化学发光免疫分析法检测HBcAb阳性、HBsAg阴性血清中隐匿性乙型肝炎病毒感染的分析

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英文篇名：Analysis of Occult Hepatitis B Virus Infection with Serum of HBcAb Positive and HBsAg Negative Using Chemiluminescence Immunoassay 作者：何成山 ; 马晨芸 ; 陆志成 英文作者：HE Cheng-shan;MA Chen-yun;LU Zhi-cheng;Bengbu Medical University;Department of Clinical Laboratory,Shanghai Seventh People's Hospital,Shanghai Universityof Traditional Chinese Medicine; 关键词：隐匿性乙型肝炎病毒感染 ; 化学发光免疫分析法 ; 乙型肝炎病毒表面抗原 ; 乙型肝炎病毒核心抗体 英文关键词：Occult hepatitis B virus infection;;Chemiluminescence immunoassay;;Hepatitis B surface antigen;;Hepatitis B virus core antibody 中文刊名：BJMY 英文刊名：Labeled Immunoassays and Clinical Medicine 机构：蚌埠医学院;上海中医药大学附属第七人民医院医学检验科; 出版日期：2019-01-25 出版单位：标记免疫分析与临床 年：2019 期：v.26;No.147 基金：上海浦东新区卫生和计划生育委员会重要薄弱学科建设项目(编号:PWZbr2017-01);; 上海市卫生和计划生育委员会科研课题面上项目(编号:201440353) 语种：中文; 页：BJMY201901033 页数：5 CN：01 ISSN：11-3294/R 分类号：135-138+177

摘要

目的分析化学发光免疫分析法(CIA)检测乙型肝炎病毒核心抗体(HBcAb)阳性、乙型肝炎病毒表面抗原(HBsAg)阴性血清学模式中隐匿性乙型肝炎病毒感染(OBI)的情况,旨在了解CIA检测HBsAg的分析性能,并为评价OBI提供实验室依据。方法收集2017年5月至2017年12月本院检验科近20000份CIA检测乙型肝炎病毒(HBV)五项血清学标志物中HBsAg无反应性、HBcAb阳性且信号值比临界信号值(S/Co值)>7.5的样本1157例,对样本HBcAb再进行酶联免疫吸附试验(ELISA)复筛,选取A450nm吸光值<0.070样本294例进行HBV DNA检测。结果 1157例样本进行HBcAb ELISA检测,复筛得HBcAb阳性标本1053例,阴性104例,其中A450nm吸光值<0.070样本294例。294例样本进行HBV DNA检测,其中HBV DNA阳性(HBV DNA>20IU/mL为阳性)34例,总阳性率为2.94%(34/1157)。22例HBV DNA载量21～99IU/mL;7例为100～1000IU/mL;5例为> 1000IU/mL;主要以低水平形式存在。以HBeAb、HBcAb阳性及HBsAb、HBeAb和HBcAb阳性这两种血清学模式中HBV DNA检出率较高;HBcAb S/Co≥10.0样本HBV DNA阳性率可达13. 5%。结论 CIA作为检测HBsAg灵敏度较高的方法 ,依然存在HBsAg阴性而HBV DNA阳性的OBI。这对于输血的安全性和乙肝的预防监测及治疗都存在重大影响。临床上对于HBsAg阴性伴高反应性HBcAb(S/Co值≥10.0)的患者应进行一步行HBV DNA检测,以明确OBI的存在。
        Objective To analyze occult hepatitis B virus infection(OBI) with serum of HBcAb postive and HBsAg negative using Chemiluminescence Immunoassay, to understand the analytical performance of HBsAg by CIA and providing laboratory evidence for the evaluation of OBI. Methods From May 2017 to December 2017, we collected around 20,000 testing results using chemiluminescence immunoassay(CIA method) in the Department of clinical laboratory. The detection of five serological markers for hepatitis B virus(HBV)with HBsAg negative, HBcAb positive and signal value greater than the critical signals(S/Co value) >7.5 were selected and 1157 samples were screened. Among these samples, we further screened by enzyme-linked immunosorbent assay(ELISA) on HBcAb, and 294 samples with A450 nm absorbance value<0.070 were selected for HBV DNA detection. Results HBcAb ELISA kit was used to detect the 1157 HBsAb positive samples, 1053 HBcAb positive samples and 104 negative samples. There were 294 cases with OD value <0. 070,of which 34 cases were HBV DNA positive(HBV DNA >20 IU/mL was positive),with the positive rate of 2.94%(34/1157). Twenty two patients had HBV DNA loads 21-99 IU/mL,7 patients were 100-1000 IU/mL,and 5 patients were >1000 IU/ml, suggesting that they were mainly present at low levels. The positive rates of categories of HBeAb and HBcAb positive, and HBsAb, HBeAb and HBcAb positive serological models were higher in HBV DNA detection,and among HBcAb S/Co ≥10.0 samples,the HBV DNA positive rate was up to 13. 5%. Conclusion CIA method, as the most sensitivity measure of HBsAg,still has negative HBsAg and HBV DNA positive OBI. This has a major impact on the safety of blood transfusions, prophylaxis, monitoring, and treatment of HBV. Clinically, patients with HBsAg negative and HBcAb hyperresponsiveness(S/Co value≥10.0) should be tested for HBV DNA to determine the presence of OBI.

引文

[1] HUANG C H,YUAN Q,CHEN P J,et al. Influence of mutations in hepatitis B virus surface protein on viral antigenicity and phenotype in occult HBV strains from blood donors[J]. J Hepatol, 2012,57(4):720-729.
    [2]徐爱强,张丽.中国成年人乙型肝炎疫苗免疫策略的循证与思考[J].中华预防医学杂志,2016,50(6):473-477.
    [3] HUANG X,HOLLINGER F B. Occult hepatitis B virus infection and hepatocellular carcinoma:a systematic review[J]. J Viral Hepat,2014,21(3):153-162.
    [4]周怡,史恩溢,曹谊,等. HBsAg阴性献血者隐匿性HBV感染的血清学特征及其与病毒载量的关系[J].临床输血与检验,2017,19(6):570-573.
    [5]蒋菲菲,吕蓉,李敏,等.华东地区献血者人群隐匿性乙型肝炎病毒感染及S区变异分析[J].中国输血杂志,2017,30(7):762-766.
    [6] YUAN Q, SONG L W, LIU C J, et al. Quantitative hepatitis B core antibody level may help predict treatment response in chronic hepatitis B patients[J]. J Gut,2013,62(1):182-184.
    [7] SONG L W,LIU P G,LIU C J,et al. Quantitative hepatitis B core antibody levels in the natural history of hepatitis B virus infection[J]. J Clin Microbiol Infect,2015,21(2):197-203.
    [8] KISHK R, NEMR N, ELKADY A, et al. Hepatitis B surface gene variants isolated from blood donors with overt and occult HBV infection in north eastern Egypt[J]. Virol J,2015,30(12):153.
    [9] SAITTA C, TRIPODI G, BARBERA A, et al. Hepatitis B virus(HBV)DNA integration in patients with occult HBV infection and hepatocellular carcinoma[J]. J Liver Int,2015,35(10):2311-2317.