Shiels M T, Taswell H F, Czaja A J, Nelson C, Swenke P
Gastroenterology. 1987 Oct;93(4):675-80. doi: 10.1016/0016-5085(87)90427-6.
Of 228 consecutive hepatitis B surface antigen (HBsAg)-positive patients who had simultaneous hepatitis B surface antibody (anti-HBs) determinations, HBsAg and anti-HBs were found concurrently in 73 (32%). Concurrence was found with greater frequency in patients with chronic active hepatitis than in those with acute hepatitis (36/57 vs 13/38, p less than 0.02). Patients with chronic active hepatitis had concurrent markers more commonly than those with chronic persistent hepatitis or asymptomatic carrier state (36/57 vs. 24/133, p less than 0.001). No major risk factors were identified. Hepatitis B e antigen was detected more frequently in patients with concurrence (68% vs. 42%, p less than 0.01). Subtyping was possible in 30 patients with chronic infection, including 18 with chronic active hepatitis, 7 with chronic persistent hepatitis, and 5 with a carrier state. In 25 patients, HBsAg subtype ad was found with antibody to subdeterminant y and in four instances, HBsAg subtype ay was found with antibody to subdeterminant d. Only 1 patient had homotypic HBsAg and anti-HBs. Of 38 patients who had successive determinations, concurrence was constant in 29. In 9 others, anti-HBs was detected intermittently and the heterotypia of the recurrent antibody remained constant. Antibody to hepatitis delta-virus was not detected. We conclude that concurrent HBsAg and anti-HBs are found frequently in acute and chronic hepatitis B. The markers are commonly heterotypic in chronic disease. The presence of heterotypic markers is not associated with specific risk factors or delta-infection. Concurrence is associated with evidence of viral replication and features of active inflammation.
在228例连续检测乙肝表面抗原（HBsAg）阳性且同时检测乙肝表面抗体（抗-HBs）的患者中，73例（32%）同时检测到HBsAg和抗-HBs。慢性活动性肝炎患者中同时出现这两种标志物的频率高于急性肝炎患者（36/57比13/38，p<0.02）。慢性活动性肝炎患者出现同时存在的标志物的情况比慢性持续性肝炎或无症状携带者状态的患者更常见（36/57比24/133，p<0.001）。未发现主要危险因素。同时出现两种标志物的患者中乙肝e抗原检测更频繁（68%比42%，p<0.01）。对30例慢性感染患者进行了亚型分析，其中18例为慢性活动性肝炎，7例为慢性持续性肝炎，5例为携带者状态。25例患者中，发现HBsAg ad亚型与亚决定簇y抗体同时存在，4例中发现HBsAg ay亚型与亚决定簇d抗体同时存在。仅1例患者的HBsAg和抗-HBs为同型。在38例进行连续检测的患者中，29例同时存在的情况持续存在。另外9例中，间歇性检测到抗-HBs，且复发抗体的异型性保持不变。未检测到丁型肝炎病毒抗体。我们得出结论，急性和慢性乙型肝炎患者中经常同时出现HBsAg和抗-HBs。在慢性疾病中，这些标志物通常为异型。异型标志物的存在与特定危险因素或丁型感染无关。同时出现与病毒复制证据和活动性炎症特征有关。
