芜湖地区HBsAg无反应性/HBV DNA反应性献血者的感染状态及追踪结果分析

HBsAg non-reactive but HBV DNA reactive blood donors in Wuhu area: infection status and tracing results

目的 使用核酸单检和化学发光技术对HBsAg无反应性/HBV DNA反应性献血者的感染状态进行检测分析,探讨献血者归队的可行性及潜在风险。方法 使用血站信息管理软件对2018年1月~2021年10月芜湖地区献血者的血筛结果进行统计,汇总全部HBsAg无反应性/HBV DNA反应性献血者献血信息,再进行电话联系召回,获取知情同意后采样进行HBV DNA核酸单检、酶联免疫法检测HBsAg、化学发光法检测HBsAg、抗-HBs、HBeAg、抗-HBe和抗-HBc 5项、谷丙转氨酶(ALT)检测。结果 2018年1月~2021年10月无偿献血共142 051人次,单HBV DNA反应性率为0.06%(91/142 051),成功随访检测33人(37人次)。HBsAg、抗-HBs和抗-HBc检出率分别为6.06%(2/33)、39.39%(13/33)和96.97%(32/33),HBeAg全阴。经2次NAT单检后,HBV DNA双系统检测均无反应性有8人,转阴率为24.24%(8/33),至少有1次HBV DNA单检呈反应性结果的有25人,其中有23人属于血清学反应性的隐匿性HBV感染;另有2人HBsAg阳转同时HBV DNA持续反应性,为窗口期感染,感染率为6.25%;HBV DNA重复单检且血清学结果均无反应性1人,判为假反应性(未感染HBV)。结论 化学发光法检测HBV血清标志物相比酶联免疫法有更高的敏感性,有利于窗口期标本的尽早检出。本地区血液筛查检出的HBsAg无反应性/HBV DNA反应性献血者抗-HBc检出率很高,且大多属于隐匿性感染,建议归队策略中核酸单检次数应不少于2次。

Objective To detect and analyze the infection status of HBsAg non-reactive/HBV DNA reactive blood donors by individual donor-NAT(ID-NAT) and chemiluminescence technology, and to explore the feasibility and potential risks of reentry. Methods The blood screening results of blood donors in Wuhu from January 2018 to October 2021 were queried by blood station information management software. The blood donation information of all HBsAg non-reactive/HBV DNA reactive blood donors was collected and then recalled by telephone. After informed consent, samples were taken for HBV DNA nucleic acid single test, enzyme-linked immunoassay for HBsAg, chemiluminescence assay for HBV seromarkers(including HBsAg, anti-HBs, HBeAg, anti-HBe and anti-HBc), and alanine aminotransferase(ALT) test. All the results were statistically analyzed. Results From January 2018 to October 2021, there were 142 051 donations, and the positive rate of sole HBV DNA was 0.06%(91/142 051), and 33 people(37 person-times) were successfully followed up. The yield rates of HBsAg, anti-HBs and anti-HBc were 6.06%(2/33), 39.39%(13/33) and 96.97%(32/33), respectively;None HBeAg was yielded. After two times of ID-NAT, 8 patients remained non-reactive to both systems, with a negative conversion rate of 24.24%(8/33). Meanwhile, 25 patients were at least once reactive to ID-NAT, and 23 of them were occult HBV infection with serologically reactivity. There were 2(6.25%) patients with HBsAg positive conversion and HBV DNA persistent reactivity, which were window period infection. One person was confirmed as false reactivity(no HBV infection) as he remained unreactive to both repeated ID-NAT and serological tests. Conclusion Chemiluminescence assay is more sensitive than ELISA in detecting HBV serum markers, which is beneficial to early detection of HBV samples in window period. The yielding rate of anti-HBc among HBsAg non-reactive/HBV DNA reactive blood donors detected by blood screening in this region is very high, and most of them are occulting infection, so the ID-NAT should be no less than 2 times in the reentry strategy.