症例は52歳女性．2008年12月当院にて急性骨髄性白血病の診断．移植目的に他院紹介となり，2009年6月同種造血幹細胞移植が行われた．移植後，移植片対宿主病と一過性の肝胆道系酵素異常が認められたがその後は著変なく，同院にて半年ごとに経過観察されていた．2014年10月近医にて脂質異常症を指摘されロスバスタチンの内服治療が開始された．1.5カ月後の血液検査で肝機能障害が認められ当科へ紹介．来院時検査にてHBs抗原陽性，IgM-HBc抗体高力価であることから急性B型肝炎と診断し保存的に加療した．核酸アナログ製剤は使用することなく1カ月の経過で肝炎は沈静化し，2.5カ月後に血中HBV-DNAの消失を確認した．後日他院照会にて移植前検査においてHBs抗原陰性，かつHBc抗体およびHBs抗体陽性の既往感染者であったことが判明しde novo B型肝炎と最終診断した．
It is unclear if genotype C-derived hepatitis B (HB) vaccine can prevent perinatal hepatitis B virus (HBV) infection caused by genotype A. The effectiveness of genotype C-derived HB vaccine in preventing perinatal transmission was retrospectively evaluated in children born to HBV carrier mothers infected with genotype A. Three children were enrolled in this study. All of the children received prophylactic treatment with hepatitis B immune globulin and a series of three-shot genotype C-derived HB vaccine after birth. All of them were positive for serum anti-HBs and negative for serum HBsAg one month after the 3rd shot of HB vaccine. In conclusion, genotype C-derived HB vaccine is effective in the prevention of perinatal transmission caused by genotype A.
Observation of liver fibrosis in patients with nonalcoholic steatohepatitis (NAFLD) is important; however, biopsy is gold standard for assessing liver fibrosis, and has risk of critical complications. New non-invasive examination, a measurement of serum Wisteria floribunda agglutinin-positive Mac-2 binding protein (WFA+-M2BP) was invented. We investigated the significance of measuring serum WFA+-M2BP for observing hepatic fibrosis in patients with NAFLD by analyzing repeated biopsied cases. 46 patients were enrolled, and between two biopsies, liver fibrosis of 15 patients was unchanged, 18 patients worsened, and 13 patients improved. In unchanged group, serum WFA+-M2BP did not change, but worsened group tended to increase and improved group decreased. From present data monitoring serum WFA+-M2BP may useful to non-invasively observe liver fibrosis in patients with NAFLD.