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目的探讨HBsAg和抗-HBs同时阳性的HBV慢性感染者随访前后病毒学特征和肝功能的变化。方法用电化学发光免疫分析法(ECLIA)筛选出HBsAg及抗-HBs同时阳性的标本,对其中资料完整的患者进行平均9.8个月的随访,检测随访前后患者血清HBV标志物、HBV DNA载量及丙氨酸氨基转移酶(ALT)和总胆红素(TBIL)水平,分析其病毒学指标的动态变化。结果 40例患者随访期间,HBsAg转为阴性的有3例,抗-HBs转为阴性的有8例。随访前后患者血清HBsAg、抗-HBs水平、HBe Ag阳性率及TBIL水平相比差异无统计学意义(P>0.05);随访后血清ALT活力、HBV DNA载量较随访前下降,差异均有统计学意义(P<0.05)。结论 HBsAg及HBV DNA水平较低的患者更容易引起HBsAg转阴,同时抗体出现却并不一定能完全有效清除表面抗原,病毒DNA往往存在持续复制,其治疗随访应引起临床的重视。
Objective To investigate the changes of virological characteristics and liver function in patients with chronic hepatitis B virus infection simultaneously with HBsAg and anti-HBs. Methods The positive samples of HBsAg and anti-HBs were screened by ECLIA. The patients with complete data were followed up for an average of 9.8 months. The serum HBV markers, HBV DNA load And alanine aminotransferase (ALT) and total bilirubin (TBIL) levels, analysis of the dynamic changes of virological indicators. Results During the follow-up period of 40 cases, there were 3 cases of negative HBsAg and 8 cases of negative anti-HBs. There was no significant difference in serum HBsAg, anti-HBs level, HBe Ag positive rate and TBIL level before and after follow-up (P> 0.05); serum ALT activity and HBV DNA load decreased at follow-up Significance (P <0.05). Conclusions Patients with low HBsAg and HBV DNA levels are more likely to cause negative HBsAg. At the same time, antibodies may not be able to completely remove surface antigens. However, viral DNA often persists and should be clinically valued.