An investigation of clinical features of HBsAg and anti-HBs positive patients with chronic hepatitis B

Objective To investigate the phenomenon of coexistence of HBsAg and anti- HBs and its clinical features,as well as related causes. Methods A total of 2260 persons who underwent physical examination in The Second Affiliated Hospital of Southeast University from February 2011 to February 2014 were enrolled,among whom 830 were diagnosed with chronic hepatitis B. Chemiluminescence microparticle immunoassay was used to screen out 188 patients with coexistence of HBsAg and anti- HBs,and these patients were divided into HBeAg positive group( 101 patients) and HBeAg negative group( 87 patients). Another 200 patients with positive HBsAg and negative anti-HBs were enrolled as controls,among whom 80 were in the HBeAg- positive group and 120 were in the HBeAg- negative group. HBV serological markers,liver function,and viral load were measured and analyzed with reference to clinical manifestations. The chi- square test was used for comparison of categorical data between groups. Results There were five patterns of HBV serological markers in patients with positive HBsAg and anti- HBs,among which positive HBsAg,anti- HBs,HBeAg,and anti- HBc and negative anti- HBe were the most common and accounted for 47. 9%( 90 /188). The overall abnormal rate of liver function parameters was 69. 1%( 130 /188),and the positive rate of HBV DNA was 56. 9%( 107 /188). The two groups with positive HBeAg had a high level of HBV DNA replication,and there was no significant difference in the positive rate of HBV DNA between positive HBsAg and anti- HBs group and control group( P > 0. 05).In the groups with negative HBeAg,there was a significant difference in the proportion of patients with HBV DNA quantitation of > 1 × 105 IU / ml between positive HBsAg and anti- HBs group and control group( P < 0. 05). The sequencing of the S region of HBV showed that among the 80 patients with positive HBsAg and anti- HBs,27 had variations in this region,and the mutation rate reached 33. 7%. The major variation sites in S region included P29 L,S61L,P62 L,I126T / S,Q129 N,M133K,F134 L,G145R / K,L175 S,and L186 H. Conclusion The patients with positive HBsA g and anti- HBs account for a certain proportion in patients with hepatitis B,and the major reason may be variation of viral strains. This situation does not indicate the improvement in disease,and the appearance of anti- HBs may not achieve complete and effective HBsA g clearance. There may be persistent replication of viral DNA,which needs to be taken seriously.