Core antibody (anti-HBc) positive

Introduction After human infection with hepatitis B virus, hepatitis B virus nucleic acid (HBV-DNA) first appears in the serum, and hepatitis B virus surface antigen (HBsAg) and e antigen (H BeAg) appear after about one month, and then anti-- HBc and so on. As the condition gradually improved, HBV-DNA, HBsAg and HBeAg in the serum were negative, and hepatitis B surface antibodies (anti-HBs) appeared after a period of disappearance of HBsAg. At this time, anti-HBc and anti-HBs can be positive at the same time. Since anti-HBs persist in serum for a shorter period of time than anti-HBc, anti-HBs disappear after a period of time, and only a single anti-HBc is positive. Whether it is a clinically symptomatic hepatitis B patient or a latent infection with no clinical manifestations, after recovery, serological tests can be expressed as a single anti-HBc positive.

Cause

According to the clinical characteristics, reference to epidemiological data, exclude other related diseases, determine the diagnosis depends on the serological examination of the pathogen. For patients with atypical clinical manifestations, liver biopsy should be performed.

1. The pathogen diagnosis is due to the presence of asymptomatic HBsAg. When these people are re-infected with hepatitis A, C, D, E virus or other hepatitis, HBsAg is easily misdiagnosed as acute hepatitis B, so the diagnosis should be cautious. .

Second, the diagnosis of acute hepatitis B is based on 1HBsAg positive; 2HBeAg positive; 3 anti-HBcIgM positive, high titer (1:1000); 4HBV-DNA positive.

an examination

Related inspection

Blood routine blood test

Generally speaking: there are several situations

(1) Single anti-HBc positive, other HBV markers are negative, most of them are false positives (more than 70%). In this case, you must check it several times before you decide.

(2) Single anti-HBc positive, may also be a sign of previous HBV infection, some people say this is called "memory response", in the past infected with HBV, anti-HBc positive in the body, it does not disappear for a long time, but there is no HBV in the body However, it was only because of a problem with immune function that no protective antibodies (anti-HBs) were produced. This kind of person cannot be called a hepatitis B virus carrier. Anti-HBc positivity is the "mark" left by previous infections, just like the sputum left after the healing of the knife wound.

(3) Single anti-HBc positive, can not rule out low levels of HBV infection. HBV enters the human body in a small amount, and HBeAg and HBsAg are not expressed, so it is not found in the blood. HBcAg is particularly antigenic, so only anti-HBc is positive, which is the carrier of hepatitis B virus. Sometimes, only one anti-HBc is detected in the blood of a hepatitis patient, which must be diagnosed as a hepatitis B patient. Because the single anti-HBc is the only sign of HBV at this time.

(4) Single anti-HBc positive has a certain relationship with hepatitis C virus infection. Therefore, single anti-HBc positive patients cannot be considered for further examination for HCV infection.

(5) A single anti-HBc positive can be vaccinated with hepatitis B vaccine. Sometimes, because the hepatitis B vaccine can stimulate the body to produce antibodies, that is, anti-hbs to obtain immunity against hepatitis B, some doctors see that the individual anti-HBc positive is sure that the other party is already infected with hepatitis B virus, thus refusing to give him hepatitis B vaccine, which it's wrong.

(6) It is worth noting that a single anti-HBc positive person cannot donate blood to a patient or donate a liver. Because they can't rule out the infection with HBV. For the sake of caution, it is still not safe.

Differential diagnosis

Be aware of the following diseases.

Drug-induced hepatitis

The characteristics are: 1 history of useful drugs, known to have a variety of drugs can cause different degrees of liver damage, such as isoniazid, rifampicin can cause similar clinical manifestations of viral hepatitis; long-term use of diacetate, methyl Dopa can cause slow-lived liver; chlorpromazine, methyltestosterone, arsenic, bismuth, ketoconazole, etc. can cause cholestatic hepatitis; 2 mild clinical symptoms, elevated ALT, eosinophils; 3 After the drug was stopped, the symptoms gradually improved and ALT returned to normal.

2. Cholelithiasis

There was a history of biliary colic, high fever chills, right upper quadrant pain, Murphy sign (Murphy sign), increased white blood cells, and increased neutrophils.

3. Primary biliary cirrhosis

Characteristics are more common in middle-aged women; 2 jaundice continues to be noticeable, itchy skin, often yellow tumor, hepatosplenomegaly is obvious, ALP is significantly elevated, most anti-mitochondrial antibodies are positive; 3 liver function damage is lighter; 4 hepatitis B flag Negative.

4. Hepatolenticular degeneration (Wilson's disease)

There is often a family history, with extensive tremors of the limbs, increased muscle tone, a brown-green pigment ring at the edge of the cornea (KF ring), decreased copper and ceruloplasmin, increased urinary copper, and slow-lived hepatic copper and copper. Blue protein is significantly elevated.

5. Acute fatty liver during pregnancy

Most occur in the second trimester of pregnancy. The clinical features are: 1 acute onset of acute abdominal pain, amylase increased, like acute pancreatitis; 2 although there are heavy jaundice, serum direct bilirubin increased, but urinary bilirubin is often negative. Domestic reports of this phenomenon can also be found in acute severe hepatitis for reference; 3 often before the onset of liver failure, severe bleeding and renal dysfunction, ALT increased, but turbidity is normal; 4B ultrasound for fatty liver waveform To help early diagnosis, diagnosed by pathological examination. The pathological features are the enlargement of the hepatic lobule to the middle zone, the cytoplasm is filled with fat vacuoles, and there is no large hepatocyte necrosis.

6. Extrahepatic obstructive jaundice

Such as pancreatic cancer, common cholangiocarcinoma, chronic pancreatitis, etc. need to be identified.

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