Marinos G, Smith H M, Naoumov N V, Williams R
Institute of Liver Studies, King's College School of Medicine and Dentistry, London, United Kingdom.
Hepatology. 1994 Feb;19(2):303-11.
Serum IgM anti-HBc was determined in 135 chronic HBsAg carriers with various categories of histological activity on liver biopsy and hepatitis B serological profile. Thirty-three patients were treated with interferon-alpha to investigate the correlation between serum IgM anti-HBc with histological activity and viral replication, to evaluate the usefulness of pretreatment IgM anti-HBc as a predictor of a successful response to interferon-alpha and to examine the IgM anti-HBc response during this treatment. All 53 patients with chronic active hepatitis with either wild-type (n = 42) or precore mutant variant HBV infection (n = 11) had an IgM anti-HBc index greater than 0.300 compared with 7.4% (2 of 27) of the chronic HBsAg/HBeAg-positive carriers with chronic persistent hepatitis, 10% (3 of 30) of the anti-HBe-positive asymptomatic carriers and none of the 25 patients with hepatitis D virus-positive chronic active hepatitis (p < 0.0001). Pretreatment IgM anti-HBc index was greater than 0.300 in 82.4% (14 of 17) of HBeAg/HBV DNA-positive patients who seroconverted after interferon-alpha treatment compared with 25% (4 of 16) of the patients who did not seroconvert (p = 0.0013), whereas an elevated pretreatment AST was present in only 52.9% (9 of 17) of responders and in 37.5% (6 of 16) of nonresponders (p = 0.42). Serial testing of IgM anti-HBc in these 33 patients during interferon-alpha treatment showed a significant rise in IgM anti-HBc in all responders, which followed the AST flare-up but preceded the time of the HBeAg to anti-HBe seroconversion.(ABSTRACT TRUNCATED AT 250 WORDS)
在135例慢性HBsAg携带者中测定血清IgM抗-HBc，这些携带者具有肝活检的不同组织学活性类别和乙肝血清学特征。33例患者接受α干扰素治疗，以研究血清IgM抗-HBc与组织学活性及病毒复制之间的相关性，评估治疗前IgM抗-HBc作为α干扰素治疗成功反应预测指标的有效性，并观察该治疗期间IgM抗-HBc的反应。所有53例慢性活动性肝炎患者，无论是野生型（n = 42）还是前核心突变型HBV感染（n = 11），其IgM抗-HBc指数均大于0.300，相比之下，慢性HBsAg/HBeAg阳性的慢性持续性肝炎携带者中7.4%（27例中的2例）、抗-HBe阳性无症状携带者中10%（30例中的3例）以及25例丁型肝炎病毒阳性慢性活动性肝炎患者中无一例如此（p < 0.0001）。α干扰素治疗后发生血清学转换的HBeAg/HBV DNA阳性患者中82.4%（17例中的14例）治疗前IgM抗-HBc指数大于0.300，而未发生血清学转换的患者中这一比例为25%（16例中的4例）（p = 0.0013），然而，治疗前AST升高仅在52.9%（17例中的9例）的反应者和37.5%（16例中的6例）的无反应者中出现（p = 0.42）。在这33例接受α干扰素治疗的患者中进行IgM抗-HBc的系列检测显示，所有反应者的IgM抗-HBc均显著升高，其升高发生在AST升高之后，但在HBeAg向抗-HBe血清学转换之前。（摘要截取自250字）
