- 期刊
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乙型肝炎核心抗體IgM的臨床應用
The Significance of Anti-HBc IgM in Patients with Acute Type B Hepatitis
摘要
臨床上血清中Anti-HBc IgM的測定對急性乙型肝炎的診斷仍有許多困擾，為了探討此問題我們分析313位年齡在20－30歲因急性肝炎現象而住院者，利用放射免疫分析法測定血清中各種乙型肝炎病毒標誌（用Abbott公司出品商用RIA kits；包括CORAR-M）且追蹤至半年以上。結果所示，在313位病患中有90位Anti-HBc IgM呈陽性反應，其中86位在半年內HBs Ag陽性轉變為陰性，而其它223位病患中只有5位發現HBsAg轉陰。若以Anti-HBc IgM陽性反應來預期HBsAg清除率，其敏感性94.5%；專一性98.2%，陽性預期值95.6%，陰性預期值97.8%，同時亦分析乙型肝炎表面抗原（HBsAg）陽性之肝硬化，肝癌病患及非乙型肝炎者各20位做對照組，發現無一位Anti-HBc IgM呈陽性反應。Anti-HBc IgM陽性組中有14位病人最初HBsAg為陰性，若只以HBsAg陽性來診斷急性乙型肝炎會有14.7%的誤差。所以我們認為利用Anti-HBc IgM診斷急性乙型肝炎是臨床上值得信賴的標誌。
並列摘要
The diagnostic aignificance of anti-HBc IgM was prospectively evaluated in 313 patients, ages from 20 to 30 years. There were presented with acute type B hepatitis which were positive for HBsAg and/or Anti-HBc IgM Hepatitis markers were assayed using commerical radioimmunoassay (RIA-abbot Lab, including CORAR-M) and followed for a minimum of 6 months. Anti-HBc IgM was detected in 90 out of 313 patients. Among these cases, 86 (95.6%) cleased their HBsAg within 6 months, while the remaining 223 cases, only 5 (2.2%) cleared their HBsAg. In terms of Anti-HBc IgM in predicting the clearance of HBsAg, the sensitivity was 94.5% and specificity was 98.2%, the positive prediction was 95.6% and negative prediction value was 97.8%. Anti-HBc IgM was also measured in 20 cirrhosis patients with HBsAg positive, 20 HCC patients with HBsAg positive and 20 patients with liver disorders not caused by HBV. None of them was shown to be positive for Anti-HBc IgM. 14(14.7%) cases were found HBsAg negative but Anti-HBc IgM positive and they all developed Anti-HBc within 6 months. All these results suggest that Anti-HBc IgM is a reliable manker for the diagnosis of acute type B hepatitis in adult patients.