乙肝患者血清抗原与抗体双阳性两对半模式与HBV-DNA和体液免疫检测结果分析

目的：探讨乙型肝炎病毒（HBV）感染者HBsAg阳性的血清学标志物少见模式与HBV-DNA和体液免疫的关系。方法：选择63例HBsAg阳性患者其血清中检出同一种抗原抗体同时存在（HBsAg与HBsAb同时阳性或 HBeAg与HBeAb同时阳性），以HBeAg是否阳性为标准分为2组：HBeAg阳性组（n=26）与HBeAg阴性组（n=37）。采用时间分辨免疫荧光分析法（TRFIA）定量测定乙型肝炎病毒血清标志物（HBV-M）；采用荧光定量聚合酶链反应（FQ-PCR）法检测HBV-DNA含量；采用Olympus AU6400全自动生化分析仪检测免疫球蛋白（IgG、IgA 、IgM）和补体（C3、C4）。结果：63例HBsAg阳性的血清学标志物少见模式表现为5种模式，以HBsAg（＋） HBsAb（＋）HBeAb（＋）HBcAb（＋）模式检出率最高，占52.38%（33/63）；各少见模式均不同程度地检出HBV-DNA；HBeAg阳性组HBV-DNA、IgG、IgM和C4与HBeAg阴性组比较差异有统计学意义（P〈0.05）；IgA和C3的差异均无统计学意义（P〈0.05）。结论：患者在慢性HBV感染过程中，血清出现抗原与抗体共存这一个特殊阶段，虽然有HBsAb的出现，但并不意味着HBV-DNA停止复制或传染性消失；不同血清学模式，其HBV复制和体液免疫水平是有差别的。

Hepatitis B patients serological antigen-antibody double positive two half and half mode and HBV-DNA and humoral immunity detection resalts analysis

Objective：Abstract To investigate the relationship between rare pattern with seropositive HBsAg markers and HBV-DNA, liver function and humoral immunity in hepatitis B patients.Methods：63 cases of HBsAg positive patients which the same kind of antigen-antibody were existed at the same time were chosen（HBsAg and HBsAb simultaneously positive or HBeAg and HBeAb simultaneously positive）, and divided into two groups by HBeAg： HBeAg -positive group （n=26 ） and HBeAg -negative group （n=37）.HBV-M were quantitatively detected by time-resolved fluoroimmunoassay（TRFIA）; HBV-DNA levels were quantitatively detected by fluorescence quantitative polymerase chain reaction （FQ-PCR）; liver function, immunoglobulin and complement were detected by automatic biochemical analyzer Olympus AU6400.Results：5 rare modes were found in 63 cases of HBsAg positive patients about the HBsAg positive serological markers. The detection rate about HBsAg （＋） HBsAb （＋） HBeAb （＋） HBcAb （＋） mode is the highest, accounting for 52.38% （ 33/ 63 ） ; HBV-DNA was detected in varying degrees in each rare pattern. The levels of HBV-DNA, AST abnormal rate and immunoglobulins IgG, IgM, complement C4 in HBeAg -positive group were significantly different from HBeAg -negative group （P 〈0.05）.Conclusions：In chronic HBV infection process, there is a coexistence of the antigens and antibodies in a special stage in the sera of patients. HBV-DNA does not stop copying or infectious appear with the appearance of HBsAb. The HBV replication level and humoral immunity level are different in different serological patterns.