自身免疫性肝病患者隐匿性HBV感染状况及意义

The prevalence of occult HBV infection in patients with autoimmune liver diseases and its significance of of immunosuppressive therapy

目的评估自身免疫性肝病不同亚型,即自身免疫性肝炎(AIH)、原发性胆汁性肝硬化(PBC)和原发性硬化胆管炎(PSC)患者中隐匿性乙型肝炎病毒(HBV)感染情况,并探讨隐匿性HBV感染检测在AIH患者免疫抑制治疗风险评估中的作用。方法荧光定量-聚合酶链反应(FQ-PCR)检测392例HBsAg阴性自身免疫性肝病患者初诊血清标本、564例健康献血者血清标本和206例来自76例行免疫抑制治疗的AIH患者随访血清中的乙型肝炎病毒脱氧核糖核酸(HBV-DNA)拷贝数。结果 48/392(12.24%)患者中检测到HBV-DNA,AIH、PBC和PSC患者中隐匿性HBV感染率分别为13.64%(18/132)、8.60%(16/186)和18.92%(14/74);与564例健康献血者(1例阳性,占0.18%)相比,差异具有统计学意义(P<0.0001)。对76例AIH患者随访标本的连续测定发现,免疫抑制治疗前HBV-DNA阴性患者中有3例在治疗过程中转为阳性,而所有初诊时HBV-DNA阳性的患者在治疗过程中转为阴性。结论自身免疫性肝病患者中隐匿性HBV感染率较高,但隐匿性HBV感染并不影响AIH患者的免疫抑制治疗效果。

Objective To evaluate the prevalence of occult HBV infection in various subtypes of autoimmune liver diseases （AIH.PBC,PSC）and to explore its role in the risk evaluation of immunosuppressive therapy in AIH patients. Methods Real time fluorescence quantitative PCR（FQ-PCR）was employed to detect HBV-DNA in 392 sera samples from negative patients with autoimmune liver diseases （ including 132 autoimmune hepatitis （ AIH ）, 186 primary biliary cirrhosis （PBC） and 74 primary sclerosing cholangitis（PSC）） ,564 healthy blood donors and 206 serial samples from 76 AIH patients under immunosuppressive therapy. Results HBVDNA was detected in the serum of 48/392 patients（12.24%）and 1/564 donors（0.18%,P〈0.000 1）.The prevalence of occult HBV in AIH,PBC and PSC was respectively 13.64%（18 patients）,8. 60% （16 patients）and 18.92% （14 patients）（P〈 0. 000 1 vs healthy control）. Consecutive testing of AIH patients revealed that 3 HBV-DNA-negative patients became positive before treatment,while all HBV-DNA-positive patients became negative before immunosuppressive therapy. Conclusion A significant proportion of autoimmune liver disease patients were found to be infected with occult HBV compared. But there is no influence on the therapeutic effects of immunosuppressive therapy on AIH patients.