青岛地区无偿献血者血液病毒核酸检测的研究

Study of nuclei-acid-test(NAT) among volunteer blood donors from Qingdao area

目的调查青岛地区现有的血液检测体系是否存在输血传播HBV、HCV和HIV的残余风险。方法对无偿献血者样本ELISA法检测HBsAg、抗-HCV和抗-HIV的同时,应用NAT技术检测HBV、HCV和HIV。NAT检测阳性ELISA HBsAg阴性或NAT检测阴性ELISA HBsAg阳性的样本,进一步跟踪确认。结果12 000人份无偿献血者血样未发现ELISA法检测抗-HCV和抗-HIV阴性,NAT检测HCV和HIV阳性的情况,发现2例HBV DNA阳性HBsAg阴性。1例HBV DNA阳性,乙肝免疫检测HBsAg、抗-HBs、HBeAg、抗-HBe和抗-HBc均为阴性,跟踪11周后采血检测HBV DNA阳性,HBsAg、HBeAg和抗-HBc阳性。另1例HBV DNA阳性,乙肝免疫检测HBsAg、抗-HBs、HBeAg、抗-HBe均为阴性,抗-HBc为阳性,跟踪3周后采血检测,2次检测结果相同,HBV DNA定量检测均为1000IU/ml左右的低含量。结论现有的血液检测体系存在输血传播HBV风险,原因可能为HBV的免疫"窗口期"、隐匿性HBV感染等,建议现有的血液检测体系下,为了阻断HBV的输血传播,增加HBV的病毒核酸检测和抗-HBc检测。

Objective To investigate the residual risks of transfusion-transmitted HBV/HCV/HIV in current donor screening system of Qingdao area. Methods After the ELISA tests （ HbsAg, anti-HCV, anti-HIV ） were performed, NAT tests of HBV-DNA, HCV-RNA, and HIV-RNA on plasma samples were conducted. Such specimens as have discrepant ELISA and NAT results （ N ＋/E - , or N -/E ＋ ） were subject to further follow-up confirmation tests. Results Among 12000 donor samples,no sample with anti-HCV （ - ）/HCV-RNA （ ＋ ）or with anti-HIV （ - ）/HIV-RNA （ ＋ ） was detected. However,2 individuals were detected as HBsAg （ - ）/HBV-DNA （ ＋ ）. One donor had negative ELISA test results in HBsAb, HBeAg, HBeAb, and HBcAb at the first screening. But the HBsAg, HBeAg and HBcAb were confirmed positive along with HBV-DNA after 11 weeks. The other donor was negative for HBsAb,HBeAg,and HBeAb but positive for HBcAb. Follow up tests after 3 weeks indicated the same serological results ,with a similar low viralload at about 1000 IU/mL. Conclusion Due to the window period and occult HBV infection,current blood donor screening system has some residual risks of transfusion-transmitted HBV. NAT and HBcAb tests should be implemented to reduce the residual risks of transfusion-transmitted HBV.