请411 GZ老师再帮忙看看我老公的检查结果

心痛123

我老公以前查体也是小三阳，1 4 5阳性，2006年开始到现在一直是4 5阳，第一项自然转阴了，DNA也一直是阴性。然后在2007年医生说需打疫苗看下能不能产生抗体，昨天检查了两对半，只有第五项是阳性，虽第一项为阴，但数值是0.999(小于1为阴性）这个数值太接近1了，医生说有可能是实验室误差，第一项本身就是阳性，那是不是说我老公有可能又变成小三阳了，真担心。医生说要第五项也变成阴性，病毒才算完全清除干净，这第五项是阳，还算体内有病毒。但我以前看过的资料好像是说只要以前得过乙肝，这第五项就没办法转阴，第五项是阳性只能说明你以前得过乙肝，好像不是说明体内还存在病毒。请411 GZ老师讲解下，谢谢！！

蓝湄

顶上去给老师解答

dumbdumber

第五项只能说曾经感染过，第六项说明近期感染，要看是否会出现第二项而且滴度超过10个国际单位才是有免疫抗体。

病毒永远，终身不会离开身体/肝脏，痊愈仅仅是机体识别到病毒的病原存在能产生抗体平衡了。

应该检查HBV DNA，第一项的S，PreS1，PreS2等看看。

如果是恢复期间，最好不要滥用药物，特别是免疫激发药物（比如疫苗），让机体免疫系统有时间和机会自己来完成痊愈过程，不然会导致其它不良转变。

liver_GZ

最新的Gastroenterology, 2008, 135(4): 1192-1199
  
HBsAg Seroclearance in Chronic Hepatitis B in Asian Patients: Replicative Level and Risk of Hepatocellular Carcinoma

Man–Fung Yuen, Danny Ka–Ho Wong, James Fung, Philip Ip‡, David But, Ivan Hung, Kevin Lau, John Chi–Hang Yuen, Ching–Lung Lai


Received 15 April 2008; accepted 3 July 2008. published online 18 July 2008.

Background & Aims: Our aims were to study the virologic, histologic, and clinical outcome in chronic hepatitis B (CHB) patients with hepatitis B surface antigen (HBsAg) seroclearance.
Methods: We determined the age of HBsAg seroclearance that is associated with a lower risk for hepatocellular carcinoma (HCC) in 298 CHB patients (median follow-up, 108 months). The following virologic and histologic features were also determined: liver stiffness (n = 229), liver histology, serum HBV DNA levels over time (n = 265), intrahepatic HBV DNA with covalently closed circular DNA (cccDNA) levels, and messenger RNA (mRNA) expression.
Results: The median age of HBsAg seroclearance was 49.6 years. Seven (2.4%) patients developed HCC. Cumulative risk for HCC was higher in patients with HBsAg seroclearance at ages ≥50 years compared with those with HBsAg seroclearance at ages <50 (P = .004) years. Of these 2 groups of patients, 29.5% and 7.9%, respectively, had significant fibrosis by liver stiffness measurement (P = .001), and 15.4% of patients had mild histologic fibrosis. Intrahepatic total HBV DNA and cccDNA were detected in 100% and 79.3% of patients, respectively. All patients had undetectable surface and precore/pregenomic RNA transcripts. One (9.1%) patient had X mRNA expression. Serum HBV DNA were detectable in 13.4%, 6.1%, and 3.7% of patients within 1 year and 5–10 and >10 years after HBsAg seroclearance, respectively, and 82.1% patients had persistently normal alanine aminotransferase levels.
Conclusions: HBV persisted at low replicative and transcriptional levels after HBsAg seroclearance. HBsAg seroclearance at age <50 years was associated with a lower risk for the development of HCC.
HBsAg 阴转后，HBV仍有低水平复制。
>50岁后转阴的患者，仍有较高的HCC发生风险。