RESUMEN
IgM antibody against hepatitis B core antigen (IgM anti-HBc), a marker of recent hepatitis B virus infection, was sought by radioimmunoassay in sera diluted 1/4000 from 376 patients presenting to four centres in Italy with acute, apparently type B hepatitis (hepatitis B surface antigen (HBsAg) positive). In 320 patients (85%) a positive IgM anti-HBc test result confirmed that hepatitis was due to primary infection with hepatitis B virus. In the remaining 56 patients absence of the IgM marker indicated that they were previously unrecognised long term carriers of HBsAg. Further serum analysis often showed delta infection and occasionally hepatitis A or cytomegalovirus infection as the true cause of their illness. After six to eight months circulating HBsAg persisted in 38 of 45 patients (84%) without IgM anti-HBc but in only six of 150 patients (4%) with the IgM antibody (p less than 0.0001). A negative IgM anti-HBc test result in patients with acute HBsAg positive hepatitis points to a factor other than hepatitis B virus as the cause of the liver damage and predicts the carriage of HBsAg.
Asunto(s)
Antígenos del Núcleo de la Hepatitis B/inmunología , Hepatitis B/inmunología , Inmunoglobulina M/análisis , Enfermedad Aguda , Portador Sano/diagnóstico , Hepatitis B/diagnóstico , Antígenos de Superficie de la Hepatitis B/análisis , Humanos , PronósticoRESUMEN
Serum samples from 2,465 diabetics were examined by radioimmunoassay for HBsAg, anti-HBs and anti-HBc at the Centro Antidiabetico of the Ospedale Maggiore di Lodi; during the same period, the same tests were carried out on serum samples from 2,176 control subjects, who had been admitted to the surgical, casualty and obstetrical departments for reasons that had nothing whatsoever to do with any form of liver disease. The ages of the two groups ranged from 6 to 90 years. The diabetics were divided into three groups; insulin-dependent, non-insulin-dependent and diabetics treated with insulin for diabetic complications. The overall frequency of HBsAg in the various groups of diabetics was 3.5%, while in the controls it was 6.1% (p less than 0.001). In the group of young insulin-dependent diabetics, the frequency was 1.7%, as compared to 6.9% for the controls in the same age group (p less than 0.05). In the group of patients treated with insulin for diabetic complications, the frequency increased to 11.5%, while for the controls in the same age group it was 5.5%. The levels of HBsAg were practically the same in the diabetics and in the controls, whereas the level of anti-HBc was higher in the diabetics: 55.6% compared to 50% (p less than 0.005). This last result indicates that the chances of hepatitis B virus infection were greater for the diabetics than for the controls. Diabetics, and especially those insulin-dependent are, therefore, believed to possess a greater capacity of resistance through their T cell-mediated immune response to the hepatitis B virus.