Zhang Ying, Zhu Ying, Zhou Yi, Tan Zhaoxia, Dan Yunjie, Zou Xin, Deng Guohong, Tan Wenting
Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China.
Chongqing Key Laboratory for Research of Viral Infectious Diseases, Chongqing, China.
Virulence. 2025 Dec;16(1):2534078. doi: 10.1080/21505594.2025.2534078. Epub 2025 Jul 17.
Acute exacerbation (AE) is common for patients with chronic hepatitis B (CHB). The aim of the study is to investigate the values of hepatitis B core antibody (anti-HBc) IgM in CHB-AE. Patients were screened from a prospective sub-cohort, 419 CHB patients with AE were enrolled and divided into groups according to antiviral treatment history, treatment naïve, withdrawal above or within 6 months, and on-treatment. The prevalence, clinical characteristics of anti-HBc IgM, and its relationship with the outcomes of CHB were assessed. A total of 157 patients (37.5%) were tested positive for anti-HBc IgM, of which patients with antiviral-withdrawal more than 6 months had the highest prevalence (49.3%). Anti-HBc IgM was significantly associated with HBV DNA and ALT, regarding to its prevalence and serum level. Furthermore, serum anti-HBc IgM values varied in different phases of CHB, of which immune active and HBeAg-negative chronic hepatitis phases were significantly higher than that in inactive carriers ( = 0.017 and = 0.0097, respectively). Anti-HBc IgM could distinguish hepatitis from inactive infection phases in HBeAg-negative patients (AUC 0.841). Anti-HBc IgM levels were significantly higher in subgroup who developed ACLF ( < 0.05), but had no relationship with short-term mortality. Finally, anti-HBc IgM seropositivity was the only predictor of HBeAg seroclearance (OR 3.18, 95% CI 1.30-7.73) and all patients who achieved HBsAg seroclearance within 1-year had a markedly elevated anti-HBc IgM level. In conclusion, our study shows anti-HBc IgM is highly prevalent in CHB patients with AE and would be a new predictor of HBeAg and HBsAg loss in this population.
急性加重（AE）在慢性乙型肝炎（CHB）患者中很常见。本研究的目的是探讨乙型肝炎核心抗体（抗-HBc）IgM在CHB-AE中的价值。从一个前瞻性亚队列中筛选患者，纳入419例CHB-AE患者，并根据抗病毒治疗史、初治、停药6个月以上或6个月内以及正在接受治疗进行分组。评估抗-HBc IgM的患病率、临床特征及其与CHB结局的关系。共有157例患者（37.5%）抗-HBc IgM检测呈阳性，其中抗病毒停药超过6个月的患者患病率最高（49.3%）。就其患病率和血清水平而言，抗-HBc IgM与HBV DNA和ALT显著相关。此外，CHB不同阶段的血清抗-HBc IgM值有所不同，其中免疫活跃期和HBeAg阴性慢性肝炎期显著高于非活动携带者（分别为=0.017和=0.0097）。抗-HBc IgM可区分HBeAg阴性患者的肝炎与非活动感染期（AUC 0.841）。发生慢加急性肝衰竭（ACLF）的亚组中抗-HBc IgM水平显著更高（<0.05），但与短期死亡率无关。最后，抗-HBc IgM血清阳性是HBeAg血清学转换的唯一预测因素（OR 3.18，95%CI 1.30-7.73），所有在1年内实现HBsAg血清学清除的患者抗-HBc IgM水平均显著升高。总之，我们的研究表明抗-HBc IgM在CHB-AE患者中高度流行，并且将是该人群中HBeAg和HBsAg丢失的新预测指标。
