抗HBc单独血清学状态在临床实践中的意义

StephenW

Lancet Gastroenterol Hepatol. 2017 Feb;2(2):123-134. doi: 10.1016/S2468-1253(16)30076-0. Epub 2017 Jan 12.
Significance of anti-HBc alone serological status in clinical practice.
Wang Q1, Klenerman P2, Semmo N3.
Author information

1    Division of Gastroenterology and Hepatology and Shanghai Institute of Digestive Disease, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China; Hepatology, Department of Clinical Research, University of Bern, Bern, Switzerland.
2    NIHR Biomedical Research Centre, Translational Gastroenterology Unit, University of Oxford, Oxford, UK; Peter Medarwar Building for Pathogen Research, University of Oxford, Oxford, UK.
3    Hepatology, Department of Clinical Research, University of Bern, Bern, Switzerland; University Clinic of Visceral Surgery and Medicine, Department of Hepatology, University of Bern, Bern, Switzerland. Electronic address: [email protected].

Abstract

Serum samples identified as positive for total anti-HBc, but negative for both HBsAg and anti-HBs, are referred to as anti-HBc alone. This serological response is compatible with acute, resolved, and chronic hepatitis B virus (HBV)infection but might also signify occult HBV infection. Once the anti-HBc alone pattern is detected, false-positive reactivity should be ruled out and further analyses can resolve the clinical status of the donor. The identification of anti-HBc positivity in the absence of HBsAg in organ transplant donors and in candidate patients for chemotherapy and immunosuppressive therapy requires further investigation because of the risk of HBV reactivation. False-positive detection, acute infection during the window phase, and resolved or chronic HBV infection are all possible and only distinguishable if the additional assays are done and measures of liver damage are taken into account. Measurement of serum anti-HBs responses after the administration of HBV vaccination can be useful to distinguish this serological profile. In view of the low risk of HBV reactivation in anti-HBc alone patients who are candidates for immunosuppressive treatment, such patients might not require pre-emptive antiviral therapy, but should be followed up on a monthly basis for alanine aminotransferase followed by quantitative HBV DNA testing in those with alanine aminotransferase increase. According to specific guidelines, nucleoside analogue prophylaxis is recommended in anti-HBc-positive liver allograft recipients and anti-HBc alone individuals who receive chemotherapy or biological therapy and should be continued for 6-12 months after discontinuation of such immunosuppressive therapies to protect against HBV reactivation.

Copyright © 2017 Elsevier Ltd. All rights reserved.

PMID:
    28403982
DOI:
    10.1016/S2468-1253(16)30076-0

StephenW

Lancet Gastroenterol Hepatol。 2017年2月; 2（2）：123-134。 doi：10.1016 / S2468-1253（16）30076-0。 Epub 2017 Jan 12。
抗HBc单独血清学状态在临床实践中的意义。
王Q1，克伦曼P2，Semmo N3。
作者信息

1上海交通大学仁济医院消化内科，上海消化病研究所消化内科，上海;肝病学，伯尔尼大学临床研究系，伯尔尼，瑞士。
2 NIHR生物医学研究中心，英国牛津大学牛津大学翻译胃肠病科;英国牛津大学牛津大学病理学研究所Peter Medarwar大楼。
3肝病学，伯尔尼大学临床研究系，瑞士伯尔尼;内科外科和医学大学诊所，伯尔尼大学肝脏病学系，瑞士伯尔尼大学。电子地址：[email protected]。

抽象

鉴定为总抗HBc阳性的血清样品，但HBsAg和抗HBs均为阴性，单独称为抗HBc。这种血清学反应与急性，解决和慢性乙型肝炎病毒（HBV）感染相容，但也可能意味着隐匿性HBV感染。一旦检测到抗HBc单独模式，应排除假阳性反应性，进一步分析可以解决供体的临床状态。在器官移植供体和候选患者化学治疗和免疫抑制治疗中，HBsAg缺乏时抗HBc阳性的鉴定需要进一步研究，因为HBV再激活的风险。假阳性检测，窗口阶段的急性感染以及解决或慢性HBV感染是可能的，只有在进行额外的测定并考虑肝脏损伤的测量时，才能区分。乙肝疫苗接种后血清抗HBs反应的测定可用于区分这一血清学特征。鉴于作为免疫抑制治疗候选人的抗HBc单独患者HBV再活化的风险较低，此类患者可能不需要先天性抗病毒治疗，但应每月对丙氨酸氨基转移酶进行跟踪，然后定量HBV DNA在丙氨酸氨基转移酶增加的测试。根据具体指导，在抗HBc阳性肝同种异体移植物接受者和接受化疗或生物治疗的抗HBc单独个体中推荐使用核苷类似物预防，并在停用此类免疫抑制疗法后继续服用6-12个月以保护HBV重新激活

版权所有©2017 Elsevier Ltd.保留所有权利。

PMID：
    28403982
DOI：
    10.1016 / S2468-1253（16）30076-0

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日本的大规模免疫学调查显示，HBc抗体阳性携带率是HBs抗原阳性携带率的8〜10倍，推测日本50岁以上人口中HBc抗体阳性携带率20～25%

以中国的HBs抗原阳性携带率来推算，HBc抗体阳性携带率是多少呢。

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多谢分享。

原文插图挺漂亮

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其他有关 HBc抗体阳性 出现 de novo乙肝的资料。



对于有de novo HBV风险人群，定期检查高敏DNA是稳妥办法。