临床中隐匿性HBV感染的病毒血清标志物和T淋巴细胞亚群特征  

Characteristics of Viral Serum Markers and T Lymphocyte Subsets in Occult HBV Infection Patients

作　　者：陈淑湘 刘新[1] 娄金丽[1] CHEN Shuxiang;LIU Xin;LOU Jinli(Center for Clinical Laboratory,Beijing Youan Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院临检中心,北京100069

出　　处：《标记免疫分析与临床》2022年第9期1446-1450,1527,共6页Labeled Immunoassays and Clinical Medicine

基　　金：北京市优秀人才基金(编号:2018000021469G287);首都医科大学附属北京佑安医院中青年人才孵育项目(编号:BJYAYY-CY2019-11);首都卫生发展科学研究专项公共卫生项目(编号:2021-1G-4302)。

摘　　要：目的分析隐匿性乙型肝炎病毒感染(occult HBV infection,OBI)患者的病毒血清学标志物特征及外周T淋巴细胞亚群情况。方法将2020年5月至2021年12月就诊于首都医科大学附属北京佑安医院血清HBsAg阴性、HBV DNA阳性的292例OBI患者作为OBI组,240例同期入院的HBsAg和HBV DNA持续阳性(>6个月)的慢性HBV感染患者为HBsAg阳性组,收集录入入组532例患者的基本病历资料和实验室检查数据,如HBV血清学标志物、血清HBV DNA载量、肝功能指标等;在OBI组中T淋巴细胞亚群检测数据完整的48例患者作为OBI亚组,同时根据性别和年龄在HBsAg阳性组中匹配48例HBsAg阳性患者作为HBsAg阳性亚组,20例同期入院体检的健康人作为健康对照组,收集此116例患者的外周血T淋巴细胞亚群数量和比值的临床数据。结果OBI患者的主要血清学模式是:HBsAg阴性、抗-HBs阴性、HBeAg阴性、抗-HBe阳性、抗-HBc阳性,占总OBI组的48.97%;抗-HBs阳性率为45.21%,抗-HBe阳性率为85.62%,都明显高于HBsAg阳性患者,差异有统计学意义(P<0.05)。94.86%的OBI组患者的HBV DNA载量<200IU/mL。OBI亚组的淋巴细胞数、T淋巴细胞数、CD8^(+)T淋巴细胞/淋巴细胞、CD8^(+)T淋巴细胞数、CD4^(+)T淋巴细胞数低于健康对照组,且差异都有统计学意义(P<0.05);OBI亚组的淋巴细胞数、T淋巴细胞数、CD8^(+)T淋巴细胞/淋巴细胞、CD8^(+)T淋巴细胞数高于HBsAg阳性亚组患者,差异有统计学意义(P<0.05)。结论OBI患者的血清学标志物特征表明HBV DNA复制和转录水平低下;OBI患者的细胞免疫功能有一定程度的恢复,但与健康人相比仍处于较低水平,体内仍存在HBV感染,且具有HBV重新激活和发展为肝硬化和肝细胞癌的风险。Objective To analyze characteristics of serological markers and peripheral T lymphocyte subsets in patients with occult hepatitis B virus infection(OBI).Methods From May,2020 to December,2021,292 OBI patients with serum HBsAg negative and HBV DNA positive in Beijing Youan Hospital,Capital Medical University,were selected as the OBI group,while 240 patients with chronic HBV infection who were continuously positive for HBsAg and HBV DNA(>6 months)were selected as the HBsAg positive group.The basic medical records and laboratory data of 532 patients were collected,including HBV serological markers,serum HBV DNA load,liver function index and more.52 patients with complete data of T lymphocyte subsets in the OBI group were included as the OBI subgroup,while 52 HBsAg positive patients in the HBsAg positive group were matched as the HBsAg positive subgroup according to sex and age,and 20 healthy people admitted for physical examination in the same period were selected as the healthy control group.The clinical data of the number and ratio of T lymphocyte subsets in peripheral blood of 124 patients were collected.Results The main serological patterns of OBI patients were:HBsAg negative,anti-HBs negative,HBeAg negative,anti-HBe positive,anti-HBc positive,accounting for 48.97%of the total OBI group;the positive rates of anti-HBs and anti-HBe were 45.21%and 85.62%,respectively,which were significantly higher than those of HBsAg positive patients(P<0.05).HBV DNA load of 94.86%of patients in the OBI group was less than 200IU/mL.The number of lymphocytes,T lymphocytes,CD4^(+)T lymphocytes,CD8^(+)T lymphocytes and CD8^(+)T lymphocytes,lymphocytes in the OBI subgroup were significantly lower than those in the healthy control group(P<0.05),while the number of lymphocytes,T lymphocytes,CD8^(+)T lymphocytes and CD8^(+)T lymphocytes in the OBI subgroup were significantly higher than those in HBsAg positive patients(P<0.05).Conclusion Characteristics of serological markers in patients with OBI show that the level of HBV DNA replicatio

关 键 词：隐匿性乙型肝炎病毒感染(OBI) 慢性乙型肝炎(CHB) 乙型肝炎病毒表面抗原(HBsAg) 乙型肝炎病毒载量(HBV DNA) T淋巴细胞亚群 

分 类 号：R512.62[医药卫生—内科学]