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目的总结成人急性乙型肝炎(AHB)病毒学及血清病毒标志物转归特点。方法选择2010年12月至2015年10月北京佑安医院收治的236例成人AHB患者,行乙型肝炎病毒定量(HBV DNA)及乙型肝炎表面抗原(HB-s Ag)、乙型肝炎e抗原(HBe Ag)、抗HBe滴度规律监测。结果本组236例中,157例获得随访。153例治愈,1例死亡,死因为急性肝衰竭,3例转为慢性乙肝。153例治愈者中,142例(92.8%,142/153)于24周内临床痊愈;11例(7.2%,11/153)于24~44周内获得临床痊愈,其HBV DNA均在发病12周以后转阴;HBV血清标志物存在不同转换模式,1HBV DNA先转模式(HBV DNA先转阴,HBe Ag和HBs Ag转换不分先后,占25.5%,39/153);2HBe Ag先转模式110例(HBe Ag先转换,HBV DNA转阴和HBs Ag转换不分先后),占71.9%;3HBs Ag先转模式4例,(HBs Ag先转换,HBV DNA转阴和HBe Ag转换不分先后)占2.6%。结论 HBV DNA≥13周未转阴可转为慢性,必要时应予抗病毒治疗。AHB应重新定义为:44周内获得HBs Ag转阴/转换并伴有HBV DNA转阴和HBe Ag转阴/转换。
Objective To summarize the characteristics of acute hepatitis B (AHB) virology and serum virus markers in adults. Methods A total of 236 adult patients with AHB who were admitted to Beijing You’an Hospital from December 2010 to October 2015 were enrolled in this study. HBV DNA and HBsAg (hepatitis B virus surface antigen), hepatitis B e Antigen (HBe Ag), anti-HBe titer monitoring. Results The group of 236 cases, 157 cases were followed up. 153 cases were cured, 1 died, the cause of death was acute liver failure, 3 cases turned to chronic hepatitis B. Of the 153 patients healed, 142 (92.8%, 142/153) recovered clinically within 24 weeks and 11 (7.2%, 11/153) achieved clinical recovery within 24-44 weeks with HBV DNA at onset HBeAg and HBsAg conversion, regardless of succession, accounting for 25.5%, 39/153); 2HBe Ag first transfer mode 110 cases (HBeAg first conversion, HBV DNA negative conversion and HBsAg conversion, regardless of the succession), accounting for 71.9%; 3HBs Ag first transfer mode in 4 cases (HBs Ag first conversion, HBV DNA negative and HBe Ag conversion ) Accounted for 2.6%. Conclusion HBV DNA ≥13 weeks without negative can be converted to chronic, if necessary, should be anti-viral treatment. The AHB should be redefined as HBs Ag negative / conversion with HBV DNA negative and HBe Ag negative / conversion within 44 weeks.