Stanciu L, Urcan S, Părău N, Radu D, Popescu S
Med Interne. 1986 Jan-Mar;24(1):19-22.
Twenty-two patients with HBsAg positive acute viral hepatitis have been followed-up for two years after the acute episode. Besides the usual clinical, pathological and biological examinations, the following tests were carried out: serum HBsAg: circulating T and B lymphocytes: serum IgG, IgA, IgM: leukocyte migration test to HBsAg; serum complement: autoantibodies, rheumatoid factors, cryoglobulins, alpha-fetoprotein. Serum HBsAg persistence was correlated with some features of the acute episode: protracted clinical form: recurrences or relapses; splenomegaly; decrease of circulating T-lymphocytes; presence of lymphocyte sensibilization to HBsAg. Among the seven serum HBsAg carriers, three developed a chronic hepatitis. The state of healthy chronic HBsAg carrier was associated with high levels of serum IgA (over 300 IU/ml). A chronic hepatitis has been also diagnosed in four out of the 15 patients who cleared their serum HBsAg. The presence, on the one hand, of a chronic hepatitis among the patients who cleared their HBsAg and, on the other hand, its absence in some of the HBsAg carriers suggest that HBsAg persistence is not a sine qua non condition for the development of the chronic liver disease. The onset of autoimmune phenomena due to the disturbance of immunologic homeostasis and perhaps other genetic or environmental factors seemingly allow the perpetuation of a hepatic damage.
22例HBsAg阳性急性病毒性肝炎患者在急性期发作后接受了两年的随访。除了常规的临床、病理和生物学检查外，还进行了以下检测：血清HBsAg、循环T淋巴细胞和B淋巴细胞、血清IgG、IgA、IgM、针对HBsAg的白细胞游走试验、血清补体、自身抗体、类风湿因子、冷球蛋白、甲胎蛋白。血清HBsAg持续存在与急性期的一些特征相关：临床病程迁延、复发或再发、脾肿大、循环T淋巴细胞减少、存在对HBsAg的淋巴细胞致敏。在7例血清HBsAg携带者中，3例发展为慢性肝炎。健康慢性HBsAg携带者状态与高水平血清IgA（超过300 IU/ml）相关。在清除血清HBsAg的15例患者中，有4例也被诊断为慢性肝炎。一方面，在清除HBsAg的患者中存在慢性肝炎，另一方面，在一些HBsAg携带者中不存在慢性肝炎，这表明HBsAg持续存在并非慢性肝病发生的必要条件。免疫稳态紊乱以及可能的其他遗传或环境因素导致的自身免疫现象的出现，似乎使得肝损伤持续存在。
