中文摘要：

目的分析HBsAg和抗HBs抗体同时阳性的HBV感染者病毒学特征及其临床意义。方法总计13080例HBsAg阳性病例中，HBsAg与抗HBs抗体同时阳性476例，分析资料完整的113例患者（研究组）HBV血清标志物（HBVM）和HBVDNA定量、抗HBcIgM抗体及ALT结果，并与76例普通HBV感染者（对照组）进行比较。结果研究组与对照组在年龄、男女性别比及HBeAg阳性率间差异无统计学意义。研究组HBsAg水平显著低于对照组（P〈0．05）。研究组抗HBcIgM抗体阳性率为30．9％，抗HBcIgM抗体阳性患者的血清HBsAg与HBVDNA水平、HBeAg阳性率及ALT水平均显著高于抗HBcIgM抗体阴性患者（P〈0．05）。结论HBsAg与抗HBs抗体同时阳性感染者HBsAg水平显著低于普通感染者，提示患者体内的抗HBs抗体可能仍起到一定作用；约30％患者可能处于HBV急性发作状态，应对其进行随访，观察疾病转归。

英文摘要：

Objective To analyze the clinical and virological characteristics of hepatitis B patients with co-existence of HBsAg and anti- HBs antibodies in serum. Methods Of 13 080 patients with positive HBsAg from January 2008 to April 2010, 476 （3.64%） were positive for HBsAg and anti-HBs. The serum HBV markers, HBV DNA quantification, anti-HBc IgM and alanine aminotransferase （ALT） were simultaneously examined in the patients of research group （113 patients with complete data） and control group （79 age- and sex-matched HBV-infected patients with positive HBsAg and negative anti-HBs）. Results There was no statistical difference of HBeAg-positive rates between the research and control group （P 〉 O. 05 ）. The HBsAg levels of patients in the research group were much lower than those of control group. The positive rate of the patients with anti-HBc IgM was 30.9% in the research group. The lev- els of HBsAg, HBV DNA and ALT in the patients with positive anti-HBc IgM were significantly higher than those in the patients with negative anti-HBc IgM. Conclusion The level of HBsAg in the research group was significantly lower than that in control group. There were significant differences of HBsAg levels between the patients with coexistence of HBsAg/anti-HBs and hepatitis B patients with only HBsAg-positive. The results suggested that anti-HBs antibody may play certain role for HBV infection. About 30% patients with coexistence of HBsAg/anti-HBs were in the state of acute flare of chronic hepatitis B.