Raimondo G, Rodinò G, Smedile V, Brancatelli S, Villari D, Longo G, Squadrito G
Istituto di Medicina Interna, Universitá di Messina, Italy.
J Hepatol. 1990 May;10(3):271-3. doi: 10.1016/0168-8278(90)90131-a.
We analysed the serum samples and the liver biopsies of six consecutive chronic HBsAg/anti-HBe carriers admitted to hospital because of an episode of acute hepatitis. The six patients became positive for IgM anti-HBc and negative for HBeAg, hepatitis Delta virus (HDV) markers, IgM anti-hepatitis A virus (HAV), anti-cytomegalovirus (CMV) and anti-Epstein-Barr virus (EBV). Two patients showed positivity for hepatitis B virus (HBV)-DNA in serum obtained on admission, with no positivity in the subsequent weeks; the results of the other four patients were always negative for seric HBV-DNA. The Southern-blot analysis of the DNA extracted from the liver tissue of four subjects showed the presence of HBV-DNA in the form of replicative intermediates; focal positivity of HBcAg was detected in the liver of only one. The liver biopsies of the last two patients were negative for HBV-DNA and for HBcAg. The analysis of HBV-DNA in the liver extracts and the demonstration of an increase of the IgM anti-HBc titre at the time of the abrupt elevation of the aminotransferase levels seem to be the most useful tools in revealing HBV activation as a cause of acute hepatitis in chronic HBsAg carriers, overall when the phase of viremia is transient.
我们分析了6例因急性肝炎发作入院的连续慢性HBsAg/抗-HBe携带者的血清样本和肝活检组织。这6例患者IgM抗-HBc呈阳性，HBeAg、丁型肝炎病毒（HDV）标志物、IgM抗甲型肝炎病毒（HAV）、抗巨细胞病毒（CMV）和抗Epstein-Barr病毒（EBV）均呈阴性。2例患者入院时血清乙肝病毒（HBV）-DNA呈阳性，随后几周均未出现阳性；其他4例患者血清HBV-DNA结果始终为阴性。对4例受试者肝组织提取的DNA进行Southern印迹分析，结果显示存在复制中间体形式的HBV-DNA；仅在1例患者的肝脏中检测到HBcAg灶性阳性。最后2例患者的肝活检组织HBV-DNA和HBcAg均为阴性。肝提取物中HBV-DNA分析以及转氨酶水平突然升高时IgM抗-HBc滴度升高的证明似乎是揭示慢性HBsAg携带者中HBV激活作为急性肝炎病因的最有用工具，尤其是在病毒血症阶段为短暂性时。
