HBsAg+/HBV DNA-献血者的追踪检测及预后分析

Tracking and prognosis analysis for HBsAg+/HBV DNA-blood donors in Shenzhen

目的研究HBsAg+/HBV DNA-无偿献血者感染转归及发展预后。方法对常规血液筛查结果为HBsAg+/NAT-献血者进行6个月以上的追踪随访,采用巢式PCR及实时荧光定量检测方法 (QPCR)确认追踪血样HBV DNA存在,及化学发光方法复检献血者HBsAg,分析该类献血者的感染转归及发展预防后情况。结果常规血液筛查从40 851例献血者检出114/40 851例(0.28%)HBsAg+/NAT-献血者,经巢式PCR、QPCR及化学发光方法对HBV DNA、HBsAg确认,有96/114例(84.21%)确认为HBsAg+/HBV DNA-。对96例HBsAg+/HBV DNA-献血者追踪,获得30/96例(31.25%)献血者追踪检测数据。30例HBsAg+/HBV DNA-献血者有10例(33.33%)献血者转为康复状态(HBsAg-/HBV DNA-),13例(43.33%)献血者转为显性HBV感染(HBsAg+/HBV DNA+),7例(23.33%)仍维持HBsAg+/HBV DNA-感染状态不变。3种感染转归状态献血者(康复、不变、阳转),以康复组的抗-HBs由阴转阳比例更高(P<0.05)。结论 HBsAg+/HBV DNA-献血者存在自然康复及转为显性HBV感染的情况,建议对HBsAg+/HBV DNA-献血者定期多次采血检测,根据不同复检结果,进行献血资格淘汰或保留,有利于减少献血者资源流失,同时保证血液安全。

Objective To study the progression and prognosis of HBsAg ＋/HBV DNA - blood donors in Shenzhen city. Methods A 6 month follow-up research was conducted for those HBsAg ＋/HBV DNA - donors via blood screening. A chemil method was used to detect HBsAg, while nested-PCR and QPCR were used to detect HBV DNA. Results Among 40 851 blood donors, 114 HBsAg ＋/NAT - samples were tested, of which 96 were confirmed as HBsAg ＋/HBV DNA - by further chemiluminescence, nest-PCR and QPCR test. Among those 96 HBsAg ＋/HBV DNA-samples, 30 donors were successfully followed up. Through detection, 10/30 （33.33%） donors with HBsAg were spontaneously cleared without treatment （HBsAg-/HBV DNA- ）, 13/30 （43.33%） donors turned into overt HBV infection （HBsAg ＋/HBV DNA ＋ ）, and 7/30 （23.33%） remained the same HBsAg ＋/HBV DNA - state. The recovered group （HBsAg -/HBV DNA - ） had a significant higher seroconversion rate of anti-HBs than the other two groups （HBsAg ＋/HBV DNA ＋ and HBsAg ＋/HBV DNA - ） （P 〈 0. 05 ）. Conclusion According to our study, HBsAg ＋/HBV DNA - donors could be spontaneously cured without any treatment or developed into overt HBV infection. A further track detection for those HBsAg ＋/HBV DNA - donors is suggested, then according to test results, donors can be either eliminated or retained. This not only reduces loss of donor resources, but at the same time guarantees blood safety.