抗HBc阳性,HBsAg阴性献血者乙型肝炎病毒感染性研究

目的为预防输血后乙型肝炎，是否有必要在献血者中加做抗－ＨＢｃ筛查以及采取何种取舍标准？为此，对常规筛查合格的献血者血液进行了抗－ＨＢｃ滴度与ＨＢＶＤＮＡ相关性的研究。方法用免疫－套式ＰＣＲ法检测了２９７份不同滴度组抗－ＨＢｃ阳性血液的ＨＢＶＤＮＡ。结果在４份抗－ＨＢｃ滴度≥１１２８的血液中检出１例ＨＢＶＤＮＡ，而在另７５份抗－ＨＢｃ滴度＜１１２８的血液中未检出，ＨＢＶＤＮＡ与抗－ＨＢｃ滴度之间有显著相关性。在２１８份抗－ＨＢｃ／抗－ＨＢｓ双阳血液及５０份抗－ＨＢｃ阴性血液中未检出ＨＢＶＤＮＡ。结论仅含高滴度单项抗－ＨＢｃ的血液可能具有传染性；ＨＢＶＤＮＡ在抗－ＨＢｃ阳性血液中的总检出率低，仅为０．３４％（１／２９７）。建议将有限的资金首先用于进一步提高现有献血者ＨＢｓＡｇ检测试剂的灵敏度（目前为１ｎｇ／ｍｌ），或许更为有效。

Studies on Hepatitis B Virus Infection in Blood Donors with Positive Anti-HBc and Negative HBsAg

OBJECTIVE: To study if it is necessary to screen for core antibody against hepatitis B (anti-HBc) to prevent post-transfusion hepatitis B and what is its criteria for screening. METHODS: Relationship between the titer of anti-HBc and HBV DNA in blood from qualified donors by routine testing was conducted. HBV DNA was detected in 297 units of blood with anti-HBc at various titers by immuno-nested polymerase chain reaction (RT-PCR). RESULTS: HBV DNA was detected in one of four units of blood with positive anti-HBc at a dilution of equal to or greater than 1:128, and no HBV DNA was detected in other 75 units of blood with a dilution of anti-HBc less than 1:128. There was significant relationship between HBV DNA and the titer of anti-HBc. No HBV DNA was detected in 218 units of blood with both positive anti-HBc and anti-HBs and in 50 units with negative anti-HBc. Detection rate of HBV DNA in blood with positive anti-HBc was only 0.34% (1/297). CONCLUSION: Blood containing higher titer of single anti-HBc may be infectious. It is suggested that sensitivity of the reagents for detecting HBsAg currently used (1 ng/ml) be improved with the limited budget.