献血人群隐匿性乙型肝炎病毒感染的流行病学和血清学研究

目的了解广州地区献血人群隐匿性乙型肝炎病毒感染（OBI）的流行病学和血清学情况。方法对广州地区199631例无偿献血者标本同时用ELISA法检测HBsAg、紫外-乳酸脱氢酶法检测ALT、核酸扩增技术（NAT）联合检测HBV/HCV/HIV及HBV单项鉴别试验,对HBsAg阴性HBV DNA阳性者进行随访,用荧光定量PCR检测病毒载量,用ELISA法检测乙肝两对半。结果 199631例标本中共检出104例HBsAg阴性HBV DNA阳性者,经随访有54例为OBI,OBI检出率为0.027%,年龄以46～55岁组检出率最高（P〈0.01）,外地身份证的献血者检出率高于广州市身份证者（P〈0.01）,OBI检出率与性别和献血次数无关（P〉0.05）。104例HBsAg阴性HBV DNA阳性的标本ALT均正常,病毒载量均〈1000IU/ml,平均值为162IU/ml。随访标本中,除6例ALT异常外其余均正常,54例OBI标本病毒载量均〈1000IU/ml,平均值为122IU/ml,乙肝两对半中抗-HBc阳性率明显高于其他项目（P〈0.01）。结论 HBsAg阴性献血者中存在OBI,有必要在献血者中开展核酸检测。

Epidemiological and serological analysis of occult hepatitis B virus infection in blood donors

Objective To study the epidemiological and serological features of occult hepatitis B virus infection （OBI） in blood donors in Guangzhou. Methods 199 631 volunteer donors in Guangzhou were tested for HBsAg by ELISA, alanine aminotransferase （ALT） by UV-LDH Method, and HBV/HCV/HIV by nucleic acid amplification testing （NAT）. Following up examination was conducted on the HBsAg negative and HBV DNA positive （HBsAg-/HBV DNA＋） blood donors. HBV DNA loading was determined by quantitative PCR. HBsAg, anti-HBs, HBeAg, anti-HBe, and anti-HBc were determined by ELISA. Results 104 samples from the 199 631 volunteer donors were HBsAg-/HBV DNA＋. 54 subjects were classified as OBI after the following examination. OBI incidence was 0.027%. The OBI incidence in the group of 46 to 55 years was higher than the others （P〈0.01）. The incidence of OBI for the donors without Guangzhou ID card was higher than the one with Guangzhou ID card. No statistical differences between female and male, first time donors and the donors with previous blood donation history （P〉0.05）. 104 samples from HBsAg-/HBV DNA＋ donor had normal level of ALT and low viral load （〈1 000 IU/ml, average 162 IU/ml）. In the following examination, Except 6 donors, all samples from the following cases had normal ALT levels. And 54 OBI samples had a low viral load （〈1 000 IU/ml, average 122 IU/ml）. The positive rate of anti-HBc in the OBI donors was higher than the others （P〈0.01）. Conclusion There was OBI in donors with negative HBsAg. It is necessary to detect HBV DNA from the donors.