乙型肝炎病毒经手术传播感染阈值的实验研究

EXPERIMENTAL STUDY OF HEPATITIS B VIRUS INFECTION THRESHOLD DURING OPERATION

目的探讨围术期乙型肝炎病毒（HBV）感染阈值。为建立其监控方法以及评价该方法的防护效果提供依据。方法使用ELISA法检测992例手术患者的HBsAg和HBeAg．套式PCR法检测156例HBsAg阳性和100例阴性者的HBVDNA。套式PCR极量稀释法检测HBVDNA阳性者的感染剂量，缝针刺伤接种模拟试验法检测HBV经手术传播的感染阈值。结果HBsAg阳性和阴性、HBeAg阳性和阴性者的HBVDNA阳性率分别为73．7％和9．0％、100．0％和67．2％：其传染性范围分别在0—109ID/ml和0～104ID/ml、102-109ID!ml和0～106ID／ml。缝针刺伤单层手套传播HBV的感染阈值为手术传播的基本阈值，其值是105ID／Ⅱd，HBsAg阴性HBV携带者都不能成为传染源；保护手术患者的感染闽值是103ID／ml，68．6％HBsAg阳性者不能成为传染源．15．2％HBeAg阴性者可成为传染源：保护外科医生的感染阂值是108.5ID!ml，所有HBeAg阴性者和99．4％HBsAg阳性者不能成为传染源。结论围术期保护医生或患者的HBV感染阈值不同．使用的防护措施也应该不同。

Objective To study the infection threshold of hepatitis B virus （HBV） during operation, so as to provide the basis for establishing a method to supervise the infection and to evaluate its protection. Methods ELISA method was used to detect HBsAg and HBeAg in 992 surgical patients. Nest PCR was used to detect HBV DNA of 156 HBsAg positive patients and 100 HBsAg negative patients. The infectious dose （ID） of HBV DNA pos- itive patients was detected by nest PCR maximal dilution method. Suture needle inoculating simulated test was used for determination of the HBV infection threshold value through operation transmission. Results The HBV DNA posi- tive rate in HBsAg positive and negative, HBeAg positive and negative patients was 73.7% and 9.0%, 100.0% and 67.2% respectively; and the infectious range was 1 - 109ID/ml, 0 - 104ID/ml; 102 - 109ID/ml, 0 - 106ID/ml respectively. HBV infection threshold value of single layer gloves was 105ID/ml;it was used as the basic threshold value of HBV transmission during operation;and HBsAg negative HBV carriers could not be the infectious source. The infection threshold of protected patients was 103ID/ml;68.6% HBsAg positive patients could not be the infec- tious source,while 15.2% HBeAg negative patients could become the infectious source. The infection threshold of protected surgeon was 10s 5ID/ml ;all HBeAg negative and 99.4% HBsAg positive patients could not be the infec- tious source. Concluson The infection threshold of protected surgeon and patients during operation are different, so the protection measures should be different.