昆明地区HBV感染的免疫学调查

The immunological investigation and analysis on infection with HBV in kunming,China

目的调查昆明地区HBV感染血清模式的分布特征,探求其免疫相关机制。方法调查2000-2006年昆明地区的98462例血清"两对半"检测结果,并选取其中涵盖了全部HBV感染模式的426份血清,以荧光定量PCR法检测HBV-DNA含量,同时检测血清ALT及AST活性。以50份HBV血清标志全部阴性血清为对照。结果共发现12种HBV感染血清模式,其中4种模式:"HBeAg(+)","HBeAg(+)、抗-HBe(+)、抗-HBc(+)","HBeAg(+)、抗-HBc(+)","HBsAg(+)、HBeAg(+)、抗-HBe(+)、抗-HBc(+)"模式检出率均较低(P<0.05),属于少见模式;在其余8种模式中,"HBsAg(+)"模式检出率低于另外7种模式(P<0.05);在12种模式中,"大三阳"模式、"HBsAg(+)、抗-HBc(+)"模式及4种少见模式HBV-DNA阳性率、复制水平及血清ALT和AST活性异常增高率均较高(P<0.05);"抗-HBs(+)、抗-HBe(+)、抗-HBc(+)"模式及"抗-HBe(+)、抗-HBc(+)"模式的HBV-DNA阳性率分别为6.0%(3/50)、8.0%(4/50),HBV-DNA平均含量为1.074×103copies/ml,同时伴有2.0%(1/50)及6.0%(3/50)的血清ALT或AST异常升高,显著高于对照组(P<0.05)。结论昆明地区HBV感染血清模式丰富,以7种模式较常见;近年来随着少见模式的出现,临床应加强对HBV复制及肝功能指标的观察以监测病情的活动性;一些被认为仅是既往感染而非"乙肝"标志的血清模式也可能出现HBV复制和肝功能异常,应引起临床重视。

Objective To investigate the distribution and to analyze the immunological mechanism of HBV-infected serum-type in Kunming City,China.Methods We studied all the 98462 tests of the ＂HbsAg,anti-HBs,HbeAg,anti-Hbe,anti-HBc＂ in our lab since 2000,from which we selected 426 samples that contain all kinds of serum-types of the HBV infection and 50 health samples as a control group.The HBV-DNA levels of the 426 samples were detected by real-time quantitative PCR,and the activity of ALT and AST were also detected at the same time.Results Among the 98462 samples,we found 12 kinds of HBV-infected serum-types in all,4 of which were recently found and infrequent in Kunming City（the proportions were lower than the others,P〈0.05）;In the serum-types of ＂HBsAg（＋）,anti-HBs（-）,HBeAg（＋）,anti-HBe（-）,anti-HBc（＋）＂,＂HBsAg（＋）,anti-HBs（-）,HBeAg（-）,anti-HBe（-）,anti-HBc（＋）＂,＂HBsAg（-）,anti-HBs（-）,HBeAg（＋）,anti-HBe（-）,anti-HBc（-）＂,＂HBsAg（-）,anti-HBs（-）,HBeAg（＋）,anti-HBe（＋）,anti-HBc（＋）＂ and ＂HBsAg（＋）,anti-HBs（-）,HBeAg（＋）,anti-HBe（＋）,anti-HBc（＋）＂,the levels and positive proportions of HBV-DNA and the activity of ALT and AST were higher than that of the others（P〈0.05）;in the serum-types of ＂HBsAg（-）,anti-HBs（＋）,HBeAg（-）,anti-HBe（＋）,anti-HBc（＋）＂ and ＂HBsAg（-）,anti-HBs（-）,HBeAg（-）,anti-HBe（＋）,anti-HBc（＋）＂,the average level of HBV-DNA was 1.074×103copies/ml,the positive proportions of HBV-DNA was 6.0%（3/50）and 8.0%（4/50）,the higher activity of ALT and AST were 2.0%（1/50）and 6.0%（3/50）,which were significantly higher than normal（P〈0.05）.Conclusion The HBV-infected serum-types in Kunming area are abundant.The recently-found serum-types of the HBV show that attention should be paid to HBV-DNA and the activity of ALT and AST when we inspect the disease.Since positive HBV-DNA and high activity of ALT and AST may appear on the serum-types of some of the HBV-infected but non-hepatitis B cases,this index should be valued especially.