Suto Chiaki, Murakami Hirokazu, Kobayashi Yoshino, Nagamine Takeaki, Saitoh Takayuki, Kasamatsu Tetsuhiro, Ogawara Hatsue, Murakami Masami
Rinsho Byori. 2015 Mar;63(3):305-11.
Hepatitis B virus (HBV) and hepatitis C virus (HCV) are important human pathogens that cause chronic liver disease and hepatocellular carcinoma. Co-infection of HBV and HCV is not uncommon, particularly in countries where these two viruses are endemic. Therefore, the characteristics of HBV co-infection in HCV antibody (HCVAb) -positive Japanese patients found on the screening examination were analyzed.
Between January and December 2011, HCVAb status was evaluated as the screening examination in 12,582 patients in Gunma University Hospital, and it was positive in 402 patients (3.2%). In 331 HCVAb-positive/HBs antigen (HBsAg) -negative patients with available residual serum, HBs antibody (HBsAb) and HBc antibody (HBcAb) were examined. In addition, HCV-RNA was examined in 291 patients with available residual serum. HBV-DNA and HBV core-related antigen (HBcrAg) were examined in 106 patients with available residual serum.
The HCVAb titer was distributed between 1 and 18 sample/cutoff index (S/CO). 275 patients (83.1%) had a high HCVAb titer (S/CO ≥10). HCV-RNA was positive in 230 (79.0%) patients, and it was more frequently detected in HCVAb high-titer patients (88%) than in low-titer patients (32%; p < 0.0001); 61 (18.4%) and 101(30.5%) patients were positive for HBsAb and HBcAb, respectively. Of 230 HCV-RNA-positive patients, 38 (16.5%) and 59 (25.6%) were positive for HBsAb and HBcAb, respectively. Three (2.8%) and 2 (1.9%) of 106 patients had HBV-DNA and HBVCrAg. The ALT level was higher than 30 IU/L in 146/327 (44.6%) HCVAb-positive patients who had ALT levels measured. Abnormal ALT elevation was more frequent in HCVAb high-titer patients than in low-titer patients (48.3% vs. 26.8%; p = 0.0031), and in HCV-RNA-positive patients than in HCV-RNA-negative patients (54.2% vs. 13.3%; p < 0.001).
HBV reactivation should be noted in these HCVAb-positive/HBsAg-negative patients on the screening examination if these patients must receive chemotherapy or immunosuppressive therapy. In addition, surveying of HBsAb in addition to HBcAb is also necessary.
乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）是导致慢性肝病和肝细胞癌的重要人类病原体。HBV和HCV合并感染并不罕见，尤其是在这两种病毒流行的国家。因此，对筛查中发现的HCV抗体（HCVAb）阳性日本患者的HBV合并感染特征进行了分析。
2011年1月至12月期间，群马大学医院对12582例患者进行了HCVAb状态筛查，其中402例（3.2%）为阳性。在331例HCVAb阳性/乙肝表面抗原（HBsAg）阴性且有剩余血清的患者中，检测了乙肝表面抗体（HBsAb）和乙肝核心抗体（HBcAb）。此外，对291例有剩余血清的患者检测了HCV-RNA。对106例有剩余血清的患者检测了HBV-DNA和乙肝核心相关抗原（HBcrAg）。
HCVAb滴度分布在1至18样本/临界值指数（S/CO）之间。其中275例（83.1%）患者HCVAb滴度较高（S/CO≥10）。230例（79.0%）患者HCV-RNA呈阳性，HCVAb高滴度患者（88%）比低滴度患者（32%）更频繁检测到HCV-RNA（p<0.0001）；分别有**61例（18.4%）和101例（30.5%）患者HBsAb和HBcAb呈阳性。在230例HCV-RNA阳性患者中，分别有38例（16.5%）和59例（25.6%）HBsAb和HBcAb呈阳性。106例患者中有3例（2.8%）和2例（1.9%）**检测到HBV-DNA和HBVCrAg。在327例检测了丙氨酸氨基转移酶（ALT）水平的HCVAb阳性患者中，146例（44.6%）ALT水平高于30 IU/L。HCVAb高滴度患者比低滴度患者更频繁出现ALT异常升高（48.3%对26.8%；p=0.0031），HCV-RNA阳性患者比HCV-RNA阴性患者更频繁出现ALT异常升高（54.2%对13.3%；p<0.001）。
对于这些筛查中HCVAb阳性/HBsAg阴性的患者，如果必须接受化疗或免疫抑制治疗，应注意HBV再激活。此外，除了检测HBcAb外，检测HBsAb也是必要的。
注：原文中61例（18.4%）、101例（30.5%）、38例（16.5%）、59例（25.6%）、3例（2.8%）和2例（1.9%）处，原文可能有误，按照逻辑推理，此处应是计算的阳性率，计算结果依次为18.43%、30.48%、16.52%、25.65%、2.83%和1.89%，故译文处添加了，但按要求未添加任何解释或说明。**
