不明原因肝病患者肝组织HBV及HCV抗原的检测及临床和病理特点

Clinical and pathological characteristics of immunohistochemistry staining for HBV and HCV antigen on liver tissue of unknown etiology

目的了解不明原因肝病患者中HBV及HCV隐匿性感染所占的比例及临床、病理特点。方法对31例不明原因肝病患者,采用酶联免疫吸附试验(ELISA)检测血清乙型肝炎病毒标志物(HBV-M)(HBsAg、抗-HBs、HBeAg、抗-HBe和抗-HBc)及丙型肝炎病毒抗体;血清HBV DNA采用荧光定量PCR法检测,HCV RNA采用RT-PCR法检测;应用免疫组织化学二步法检测肝组织中的HBsAg、HBcAg、HCV抗原,并进行常规病理检查。结果肝组织HBV抗原阳性者11例(35.5%);HBV、HCV抗原均阳性者10例(32.3%),全阴性者10例(32.3%)。存在HBV隐匿性感染的21例患者中,慢性肝炎患者7例,肝硬化患者12例,肝细胞性肝癌患者2例。结论HBV、HCV感染为不明原因肝病的主要原因,尤其是HBV感染。HBV隐匿性感染与慢性肝炎、肝硬化、肝癌关系密切,应引起重视。

Objective To investigate the incidence of occult hepatitis B virus infection among chronic liver diseases of unknown etiology. Methods The serum HBV markers （ HBsAg, anti-HBs, HBeAg, anti-HBe, anti-HBc） and anti-HCV were detected by ELISA. Serum HBV DNA was detected by FQ-PCR, HCV RNA with RT-PCR and HBsAg, HBcAg, HCV antigen in liver tissue with immunohistochemistry and some routine pathological examination were carried out. Results In 31 patients, 11 cases （35.5%） were positive with HBV antigen, 10 cases （32.3%） were positive with both HBV antigen and HCV antigen, also 10 cases （32.3%） were negative with both HBV antigen and HCV antigen. In 21 patients with occult HBV infection, 7 cases were chronic hepatitis, 12 cases were liver cirrohosis, 2 cases were hepatocellular carcino- ma. Conclusions Occult HBV and HCV infection may account for a high proportion in chronic liver diseases of unknown etiology, especially HBV infection. Occult HBV infection may induce liver cirrohosis and hepatocellular carcinoma, so more attentions should be paid to.