茂名地区无偿献血者72例HCV感染特征及检测效果评价分析  

Classification and characterization of 72 blood donor with HCV infection in Maoming

作　　者：高艳 孙亚纯 李婷婷[2] 陈龙菊 陆超劲 

机构地区：[1]茂名市中心血站,广东茂名525000 [2]南方医科大学输血医学系

出　　处：《中国输血杂志》2015年第5期527-530,共4页Chinese Journal of Blood Transfusion

基　　金：茂名市科技计划项目(20130334);广东省医学科学技术研究基金(WSTJJ20121205210423198304280024)

摘　　要：目的测定茂名地区部分丙型肝炎病毒感染献血者中不同感染状态比率及其分子特征,分析丙型肝炎病毒感染基因型分布流行特征及趋势,评价ELISA法检测血液HCV的效果。方法对本地区献血者中抗-HCV检测呈反应性的血液标本采用定量PCR方法检测血浆中病毒载量,同时采用巢式PCR技术扩增核酸片段,进而将血液标本分为病毒自然清除(RNA-/抗-+)与病毒血症(RNA+/Ab抗-+)2种状态,并分析2种状态在献血者性别方面的差异。HCV RNA阳性标本通过分析5’-NCR序列进行基因分型。比较ELISA与NAT检测方法的符合性。结果72份抗-HCV呈反应性的标本中,病毒自然清除50份(69.4%),病毒血症22份(30.6%)。22份PCR定量阳性标本中基因分型阳性17份,其中基因1型占17.6%(3/17),基因2型占11.8%(2/17),基因3型17.6%(3/17),基因6型47.1%(8/17),无法准确定型5.8%(1/17)。试剂A检测呈反应性标本中核酸确认阳性标本占32.3%;试剂B为54.5%。女性病毒血症的比例(2/19)比男性(20/53)低27.2%(χ2=9.637,P<0.05)。结论茂名地区献血者HCV感染病毒自然清除率约为69.4%,HCV基因型中6型为主要基因型,女性献血者更容易清除病毒。现行2遍ELISA检测策略安全有效,但同时存在特异性不高的弊端,实施ELISA加NAT检测的策略,更能保证血液的安全和降低检测假阳性。Objective To determine the ratio of different infection status in blood donors infected with hepatitis C virus（ HCV）,to explore the distribution and trends of HCV genotypes from Maoming,and to evaluate the effectiveness of ELISA reagents. Methods Antibody reactive serum confirmed by at least two anti-HCV ELISAs were tested for viral load by QPCR,confirmed by RT-Nested PCR,and then categorized into two different statuses of spontaneous clearance（ RNA-/ Ab ＋） and viremia（ RNA ＋ / Ab ＋）. Statistical analysis was conducted according to gender difference. HCV phylogenetic analyses were also conducted by 5＇-NCR genotyping. The conformity of ELISA and NAT was compared. Results Seventy-two index plasma samples were stratified into 50 spontaneous clearance statuses and 22 viremia statuses. Viral loads of 22 serums with viremia status ranged from 1. 187 × 102 to 2. 954 × 106 IU / ml,with a median value of 2. 07 × 104 IU / ml. Genotypes 1（ 17. 6%）,2（ 11. 8%）,3（ 17. 6%）,6（ 47. 1%） and undecided（ 5. 8%） of 17 HCV strains were identified phylogenetically.32. 3% of Lizhu reagents on anti-HCV ELISA positive samples were tested HCV RNA positive,and 54. 5% of Xinchuang reagents were tested positive. Females with viremia statuses（ 2 /19） were 27. 2% lower than the males（ 20 /53）（ χ^2= 9. 637,P 0. 05）. Conclusion The spontaneous clearance rate was 69. 4% and genotype 6 was dominant. Female blood donors were perceived to be easier to recover from HCV infection. The current two rounds ELISA detection strategy is feasible,but has lower specificity. Adopting ELISA and NAT methods together will ensure blood safety and reduce the ratio of false positives.

关 键 词：HCV 病毒自然清除 病毒血症 特征 基因分型 

分 类 号：R446.6[医药卫生—诊断学]