ELISA检测乙肝两对半少见模式和弱阳性结果分析及报告单注释策略

Analysis on the rare patterns and weakly positive results of hepatitis B serologic testing by ELISA and the strategy of interpreting commenting

目的对酶联免疫吸附测定法(ELISA)检测的乙肝表面抗原(HBsAg)弱阳性、HBsAg与乙肝表面抗体(HBsAb)同时阳性、乙肝e抗体(HBeAb)与乙肝核心抗体(HBcAb)同时阳性或其中一项阳性的标本的表面抗原进行定量复检,并比较分析其表面抗原阳性率,从而为解释性注释提供依据。方法筛选出56例HBsAg弱阳性、58例HBsAg与HBsAb同时阳性和61例HBeAb与HBcAb同时阳性或其中一项阳性的ELISA标本,利用化学发光法(CLIA)进行HBsAg定量复查。结果1±模式与1±4+5+模式表面抗原复查后阳性率分别为15.4%与100%;1+2+模式与1+2+4+5+模式表面抗原复查后阳性率分别为5%与93.8%;5+模式与4+5+模式表面抗原复查后阳性率分别为10.8%与52.6%。以上2组间比较差异皆有统计学意义(P<0.01)。结论HBsAb、HBeAb、HBcAb结果对判断HBsAg结果有重要的指导意义。HBeAb与HBcAb同时阴性在HBsAg弱阳性、HBsAg与HBsAb同时阳性的ELISA模式中提示HBsAg存在假阳性可能,仅HBeAb与HBcAb同时阳性的ELISA模式提示HBsAg存在漏检可能。应根据HBeAb和HBcAb两项结果给予HBsAg复查建议。

Objective To detect quantitative results of hepatitis B surface antigen(HBsAg) in HBsAg weakly positive or both HBsAg and hepatitis B surface antibody(HBsAb) positive or anti-HBe antibody(HBeAb) and(or) anti-hepatitis B core antibody(HBcAb) positive in 5 items of hepatitis B detected by enzyme-linked immunosorbent assay(ELISA) and analyze their positive rates, thereby providing gist of interpreting commenting.Methods 56 cases of HBsAg weakly positive, 58 cases of both HBsAg and HBsAb positive and 61 cases of HBeAb and(or) HBcAb positive were screened out, and HBsAg quantitative value was re-detected by chemiluminescence immunoassay(CLIA).Results The positive rates of HBsAg in group 1±and 1±4+5+ re-detected by CLIA were 15.4% and 100%, respectively;the positive rates of HBsAg in group 1+2+ and 1+2+4+5+ re-detected by CLIA were 5% and 93.8%, respectively;the positive rates of HBsAg in group 5+ and 4+5+ re-detected by CLIA were 10.8% and 52.6%, respectively. The difference between the above two groups was statistically significant(P<0.01).Conclusion The results of HBsAb, HBeAb and HBcAb have important guiding significance for judging HBsAg results. HBeAb and HBcAb both being negative suggests the possibility of false positive of HBsAg in HBsAg weakly positive, both HBsAg and HBsAb positive ELISA patterns. Only HBeAb and HBcAb positive ELISA pattern suggests the possibility of false negative of HBsAg. Re-detection advice of HBsAg should be given according to the levels of HBeAb and HBcAb.