Kiyosawa K, Sodeyama T, Franca S T, Yoda H, Ohike Y, Imai H, Imai Y, Furuta S
Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
J Med Virol. 1988 Mar;24(3):241-50. doi: 10.1002/jmv.1890240302.
Serial assays for immunoglobulin M antibody to hepatitis B core antigen (IgM anti-HBc) were performed in 51 patients with antibody to hepatitis B e antigen (anti-HBe) in their sera. IgM anti-HBc was detected periodically and persistently in 8 (53%) of 15 patients with chronic hepatitis whose serum glutamic pyruvic transaminase (GPT) levels were elevated and was not detected in 36 patients with normal serum GPT levels. Antibody to delta agent was not detected in any of the patients. Of the eight patients positive for IgM anti-HBc, four had a high titer of IgM anti-HBc and either developed liver cirrhosis (three cases) or died due to massive hepatic necrosis (one case); the other four showed a low level of IgM anti-HBc and either recovered (two cases) or developed chronic persistent hepatitis (two cases). Of seven patients negative for IgM anti-Hbc, two had a fatty liver, and five, who had a history of blood transfusion, had chronic hepatitis. Thus, even though anti-HBe may be present, if the titer of IgM anti-HBc is high, the histological activity can be expected to increase, and the prognosis will be poor. If the titer of IgM anti-HBc is low, the histological activity may be expected to decrease, and the prognosis may be good. In patients with abnormally high serum GPT but without IgM anti-HBc, another type of hepatitis or a secondary form of liver disease should be considered.
对51例血清中存在乙型肝炎e抗原抗体（抗-HBe）的患者进行了乙型肝炎核心抗原免疫球蛋白M抗体（IgM抗-HBc）的系列检测。在15例血清谷丙转氨酶（GPT）水平升高的慢性肝炎患者中，有8例（53%）定期且持续检测到IgM抗-HBc，而在36例血清GPT水平正常的患者中未检测到。所有患者均未检测到丁型肝炎病毒抗体。在8例IgM抗-HBc阳性的患者中，4例IgM抗-HBc滴度高，其中3例发展为肝硬化，1例因大块肝坏死死亡；另外4例IgM抗-HBc水平低，其中2例康复，2例发展为慢性持续性肝炎。在7例IgM抗-HBc阴性的患者中，2例有脂肪肝，5例有输血史，患有慢性肝炎。因此，即使存在抗-HBe，但如果IgM抗-HBc滴度高，则组织学活性可能增加，预后不良。如果IgM抗-HBc滴度低，则组织学活性可能降低，预后可能良好。血清GPT异常升高但无IgM抗-HBc的患者，应考虑为其他类型的肝炎或继发性肝病。
