自身免疫性肝炎患者隐匿性HBV感染流行情况及临床、病毒学特征

Prevalence,clinical features,and virological characteristics of occult HBV infection in patients with autoimmune hepatitis

目的探讨自身免疫性肝炎(AIH)患者隐匿性乙型肝炎病毒感染(OBI)的流行情况及临床、病毒学特征。方法纳入2010年4月至2023年4月南京市第二医院收治的318例AIH患者,其中合并OBI 41例和无OBI 277例,分析两组临床特征、实验室检查指标;荧光聚合酶链反应测量病毒载量,HBV基因分型,分析AIH合并OBI者的病毒学特征和突变。结果合并OBI组抗-HBc阳性/抗-HBs阳性/抗-HBe阳性率为41.5%(17/41),高于无OBI组的17.3%(48/277)(P<0.05);合并OBI病毒基因以B、C型为主,B型23例、C型17例;抗-HBc/抗-HBe阳性患者为HBV DNA(685.3±154.7)IU/mL,抗-HBc/抗-HBs阳性、抗-HBc阳性、抗-HBc/抗-HBs/抗-HBe阳性患者分别为(465.8±134.5)IU/mL、(323.6±103.6)IU/mL、(131.4±83.4)IU/mL,(P<0.05);合并OBI患者中共检出10例OBI表面抗原“a”决定簇突变。结论AIH患者OBI感染风险较高,表现为抗-HBc/抗-HBs/抗-HBe阳性,AIH合并OBI病毒基因以B、C型为主,与T126A、Q129R突变有关。

Objective To investigate the prevalence,clinical features,and virological attributes of occult hepatitis B virus(HBV)infection(OBI)in patients with autoimmune hepatitis(AIH).Methods Between April 2010 and April 2023,318 patients with AIH admitted to our hospital were tested for HBV DNA.These patients were categorized into groups with combined OBI and without OBI based on thequantification of HBV DNA.We analyed the prevalence,clinical features,and laboratory indices for each group.Viral vectors were assessed using fluorescent polymerase chain reaction,HBV genotyping,and the virological characteristics and mutations associated with AIH combined with OBI were also examined.Results 318 patients diagnosed with AIH were assessed,and 41 of them(12.9%)were found to have a concurrent OBI.The proportion of patients with combined OBI exhibiting seropositivity for anti-hepatitis B core antibody(anti-HBc),hepatitis B surface antibody(anti-HBs),and hepatitis B e antibody(anti-HBe)was 41.5%,significantly exceeding the 17.3%in patients without OBI(P<0.05).The predominant HBV genotypes in the OBI combined cases were type B and C,with 23 cases of type B and 17 of type C identified.The viral load was highest in patients with anti-HBc and anti-HBe positivity at(685.3±154.7)IU/mL.This load decreased sequentially in those with anti-HBc and anti-HBs positivity,anti-HBc positivity alone,and combined anti-HBc,anti-HBs and anti-HBe positivity,with respective values of(465.8±134.5)IU/mL,(323.6±103.6)IU/mL,(131.4±83.4)IU/mL(P<0.05).Additionally,11 patients in the group with combined OBI were found to have“a”determinant mutations on detection of HbsAg were detected.Representing 26.8%of these cases.Conclusion Patients with AIH are at a higher risk of OBI infection,typically indicated by positivity for anti-HBc,anti-HBs,and anti-HBe.The viral genes in AIH cases combined with OBI predominantly belong to types B and C.Moreover,AIH combined with OBI infection is commonly associated with T126A and Q129 mutations.