乙型肝炎病毒“隐匿型”感染的临床意义

目的 了解血清中乙型肝炎病毒标志 (HBVM)阴性而HBV DNA阳性的乙型肝炎病毒 (HBV)携带者的临床意义。方法 在肝病门诊患者中认为有必要行肝组织病理检查 ,征得同意后行超声引导下右肝取材共连续 5 0例。上述患者均两次以上检查血清丙氨酸转氨酶 (ALT)、门冬氨酸转氨酶 (AST) ,以ELISA法检测HBVM五项、抗 HCV ,以PCR ELISA法检测血清HBV DNA含量 ,部分病例以PCR定性法检测HCV RNA。其肝组织以免疫组化检测HBsAg及HBcAg的表达 ,HE染色判定炎症分级 (G)、纤维化分期 (S) ,并附组织学活动性指数 (HAI)记分。 结果 5例临床疑为HBV携带者中 1例HBV DNA含量为 >10 4 copies ml,3例 >10 5copies ml。 4例肝组织HBsAg、HBcAg表达同时阳性。G、S、HAI记分提示肝脏有轻度炎症。结论 血清HBVM假阴性所造成的HBV“隐匿型”感染 ,影响了乙型肝炎的诊断及供血源的筛选 ,从而使HBV传染源的管理更加困难 ,且此类患者可成为原因不明肝硬化及肝癌的病因 。

An overview of occult hepatitis B virus infection

Occult hepatitis B virus (HBV) infection (OBI), alternatively defined as occult hepatitis B (OHB), is a challenging clinical entity. It is recognized by two main characteristics: absence of HBsAg, and low viral replication. The previous two decades have witnessed a remarkable progress in our understanding of OBI and its clinical implications. Appropriate diagnostic techniques must be adopted. Sensitive HBV DNA amplification assay is the gold standard assay for detection of OBI. Viral as well as host factors are implicated in the pathogenesis of OBI. However, published data reporting the infectivity of OBI by transfusion are limited. Several aspects including OBI transmission, infectivity and its relation to the development of chronic liver diseases and hepatocellular carcinoma have to be resolved. The aim of the present review is to highlight recent data on OBI with a focus on its virological diagnosis and clinical outcome.