Romano M, Di Napoli M, Pesce M
II Divisione di Medicina, Ospedale Sandro Pertini, Roma.
Minerva Gastroenterol Dietol. 1995 Dec;41(4):303-5.
The paper reports a case of acute hepatitis C (HCV) in a patient who was a chronic carrier of hepatitis B virus (HBV) during the course of which the authors observed a transient HBsAg clearance. The 53-year-old patient was a carrier of chronic HBV infection in an integrated minus variant phase. The patient presented an abrupt increment in aminotransferase (ALT) which was not compatible with the typical "a poussée" progress of atypical chronic HBV hepatitis in that it was associated with HbsAg clearance in the absence of signs of superinfection by delta hepatitis virus (HDV), with subsequent repositivisation of HBsAg and contemporary anti-HCV seroconversion (RIBA positive for C-22, C-33, C-100, 5-1-1) on clinical remission. Polymerase chain reaction (PCR) was negative on remission for both HBV DNA and HCV. RNA became positive six months afterwards for HCV RNA alone; moreover HBsAg, anti-HCV, RIBA C-22, C-33, C-100, 5-1-1 were constantly positive, thus further confirming the inhibitory capacity of HCV towards HBV and not vice versa, as also shown by the chronic nature of infection and deterioration of clinical conditions. The authors conclude by underlining the need to assay for HCV RNA using a PCR method in alla cases of re-acutisation of chronic hepatitis due to both wild virus B and the domestic virus during the course of which HBsAg becomes negative, even transiently, in the absence of Delta superinfection.
该论文报告了一例急性丙型肝炎（HCV）病例，患者为乙型肝炎病毒（HBV）慢性携带者，在此过程中作者观察到HBsAg短暂清除。这位53岁的患者处于整合负变异期的慢性HBV感染携带者。患者出现转氨酶（ALT）突然升高，这与非典型慢性HBV肝炎典型的“突发”进展不相符，因为其与HBsAg清除相关，且无丁型肝炎病毒（HDV）重叠感染迹象，随后HBsAg重新阳性，同时临床缓解时抗-HCV血清学转换（RIBA检测C-22、C-33、C-100、5-1-1阳性）。缓解期聚合酶链反应（PCR）检测HBV DNA和HCV均为阴性。6个月后仅HCV RNA变为阳性；此外，HBsAg、抗-HCV、RIBA C-22、C-33、C-100、5-1-1持续阳性，从而进一步证实HCV对HBV的抑制作用而非相反，感染的慢性性质和临床状况恶化也表明了这一点。作者强调，在所有因野生型B病毒和本土病毒导致慢性肝炎再急性化的病例中，若在此过程中HBsAg变为阴性（即使是短暂的）且无丁型肝炎病毒重叠感染，均需使用PCR方法检测HCV RNA。
