HBsAg阴性患者HBV隐匿性感染：110例临床分析  

Clinical analysis of occult hepatitis B virus infection in 110 HBsAg-negative patients

作　　者：袁琴[1] 伍春霞[1] 刘飞飞[2] 罗旗 刘何蕾 李成敏[1] 郑洁[1] 罗舒文[4] 张聪 曾爱中[1] 

机构地区：[1]重庆医科大学附属第一医院感染科,重庆400016 [2]四川德阳德阳市人民医院感染科,618000 [3]大足县人民医院感染科,重庆大足402360 [4]重庆市第九人民医院感染科,重庆400700 [5]嘉兴市第一人民医院感染科,浙江嘉兴314001

出　　处：《解放军医学杂志》2015年第2期133-136,共4页Medical Journal of Chinese People's Liberation Army

基　　金：国家自然科学基金(3097258)~~

摘　　要：目的分析隐匿性乙型肝炎病毒感染(OBI)患者的临床特征。方法纳入2012年3月—2014年1月于重庆医科大学就诊的HBs Ag阴性、HBV DNA在检测值以下的乙肝患者110例。采用高纯度病毒核酸检测试剂盒提取血清HBV DNA,采用巢式PCR对HBV基因组C、S、X区进行扩增。对不同性别、年龄及血清学模式[单独抗-HBc(+)及抗-HBs(+)/抗-HBc(±)]患者,以及不同病因所致肝损害患者的OBI发生率进行分析。结果以巢氏PCR结果2个或2个以上区段同时阳性判定为OBI,110例入选患者OBI阳性率为23.6%(26/110);不同性别、年龄段、血清学模式患者OBI发生率差异无统计学意义。肝功能异常组OBI发生率明显高于正常组(35.1%vs 11.3%),两者比较差异有统计学意义(P<0.01);不明原因肝损害及有明确病因肝损害的OBI发生率分别为31.0%(9/29)和39.3%(11/28),差异无统计学意义。结论在HBs Ag阴性患者中,OBI更易发生在有肝功能损害的患者。当HBs Ag阴性患者肝损害原因不明时,应及时采用高灵敏HBV DNA检测方法以排除HBV隐匿性感染。Objectives To investigate the prevalence of occult HBV infection （OBI） in HBsAg-negative patients, and analyze its clinical features. Methods Serum samples from HBsAg-negative patients from Mar. 2012 to Jan. 2014 in Chongqing Medical University were collected. The amount of HBV DNA of these patients was undetectable by fluorescent quantitative PCR. HBV DNA was extracted with high pure viral nucleic acid kit. The C, S and X genes of HBV genome were amplified by nested PCR. The patients with different gender, different ages, and different serological patterns （anti-HBc＋ alone and anti-HBs＋/anti-HBc ~ ）, and OBI incidence in the patients with liver injury induced by various etiological factors were analyzed. Results The patients with two or more positive DNA segments were identified to have OBI based on nested PCR, and the positive rate of OBI was 23.6%（26/110）, and there was no statistically significant difference in gender, age, and serological patterns. The incidence of OBI was 35.1% in the patients who had liver injury, while 11.3% in those with normal liver function, showing a significant statistical difference （P〈0.01）. The prevalence of OBI was 31.0%（9/29） and 39.3%（11/28） in the patients with liver injury of undetermined origin and in those with liver injury of defined origin respectively. Conclusions OBI is more likely to occur in HBsAg-negative individuals with liver dysfunction, while OBI is one of the causes of unexplained liver damage. Therefore, prompt detection of HBV DNA is necessary to exclude OBI in those individuals.

关 键 词：肝炎病毒 乙型 肝炎表面抗原 乙型 聚合酶联反应 

分 类 号：R512.62[医药卫生—内科学]