2372例慢性无症状HBV携带者血清HBVM模式的转变规律分析

目的 研究乙型肝炎病毒（HBV）感染血清标记物（HBVM）模式的转变规律。方法 对2372例无症状HBV携带进行了2－11年（平均4．14年）血清HBVM模式的随访，随访期内不用任何抗病毒药。结果 最初HBVM模式为HBsAg、HBeAg、抗－HBc均阳性（简称“大三阳”）和HBsAg、抗－HBe、抗－HBc均阳性（简称“小三阳”），随访终点时分别有62．1％和67．4％保持原模式不变；而最初模式为“大二阳”（HBsAg、HBeAg均阳性）、“小二阳”（HBsAg、抗－HBc均阳性）、“单抗－HBc阳性”（单项抗－HBc阳性，其余4项均阴性）、“单HBsAg阳性”（HBsAg阳性，其余4项均阴性），随访终点时保持原模式不变的比率较低（分别为39．3％、32．4％、8．7％、5．6％）。小三阳或小二阳随访期间仍可出现病毒复制（HBsAg阳转）。HBsAg、HBeAg平均每年阴转率分别为1．16％、7．1％，抗－HBs、抗－HBe平均每年阳转率分别为0．63％、4．8％；HBeAg阴转率明显高于HBsAg阴转率（P＜0．01）；抗－HBe阳转率明显高于抗－HBs转阳率（P＜0．01）。在随访期出现ALT升高468例（19．7％），其中160例（6．7％）表现为急性肝炎发作。结论 慢性无症状HBV携带长期随访中不同的血清HBVM模式可相互转换，并可出现肝炎活动。HBsAg自然阴转率和抗－HBs的自然阳转率均较低。

Analysis of Conversion of HBV Serum Markers Patterns in 2 372 Chronic Asymtomatic Cases with HBV Infection

Objective To analyze the conversion of hepatitis B virus serum markers (HBVM, including HBsAg, anti-HBs, HBeAg, anti-HBe and anti-HBc) in chronic asymtomatic cases with hepatitis B virus (HBV)infection. Methods 2 372 chronic asymtomatic cases with HBV infection were selected and followed up from 2 to 11 years without receiving antiviral treatment. Results HBVM patterns did not change in 62.1% cases with HBsAg(+), HBeAg (+) and anti-HBc(+), 67.4% cases with HBsAg(+), anti-HBe(+) and anti-HBc(+), 39.3% cases with HBsAg(+) and HBeAg (+), 32.4% cases with HBsAg (+) and anti-HBc(+), 8.7% cases with only anti-HBc(+) and 5.6% cases with only HBsAg(+). Viral replication (presented as positive HBeAg) may occur in cases with HBsAg (+), anti-HBe(+) and anti-HBc(+) and cases with HBsAg (+) and anti-HBc(+). Annual negative conversion rate of HBsAg (1.16%) was significantly lower than that of HBeAg(7.1%); annual positive conversion rate of anti-HBs(0.63%) was lower than that of anti-HBe(4.8%). A total of 468 cases were found with increased Serum alanine aminotransferase (ALT), 160 of whom showed episode of acute hepatitis. Conclusion Mutually conversion of various HBVM patterns may occur, but conversion rates are different. Natural serum negative conversion rate of HBsAg and positive conversion rate of anti-HBs were very low.