单独抗-HBs阳性献血者HBV DNA阳性原因分析

Analysis of HBV DNA positive blood donors with anti-HBs only

目的分析乙肝血清学仅抗-HBs(+)的献血者HBV DNA(+)的原因。方法对ELISA法HBsAg(-)/HBV DNA(+)献血者标本进行化学发光法乙肝血清学(HBsAg、抗-HBs、HBeAg、抗-HBe、抗-HBc)检测和HBV DNA定量检测,对乙肝血清学中仅抗-HBs阳性者进行随访。将化学发光法乙肝血清学均阴性或仅HBsAg阳性者定义为ELISA法乙肝窗口期者,同样进行随访,作为对照。结果 2010年6月—2018年5月期间共检出23例单独抗-HBs(+)且HBV DNA(+),对其中4名献血者进行了随访:有1例随访时出现抗-HBc,并且抗-HBs数值显著上升,HBV DNA检测阴性;其余3例的乙肝血清学模式不变,且抗-HBs变化不大,HBV DNA检测结果或阴或阳。作为对照的7例窗口期献血者经随访均发生乙肝血清学模式的改变,其中6例出现抗-HBs/抗-HBc,1例只出现抗-HBs;HBV DNA检测均转阴。结论单独抗-HBs(+)的献血者HBV DNA(+)可能为乙肝疫苗注射后的突破感染,也可能为隐匿性乙肝感染。

Objective To analyze why blood donors with anti-HBs as the only HBV serological marker are HBV DNA positive.Methods Samples collected form blood donors which were ELISA HBsAg negative but HBV DNA positive were further tested by CLIA HBV serological tests(HBsAg,anti-HBs,HBeAg,anti-HBe and anti-HBc)and quantitative PCR.Donors with anti-HBs as the only HBV serological marker were followed-up.Those HBV serological negative and HBsAg positive only,defined as HBV ELISA window-period,were also followed-up as control.Results During June 2010 and May 2018,altogether 23 donors were detected to be anti-HBs also HBV DNA positive.Four of them were successfully followed-up.One of them developed anti-HBc and a dramatic rise of anti-HBs but without HBV DNA detected.The other 3 donors remained unchanged serological pattern and stable anti-HBs levels,with or without HBV DNA detected.In contrast,serological patterns of 7 window-period donors were altered during followed-up.Six of them developed both anti-HBs and anti-HBc,and one was anti-HBs-only.HBV DNA turned negative in all these 7 donors.Conclusion The anti-HBs-only donors carrying HBV DNA may be ones experienced breakthrough after HBV vaccination or just occult HBV infection ones.