慢性乙型肝炎病毒感染者血清中乙型肝炎病毒表面抗原持续低水平表达的临床特征及相关性研究  

Clinical characteristics and correlation of chronic HB V infection patients with persistent low-level expression of HBsAg in serum

作　　者：周华君 陶昭君 戴玉柱[1] 车飞虎[1] 成军[1] ZHOU Hua-jun;TAO Zhao-jun;DAI Yu-zhu;CHE Fei-hu;CHENG Jun(Laboratory Department,903 Hospital of PLA Joint Logistics Support Force,Hangzhou,Zhejiang 310000,China)

机构地区：[1]中国人民解放军联勤保障部队第903医院检验科,浙江杭州310000

出　　处：《中国卫生检验杂志》2020年第20期2433-2438,共6页Chinese Journal of Health Laboratory Technology

基　　金：南京军区医学基金会(12MA117);浙江省自然科学基金(LY15H2000)。

摘　　要：目的了解慢性HBV感染者血清HBsAg持续低水平表达的临床特征及相关性分析。方法收集2017年体检者21217例样本,其中1204例HBsAg阳性样本,采用化学发光微粒子免疫法对其进行其他血清标志物和HBVDNA(实时荧光定量)做进一步检测,按HBsAg水平将样本分为高水平组(≥10 IU/ml)和低水平组(<10 IU/ml),对低水平组样本按年龄、性别、血清学模式、临床分型等指标分组统计分析HBsAg和HBVDNA的阳性分布及浓度;并与同期收集的高水平组样本比较。结果低水平HBsAg感染者占总HBsAg阳性人群的15.03%,其主要血清学模式和临床分型为HBsAg/anti-HBe/anti-HBc阳性(93.37%)、无症状携带者(ASC,98.34%),HBVDNA呈低水平复制,HBVDNA阳性率为40.33%,低水平HBsAg人群呈高龄偏态分布特征,相关性分析显示低水平HBsAg与低复制的HBVDNA存在正相关(r=0.452,P<0.05)。结论对低水平HBsAg人群的系统研究,可为进一步分析低水平HBsAg形成的机制、打破免疫耐受清除慢性HBV感染、预防HBV传播奠定了基础。Objective Hepatitis B surface antigen(HBsAg)is one of the most important pathogen markers and direct evidence of hepatitis B virus(HBV)infection.The phenomenon of sustained low-level HBsAg and low replication of nucleic acid in the sera of chronic HBV-infected patients have been proved to be a new challenge to the prevention and treatment of hepatitis B,Therefore,it is of great clinical and epidemiological significance to understand the clinical characteristics of crowd with sustained low-level HBsAg.Methods 21217 samples were collected from physical examination population in 2017.A total of 1204 HBsAg positive samples were further detected by chemiluminescent particle immunoassay for other serum markers and HBV DNA(real-time fluorescence quantification).The samples were divided into high-level group(>10 IU/ml)and low-level group(<10 IU/ml)according to the level of HBsAg.The samples of low-level group were divided into age,sex,serological pattern and prognosis.The positive distribution and concentration of HBsAg and HBV DNA were analyzed by grouping and statistical analysis,and compared with high-level group samples collected in the same period.Results Low-level HBsAg infection accounted for 15.03%of the total HBsAg-positive population.The main serological patterns and clinical typing were:HBsAg/anti-HBe/anti-HBc positive(93.37%)and asymptomatic carriers(ASC,98.34%).HBV DNA was replicated at a low level,and the positive rate of HBV DNA was 40.33%.The low-level HBsAg population showed a skewed distribution at an advanced age.There was a positive correlation(r=0.452,P<0.05).Conclusion Systemic investigation of subjects with low-level HBsAg is clinically and epidemiologically important to enhance the detection of HBV serological markers,elucidate the mechanism of sustained low-level HBsAg,break the immune tolerance of chronic HB infection,eliminate chronic HBV infection and prevent HBV transmission.

关 键 词：乙型肝炎病毒表面抗原 乙型肝炎病毒 低水平 临床特点 相关性研究 

分 类 号：R512.62[医药卫生—内科学]