HBV感染者HBsAg和HBsAb同时阳性的血清学异常模式的研究

目的：分析HBsAg和HBsAb同时阳性的慢性HBV感染者的血清学模式，分析病毒Pre-S/S区基因序列变异或缺失情况对其进行基因分型，并探讨其临床意义。方法采用酶联免疫分析法筛选出HBsAg和HBsAb同时阳性的慢性HBV感染者共100例，采用化学发光微粒子免疫分析确认，用实时荧光定量聚合酶链反应（PCR）检测其HBV DNA含量，其中HBV DNA阳性者60例， HBV DNA阴性者40例。将60例HBsAg和HBsAb同时阳性的慢性HBV感染者作为实验组，并选取60例HBsAg（＋）HBsAb（-）的慢性乙型肝炎患者作为对照组。采用PCR法体外扩增两组患者HBV Pre-S/S基因序列并测序分析，根据测序结果对患者的基因型进行分型，比较两组Pre-S/S基因变异情况，结合临床资料探讨其临床意义。结果实验组患者中B基因型19例、C基因型41例，对照组患者中B基因型18例、C基因型42例。实验组B基因型患者的年龄[（50.0＆#177;16.3）岁]大于C基因型[（34.0＆#177;13.4）岁]，差异具有统计学意义（F=31.6，P=0.0432）。实验组B基因型和C基因型的S区氨基酸突变率分别为10.8%和21.6%，差异具有统计学意义（F=24.31，P=0.046）。同样为C基因型的两组患者，实验组S区氨基酸突变为41.6%，显著大于对照组的氨基酸突变率（3.2%），差异具有统计学意义（F=85.68，P=0.006）。结论 HBsAg（＋）且HBsAb（＋）并伴有HBeAg（＋）的患者血清中HBV DNA的阳性率显著增高。HBsAg和HBsAb同时阳性的现象与pre-S/S区基因突变具有显著关性，且C基因型的突变率高于B基因型患者的突变率。

Study on the serology anomaly pattern of HBsAg and HBsAb positive at the same time of patients with HBV infection

Objective To analyze the serological patterns of both HBsAg and HBsAb positive patients with chronic HBV infection, and to investigate the virus gene sequence variation or missing pre-S/S ifeld for genotyping and in order to explore its clinical signiifcance. Methods Total of 100 cases with chronic HBV infection whom with both HBsAg and HBsAb positive at the same time were screened by enzyme linked immunoabsorbent assay analysis method and the results were reconfirmed by chemiluminessence micro-particle immunoassay. HBV DNA content were detected by real-time lfuorescent quantitative PCR. There were 60 cases with HBV DNA positive and 40 cases with HBV DNA negative. Among the 100 cases, 60 cases with both HBsAg and HBsAb positive as experimental group, and 60 cases with chronic hepatitis B whom with HBsAg （＋） and HBsAb （-） as control group. HBV pre-S/S gene sequences and sequencing analysis of the two groups were detected by polymerase chain reaction （PCR） method with in vitro ampliifcation. Compared the two groups of pre-S/S gene variants according to the sequencing results of genetic classiifcation, thus combined with clinical data to explore its clinical signiifcance. Results Among the experimental group, genotypes B were 19 cases and genotype C were 41 cases;among the control group, of genotype B were＆amp;nbsp;18 cases and genotype C were 42 cases. Patients with genotype B were older than cases with genotype C in experimental group （50.0 ＆#177; 16.3 vs 34.0 ＆#177; 13.4, F=31.6, P=0.0432）. The amino acid mutation rate in S area of cased with genotype B and C in experimental group were 10.4%and 21.6%, respectively （F=24.31, P=0.046）. The amino acid mutation rate in S area of cases of genotype C in experimental group was 41.6%, which significantly higher than those in control group （3.2%）, with significant difference （F=85.68,P=0.006）. Conclusions The serum HBV DNA positive rate in patients with HBsAg （＋） and HBsAb （＋） accompanied by HBeAg （＋） increased signiifcantly. The phenomenon of both HBsAg and HBsAb positive genetic mutations and pre-S/S area has signiifcant relevance, while the mutation rate of genotype C higher than that of genotype B.