维持性血液透析患者隐匿性乙型肝炎病毒感染的调查与分析

Prevalence of occult hepatitis B virus infection in maintenance hemodialysis patients

目的:旨在评估维持性血液透析(MHD)患者中隐匿性乙型肝炎病毒(HBV)感染(OBI)情况。方法:对2014年12月至2015年12月四川省人民医院血液透析中心的MHD患者采用ELISA法检测HBV标记物,并对HBs Ag(-)/HBc Ab(+)患者进行实时定量荧光PCR(real-time PCR)检测HBV-DNA,了解OBI的患病率。结果:(1)入选本中心MHD患者330例,平均年龄60.66±14.32岁,男性55.7%,女性44.3%;HBV患病率为7.3%(24/330),54.5%(180/330)为既往感染过HBV[HBs Ag(-)/HBc Ab(+)];(2)共收集到165例既往感染过HBV患者的血浆标本进行HBV-DNA检测,发现7例阳性,水平均很低(<20 IU/ml),所以OBI的患病率对于进行检测的患者来说为4.2%(7/165),对于整个透析中心患者来说为2.2%(7/315);(3)将7例OBI患者作为观察组,剩下158例HBV-DNA(-)患者作为对照组进行比较发现,男性OBI比例更高(P=0.042),疫苗接种可预防OBI(P=0.010);(4)单一HBc Ab(+)患者(6.5%)比HBc Ab(+)/HBs Ab(+)患者(3.8%)具有更高的OBI患病率,但两者间无明显统计学差异(P=0.617)。结论:本组MHD患者中54.5%既往感染过HBV,目前OBI患病率为2.2%,且HBV-DNA水平低下,但仍有引起病毒传播的风险,特别是单一HBc Ab(+)患者。

Objective： To investigate the prevalence of occult hepatitis B virus（ HBV） infection（ OBI） in maintenance hemodialysis（ MHD） patients. Methodology： MHD patients in our dialysis units from December 2014 to December 2015 were enrolled. HBV marker was examined by ELISA. The sera from HBc Ab（ ＋）/HBs Ag（-） individuals were tested for HBV-DNA by a real-time quantitative PCR to investigate the prevalence of OBI. Results：（ 1） They were three hundred and thirty patients,55. 7% were male and 44. 3% were female with a mean age of 60. 7 ± 14. 3 years. 24（ 7. 3%） patients had chronic HBV infection（ HBs Ag positive）. 180（ 54. 5%） patients were HBc Ab（ ＋）/HBs Ag（-）which suggested past infection.（ 2） Plasma samples of 165 patients with past HBV infection were obtained for HBV-DNA detection. Elevated HBV-DNA level（ 〈20 IU/ml） was detected in 7（ 4. 2%） patients,therefore the prevalence of OBI was2. 2%（ 7/315） in all the dialysis patients.（ 3） Comparing the 7 patients with OBI,it was found that male were more prone to OBI（ P = 0. 042）,and vaccination may be effective in preventing OBI（ P = 0. 010） in the 158 patients who were HBVDNA negative.（ 4） The prevalence of OBI in HBc Ab（ ＋）/HBs Ab（-） patients（ 6. 5%） was higher than that in HBc Ab（ ＋）/HBs Ab（ ＋） patients（ 3. 8%）,but the difference was not significant（ P = 0. 617）. Conclusion： 54. 5% of MHD patients in our center had evidence of past HBV infection,and the prevalence of OBI was 2. 2% with very low level of HBV-DNA. However,there may be a potential risk that the patients with OBI may transmit infection within dialysis units,especially when the patient was HBc Ab（ ＋）/HBs Ab（-）.