献血员HBsAg筛查的安全性和病毒变异分析

目的探讨国内血站对献血员乙型肝炎病毒表面抗原（HBsAg）筛查的安全性和可靠性。方法收集经血站筛查HBsAg阴性的合格献血员血浆983份，用雅培Architect12000电化学发光仪定量检测HBsAg；巢式PCR扩增乙肝病毒S区、C区、X区。诊断为隐匿性乙肝病毒感染者，巢式PCR扩增病毒PreS／S区，产物直接测序并与标准病毒序列对比分析病毒株变异。结果经雅培Architect I2000复检HBsAg弱阳性率为6．5％（64／983），HBsAg滴度中位数为0．171U／ml；60．9％（39／64）病毒两个区扩增阳性，4．0％（39／983）健康献血员为隐匿性HBV携带者；35．9％（14／39）病毒PreS／S区段扩增阳性，未发现“a”决定簇内的变异株。结论目前经血站常规检测ItBsAg为阴性的合格血液用敏感性更高的试剂仍能检测出HBsAg及HBV DNA。

Viral mutation and the safety of screening of hepatitis B surface antigen in blood donors

Aim To explore the safety and reliability of screening of hepatitis B surface antigen in blood donors from domestic blood bank. Methods Plasmas from nine hundred and eighty three donors negative for HBsAg from blood bank were collected and detected quantitatively through Abbott Architect 12000 eleetrochemiluminescenee apparatus; nested-PCR was performed to amplify HBV S,C and X region,When defined as occult HBV infection,the samples were amplified by nested-PCR for HBV PreS/S region,the PCR products were sequenced direcdy,and sequence alignments were performed to analyze viral mutation. Results There 65% of health donors （64/983） was positive for HBsAg determined through Abbott Architect 12000 chemiluminescence apparatus,with the median of HBsAg titer of 0.17 IU/m]. Two genes were amplified both positively in 39 of 64 positive samples,and 4.C% of the donors （39/983） was defined as occult HBV infection. The PreS/S gene amplified positive was 35.9% in all occult HBV infection carders （14/39）,however,mutation in ＂a＂ determinant was not observed. Conclusions In case the sensitivity of HBsAg reagent could be improved,HBsAg and HBV DNA could be determined.