Löhr H, Goergen B, Weber W, Gödderz W, Meyer zum Büschenfelde K H, Gerken G
I.Medizinische Klinik und Poliklinik, Johannes-Gutenberg-Universität, Mainz, Germany.
J Med Virol. 1994 Dec;44(4):330-5. doi: 10.1002/jmv.1890440404.
The case of a young female patient with chronic active hepatitis B, vasculitic purpura, edema, and circulating immune complexes due to mixed cryoglobulinemia is described. Serum transaminases were elevated. Serological assays showed hepatitis B surface antigen (HBsAg), antibody to hepatitis B e antigen (anti-HBe), and antibody to hepatitis B core antigen (anti-HBc) antibodies but no antibody to hepatitis C virus (anti-HCV) or antibody to hepatitis delta virus (anti-HDV) antibodies. Using hepatitis B virus-polymerase chain reaction (HBV-PCR) and direct sequencing a precore/core (preC/C) mutant unable to synthesize HBeAg was detected in serum. HBV antigens were demonstrated in the circulating immune complexes. Following 1 month of treatment with interferon-alpha 2b3 miu three times weekly, alanine aminotransferases returned to normal levels while cryoglobulins and immune complexes disappeared from serum. In addition, 2 months after the onset of treatment serum HBV-DNA was no longer detectable by PCR. Prior to treatment the analysis of cellular immune reactions of peripheral blood mononuclear cells showed a major proliferative response to HBcAg, preS1Ag and HBxAg and a minor response to HBeAg and HBsAg. One month after conclusion of treatment a decline in T-cell reactivity against all HBV antigens was observed. During clinical response to the therapy, however, a strong proliferative response of T cells to HBcAg and HBeAg was demonstrated. In conclusion, immune complex disease may complicate chronic hepatitis B in patients expressing HBe-minus HBV mutants. Treatment with interferon-alpha was found to be effective in mixed cryoglobulinemia even in the presence of HBe-minus HBV mutants.(ABSTRACT TRUNCATED AT 250 WORDS)
本文描述了一名患有慢性活动性乙型肝炎、血管炎性紫癜、水肿以及因混合性冷球蛋白血症导致循环免疫复合物的年轻女性患者的病例。血清转氨酶升高。血清学检测显示有乙肝表面抗原（HBsAg）、乙肝e抗原抗体（抗-HBe）和乙肝核心抗原抗体（抗-HBc），但没有丙肝病毒抗体（抗-HCV）或丁肝病毒抗体（抗-HDV）。通过乙肝病毒聚合酶链反应（HBV-PCR）和直接测序，在血清中检测到无法合成HBeAg的前核心/核心（preC/C）突变体。在循环免疫复合物中证实有HBV抗原。每周三次使用300万单位的α-2b干扰素治疗1个月后，丙氨酸转氨酶恢复到正常水平，同时冷球蛋白和免疫复合物从血清中消失。此外，治疗开始2个月后，PCR检测不再能检测到血清HBV-DNA。治疗前对外周血单个核细胞的细胞免疫反应分析显示，对HBcAg、前S1Ag和HBxAg有主要增殖反应，对HBeAg和HBsAg有轻微反应。治疗结束1个月后，观察到针对所有HBV抗原的T细胞反应性下降。然而，在治疗的临床反应期间，T细胞对HBcAg和HBeAg有强烈的增殖反应。总之，免疫复合物疾病可能使表达HBe阴性HBV突变体的慢性乙型肝炎患者病情复杂化。发现α-干扰素治疗对混合性冷球蛋白血症有效，即使存在HBe阴性HBV突变体。（摘要截短为250字）
