Trepo C G, Robert D, Motin J, Trepo D, Sepetjian M, Prince A M
Gut. 1976 Jan;17(1):10-13. doi: 10.1136/gut.17.1.10.
Hepatitis B surface antigen (HBSAg) and antibodies to both the surface and core antigens of the hepatitis B virus (anti-HBS and anti-HBC) have been studied in 64 consecutive cases of fulminant hepatitis. HBSAg was detected by counterelectrophoresis in 23 (35-9%) but by radioimmunoassay in 38 (59-3%). Anti-HBS was detected by passive haemagglutination in 26 (40-6%), coexisting HBSAg and anti-HBS were found in 16 cases (25%). Using an indirect immunofluorescence technique, anti-HBC was found in all of the cases in whom either HBSAg or anti-HBS was present. The highest survival rate was observed in patients with no evidence of HBV infection (31-3%) and was lowest in those who had both HBSAg and anti-HBS detected simultaneously (6-2%). The prognosis of those who exhibited anti-HBS only was no better than those with HBSAg alone. In a further case, transient interruption of the asymptomatic chronic HBSAg carrier state with seroconversion to anti-HBS was associated with the development of a fulminant hepatitis syndrome. The results suggest that an unusually strong and rapid immune clearance of HBSAg may be involved in the pathogenesis of fulminant hepatitis.
对64例暴发性肝炎连续病例研究了乙肝表面抗原（HBSAg）以及乙肝病毒表面和核心抗原的抗体（抗-HBS和抗-HBC）。通过对流电泳在23例（35.9%）中检测到HBSAg，但通过放射免疫测定在38例（59.3%）中检测到。通过被动血凝试验在26例（40.6%）中检测到抗-HBS，在16例（25%）中发现HBSAg和抗-HBS共存。使用间接免疫荧光技术，在所有存在HBSAg或抗-HBS的病例中均发现抗-HBC。在无乙肝病毒感染证据的患者中观察到最高生存率（31.3%），而在同时检测到HBSAg和抗-HBS的患者中最低（6.2%）。仅表现出抗-HBS的患者的预后并不比仅患有HBSAg的患者好。在另一例中，无症状慢性HBSAg携带者状态短暂中断并血清转化为抗-HBS与暴发性肝炎综合征的发生有关。结果表明，HBSAg异常强烈和快速的免疫清除可能参与暴发性肝炎的发病机制。
