How to interpret the five-item hepatitis B report? What do big triple positive and small triple positive mean?

Author: Lou Jinli, researcher/professor at Beijing You'an Hospital, Capital Medical University

Reviewer: Wang Lixiang, Chief Physician, Third Medical Center, PLA General Hospital

The 10th Chairman of the Science Popularization Branch of the Chinese Medical Association

Hepatitis is an inflammation of the liver caused by a variety of factors, including viral infection, bacterial infection, parasitic infection, chemical exposure, alcohol use, and autoimmune response. Among these factors, viral hepatitis is particularly common, mainly caused by hepatitis A, B, C, D, and E viruses. The clinical manifestations of viral hepatitis are diverse, including but not limited to fatigue, loss of appetite, aversion to oily food, abnormal liver function, etc., and in severe cases, it can cause symptoms such as jaundice.

Regarding the transmission routes of viral hepatitis, different types of viral hepatitis have different modes of transmission. For example, hepatitis A and E are mainly transmitted through the fecal-oral route, that is, the virus enters the human body through contaminated food or water, thereby causing infection. Outbreaks of this type of hepatitis are often related to unclean food. In contrast, hepatitis B, C, and D are mainly transmitted through blood, such as mother-to-child transmission, sexual transmission, and the use of unsterilized syringes. Among them, the transmission routes of hepatitis B also include medical operations such as blood transfusions, tattoos, punctures, and organ transplants. It is worth noting that although the hepatitis D virus itself cannot infect humans independently, it can be co-infected with the hepatitis B virus, or cause overlapping infections in individuals already infected with the hepatitis B virus, aggravating the condition.

For the diagnosis of viral hepatitis, especially hepatitis B, one of the commonly used methods in clinical practice is the "five hepatitis B tests", which include the detection of hepatitis B virus surface antigen (HBsAg), surface antibody (anti-HBs), e antigen (HBeAg), e antibody (anti-HBe) and core antibody (anti-HBc). These indicators can help doctors determine whether the patient is infected with the hepatitis B virus and the activity of the virus in the body. For example, HBsAg positive indicates that the patient has been infected; anti-HBs positive means that the individual has developed immunity to the hepatitis B virus, which may be due to vaccination or recovery from natural infection; HBeAg positive indicates that the virus is actively replicating and highly contagious; while anti-HBe positive means that the virus replication is reduced and the contagiousness is reduced; finally, anti-HBc positive usually indicates that the individual has been infected with the hepatitis B virus.

Among the five hepatitis B test results, "145 positive" and "135 positive" are two concepts that are often mentioned. "145 positive" means that HBsAg, anti-HBe and anti-HBc are all positive. This pattern is called "small three positives", indicating that although the patient has hepatitis B virus in the body, the level of viral replication is low and the infectiousness is relatively weak. "135 positive" means that HBsAg, HBeAg and anti-HBc are all positive, called "big three positives", indicating that the virus replicates actively and is highly infectious. Patients need to receive professional treatment in time to control the disease.

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Fortunately, not everyone infected with HBV will develop a chronic disease. In fact, after infection in adults, approximately 60%-90% of individuals will experience an acute self-limiting course, eventually clearing the virus and developing protective antibodies. However, in certain circumstances, such as when receiving chemotherapy drugs, immunocompromised or having immune disorders, the virus may reactivate from a latent state, leading to reactivated infection. Therefore, even if test results show that an individual is immune to HBV, vigilance should be maintained and health status should be monitored regularly.

For the five tests for hepatitis B, qualitative tests and quantitative tests have different focuses. Qualitative tests are mainly used for preliminary screening to determine whether an individual is infected with the hepatitis B virus, and the results are expressed as positive or negative. Once HBsAg is found to be positive, doctors usually recommend further HBsAg quantitative tests to assess the viral load and guide subsequent treatment decisions. HBsAg quantitative tests can provide more accurate data support, which helps monitor treatment effects and adjust treatment plans. For example, by observing changes in HBsAg quantitative values, doctors can understand the progression of the disease and monitor prognosis; monitor changes in HBsAg to decide when to start or stop treatment (interferon or nucleic acid analogs).

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Patients do not need to make special preparations before taking the five-item hepatitis B test. However, if the doctor needs to make a comprehensive assessment or diagnosis of the condition, he may need to combine the five-item hepatitis B test with the results of other tests (such as HBV-DNA, liver function tests, B-ultrasound, etc.) to make a comprehensive judgment. In this case, patients need to fast for 8-12 hours to ensure the accuracy of the test results. At the same time, they should also pay attention to rest and avoid strenuous exercise before the test to avoid affecting the test results.