correlation with HBeAg/anti-HBe status, anti-HD and liver histology.

Hepatitis B virus DNA was determined in the sera of 198 chronic hepatitis B surface antigen (HBsAg) carriers by the spot hybridization technique. The results were correlated with hepatitis Be antigen (HBeAg) and antibody (anti-HBe), delta antibody (anti-HD) and liver histology. All subjects had a liver biopsy. The prevalence of HBV DNA was 63% in HBeAg-positive subjects and 8.8% in anti-HBe positives. HBV DNA was not found more frequently in chronic HBsAg carriers who had histological evidence of liver disease than in carriers without such evidence. Anti-HD was detected in 48.5% of subjects, with an increasing trend (p less than 0.001) according to the severity of liver disease. Among patients with more severe liver disease (CAH and cirrhosis), HBV DNA and HBeAg were detected less frequently in anti-HD-positive than in anti-HD-negative subjects (7% vs. 42.3%, p less than 0.001 and 7% vs. 34.4%, p less than 0.005, respectively). These findings indicate that HDV infection jointly affects both HBeAg status and HBV DNA.     

Allogeneic bone marrow transplantation from HBsAg+ donors: a multicenter study from the Gruppo Italiano Trapianto di Midollo Osseo (GITMO)

Hepatitis B virus (HBV)-infected individuals are occasionally used as donors for bone marrow transplantation (BMT). We studied the rate of HBV infection and the clinical expression of the associated liver disease in patients receiving marrow from HBsAg+ donors. We performed a retrospective survey in 14 BMT units in Italy in which all BMTs performed between 1984 and 1994 were reviewed and those involving HBsAg+ donors were identified. Donors and recipients were analyzed for HBV markers and liver disease. A total of 24 of 2,586 patients (0.9%) had received an HBsAg+ marrow. HBsAg became detectable in 22% of pre- BMT HBsAg- patients, but only 5.5% became chronic HBsAg carriers. Antigenemia developed more frequently in anti-HBs- compared with anti- HBs+ patients independently of passive prophylaxis with hyperimmune anti-HBs Ig, although the difference was not significant. Severe liver failure with death occurred in 21% of patients, which was a value greater than that generally observed after BMT in our units (3.7%). Patients with an anti-HBe+ donor had higher frequency of liver failure (28% v 0%) and alanine aminotransferase peaks as compared with those of patients with an HBeAg+ donor. Liver failure was not observed in anti- HBs+ recipients. The use of HBsAg+ donors, particularly if anti-HBe+, increases the risk of severe liver disease in BMT recipients. Anti-HBs positivity may prevent severe liver damage.     

45例HBsAg阴性乙型肝炎的临床分析

目的研究HBsAg阴性乙型肝炎的临床特点、血清HBV标志物、HBVDNA水平、肝脏病理变化及肝组织HBsAg和HBcAg的表达情况。方法回顾性分析45例HBsAg阴性乙型肝炎患者的临床资料,所有患者均进行了肝组织活检和病理免疫组化检测。结果在45例患者中,23例(51.1%)感染途径不明,25例(55.5%)无任何自觉症状,肝功能异常和病理损害均为轻度,但8例(17.8%)肝脏病理诊断为早期肝硬化;45例患者肝组织HBsAg和(或)HB-cAg均有至少一项阳性;43例(95.6%)患者血清抗-HBs、抗-HBe和抗-HBc出现单独或联合阳性,而仅4例(8.9%)血清HBVDNA阳性。结论HBsAg阴性乙型肝炎起病隐匿,临床症状、肝功能变化和病理损害相对较轻,但其危害不容忽视,明确诊断需检测血清HBVDNA和(或)肝组织HBsAg和HBcAg。     

Hepatitis B virus markers in peripheral blood mononuclear cells]

Recent studies have shown tropism of the hepatitis B virus (HBV) by peripheral blood mononuclear cells (PBMC). The consequences of this phenomenon and their clinical use are not yet clear, however. Seventy-nine patients were studied between March 1989 and October 1990. Sixty-nine patients had chronic liver disease with histological evaluations, and 10 were vaccinated for HBV. The following markers were determined: serum: HBsAg, HBeAg, anti-HBe, antitotal-HBc, anti-HBs, anti-HCV, HBV-DNA; lysated PMBC cells: HBsAg, HBeAg. Hepatic tissue: HBsAg, HBcAg. Four groups were formed according to serology. Group I--positive HBsAg patients (n = 25) HBsAg was observed in the lysated of PBMC in 19 (76%) of the patients. HBeAg in PBMC was detected in 8 (32%), all of them showed evidence of viral replication (presence of HBcAg and/or HBV-DNA in the serum HBcAg in the tissue). Group II--antitotal HBc/anti-HBs positive (n = 14), HBsAg in PBMC was found in 5 (36%) and HBeAg in 1 (7.0%). In this patient replication markers in the serum and in the tissue (HBV-DNA, HBcAg) was also present. Three patients out of 9 anti-HBs positive had HBsAg in PBMC. Group III--seronegative patients for HBV. HBsAg was present in PBMC in 2 (6.6%) of the patients, but was absent in all of them. There was concomitant presence of HBsAg in MN and the hepatic tissue in 1 patient. Replication markers were not observed in the group. Group IV--10 asymptomatic individuals vaccinated for HBV. Except anti-HBs in serum, no other HBV marker could be identified in serum or in PBMC.(ABSTRACT TRUNCATED AT 250 WORDS)     

Why most patients with hepatitis delta virus infection are seronegative for hepatitis B e antigen. A prospective controlled study

A prospective age/sex matched control and follow-up study was conducted to explore the reason(s) for the association of hepatitis delta virus (HDV) infection with hepatitis B e antigen (HBeAg) negative hepatitis B surface antigen (HBsAg) carrier state. Over a 3-year period, a total of 110 patients (104 males and six females) with acute HDV superinfection were documented in our unit. Twenty-four (21.8%) of them were HBeAg positive at the onset of acute HDV infection. In the control study, 110 age- and sex-matched asymptomatic HBsAg carriers with normal serum transaminase, as well as 110 age- and sex-matched patients with chronic type B hepatitis were randomly selected from the computer files of the same 3-year period of entry. The prevalence of serum HBeAg in patients with HDV infection was similar to that of asymptomatic HBsAg carriers (20.9%), but significantly lower than that of the patients with chronic type B hepatitis (72.7%). In a follow-up study of 16 HBeAg-positive patients with HDV infection, eight (50%) cleared HBeAg and three (18.8%) seroconverted to anti-HBe within 3 months. The HBeAg clearance rate was significantly higher than for chronic type B hepatitis and asymptomatic carriers (p less than 0.01). The results suggest that the low prevalence of serum HBeAg in HDV infection simply reflects the HBeAg/anti-HBe status of the asymptomatic HBsAg carriers in the population under study. Also in some patients HDV superinfection may itself suppress HBV and thus clear HBeAg.     

Radioimmunoassay in the detection of the hepatitis B e antigen/antibody system in asymptomatic carriers of hepatitis B surface antigen

Summary A radioimmunoassay for hepatitis e antigen (HBeAg) and antibody to e (anti-HBe) was developed and sera of 71 asymptomatic chronic carriers of hepatitis B surface antigen (HBsAg), in 44 of whom liver biopsy was obtained, were tested. In addition, testing for Dane particle associated DNA polymerase activity was performed in all sera. HBeAg was detected in 14 subjects (19.7%) and anti-HBe in 46 (64.8%). The highest proportion of HBeAg positivity (40%) was found among carriers with histological evidence of chronic hepatitis, whereas anti-HBe was present in 80% of carriers with normal liver histology, in 58% of carriers with nonspecific reactive hepatitis and in 60% of carriers with chronic liver lesions. DNA polymerase activity was present in 92.8% of sera positive for HBeAg, in 13% of sera positive for anti-HBe, and in 9% of sera negative for both markers. Our results demonstrate that not all HBsAg carriers reactive to HBeAg show evidence of chronic hepatitis nor, conversely, that anti-HBe is invariably associated with the healthy carrier state of HBsAg. Finally, circulating Dane particles, as revealed by the presence of serum specific DNA polymerase activity, may also be present in anti-HBe positive sera other than those of some HBsAg carriers lacking both HBeAg and anti-HBe.

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Ein Radioimmunassay zum Nachweis des Hepatitis-B-e-Antigen/Antikörper-Systems bei asymptomatischen Trägern von Hepatitis-B-Oberflächen-AntigenKorrelation mit der Dane-Partikel-assoziierten DNS-Polymerase-Aktivität

Zusammenfassung Ein Radioimmunoassay für das Hepatitis e Antigen (HBeAg) wurde entwickelt und Seren von 71 asymptomatischen Trägern von Hepatitis-B-Oberflächen-Antigen (HBsAg) wurden untersucht; bei 44 von ihnen wurden Leberbiopsien entnommen. Zusätzlich wurden bei allen Seren der Test auf Dane-Partikel-assoziierte DNS-Polymerase-Aktivität durchgeführt. HBeAg wurde bei 14 Patienten (19,7%) entdeckt, anti-HBe bei 46 (64,8%). Der größte Anteil HBeAg-positiver Seren (40%) fand sich bei Trägern mit den histologischen Zeichen der chronischen Hepatitis, während anti-HBe bei 80% der Träger mit normaler Leberhistologie vorhanden war, bei 58% der Träger mit unspezifischer reaktiver Hepatitis und bei 60% der Träger mit chronischem Leberschaden. Die DNS-Polymerase-Aktivität war bei 92,8% der HBeAg-positiven Seren vorhanden, bei 13% der anti-HBe-positiven und bei 9% der bezüglich beider Marker negativen Seren. Unsere Ergebnisse zeigen, daß nicht alle HBsAg-Träger, die HBeAg-reaktiv sind, Zeichen einer chronischen Hepatitis aufweisen und daß umgekehrt auch nicht anti-HBe ausnahmslos mit dem gesunden Träger-Status von HBsAg assoziiert ist. Schließlich können, wie durch die Anwesenheit von spezifischer Serum-DNS-Polymerase-Aktivität gezeigt wurde, zirkulierende Dane-Partikel auch in anderen anti-HBe-positiven Seren vorhanden sein als in denjenigen einiger HBsAg-Carrier, bei denen sowohl HBeAg als auch anti-HBe fehlen.

     

Natural history of hepatitis B virus infection in renal transplant recipients--a fifteen-year follow-up

Hepatitis B virus (HBV) markers were measured in 83 immunosuppressed renal transplant patients who were followed for periods of 2 to 15 years. Sixty-nine patients were negative for HBsAg before transplantation, of whom 14 were positive for anti-HBs. The remaining 14 patients were HBsAg positive prior to transplantation. Eighteen patients were identified as being HBsAg positive during the follow-up period. Four patients acquired primary type B hepatitis; one died of submassive hepatic necrosis and the remaining three became chronic HBV carriers with positive HBeAg, DNA polymerase, and HBV DNA. Several patterns of HBV expression were observed in HBsAg-positive patients. Four patients were HBsAg, HBeAg, DNA polymerase, and HBV DNA positive prior to transplantation, and these markers persisted. Reactivation of HBV replication occurred in eight patients, seven of whom were HBsAg positive and HBeAg and anti-HBe negative originally; one patient was anti-HBc positive. A single patient was HBsAg and anti-HBe positive and remained so for 22 months. The remaining previously HBsAg-positive patient is currently HBsAg negative. These serological data suggest that reactivation of HBV replication or continued hepatitis B virion replication occurs as commonly or more commonly than de novo infection in renal transplant recipients. The presence of HBeAg in serum predisposes to long-term Dane particle expression in immunosuppressed patients, whereas anti-HBe-positive carriers may not always be susceptible to reactivation of HBV replication despite immunosuppression.     

Reverse seroconversion of hepatitis B virus infectious status after allogeneic bone marrow transplantation from a carrier donor.

A 35-year-old man with acute promyelocytic leukemia received an allogeneic bone marrow transplant (BMT) in second complete remission. The donor was his 18-year-old brother, a chronic hepatitis B virus (HBV) carrier with detectable serum hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg) and hepatitis B virus DNA (HBV DNA). Before BMT, the recipient was immune to HBV, with serum antibody to HBsAg (anti-HBs), antibody to HBeAg (anti-HBe) and normal liver function. Examination of the recipient serum drawn 2 months after BMT revealed reverse seroconversion from anti-HBs/anti-HBe to HBsAg/HBeAg, which remained positive thereafter. Upon reducing cyclosporin 6 months after BMT, acute hepatitis occurred with HBV DNA in serum as evidence of active HBV replication; the patient then developed chronic hepatitis which progressed to cirrhosis and hepatic decompensation within 8 months. Transfusion of HBV DNA/HBeAg-positive bone marrow is thus harmful even when the recipient has anti-HBs prior to BMT.