剖析住院患者中的乙肝病毒携带状态

目的 剖析住院患者中的乙型肝炎病毒（HBV）携带状态,为制定护理人员HBV职业感染的防护方法提供依据.方法对992例连续入院的住院患者入院时取空腹静脉血3 ml,分离血清于-40℃保存备用.使用ELISA法检测每份血清的乙型肝炎病毒表面抗原（HBsAg）和乙型肝炎病毒e抗原（HBeAg）.使用套式聚合酶链反应（n-PCR）检测所有HBsAg阳性患者和100例连续入院的HBsAg阴性患者血液的HBV DNA.将n-PCR检测HBV DNA低限作为一个HBV感染剂量,使用n-PCR极量稀释法检出每份HBV DNA阳性血清所含的HBV感染剂量/ml,以此作为HBV传染性或病毒浓度的指标.结果 992例住院患者中156例HBsAg阳性（HBsAg阳性者）,依据HBeAg是否阳性将HBsAg阳性者分为HBeAg阳性和阴性2种类型,HBeAg阳性者31例（19.87%）,阴性者125例（80.13%）.73.7% 的HBsAg阳性者HBV DNA阳性,病毒浓度范围为0～109感染剂量/ml,26.3%的 HBsAg阳性者HBV DNA阴性,病毒浓度在n-PCR的检测阈值之下.9%的HBsAg阴性者HBV DNA阳性,病毒浓度范围在0～104感染剂量/ml,最大传染性较HBsAg阳性者小105感染剂量/ml.HBeAg阳性者的病毒浓度范围在102～109 感染剂量/ml,阴性者在0～106 感染剂量/ml;HBeAg阳性者的病毒浓度较阴性者高103倍.结论住院患者中存在隐匿性和HBsAg阳性2种HBV携带状态,两者的最大HBV浓度相差105感染剂量/ml;HBeAg阳性者是HBV携带者中传染性较强部分,病毒浓度较阴性者高103倍.这些特点可为制定护理人员HBV职业感染的防护方法提供依据.

The analysis of hepatitis B virus carrier state of inpatients

Objective To investigate the hepatitis B virus （HBV） carrier state of inpatients and to provide bases for making preventive measures against HBV infection for nursing staff. Methods 3ml of Peripheral venous blood per patient was drawn from a series of 992 patients admitted to hospital. Serum was isolated immediately and stored at -40~C. The levels of HB- sAg and HBeAg in serum were detected by ELISA. The HBV-DNA was detected in all HBsAg＋ patients and 100 HBsAg- pa- tients by nPCR and its detectable lower limit was set as a HBV infectious dose. Then the infectious dose in patients with HBV- DNA was measured by nPCR maximal dose dilution method and taken as the index to HBV infectivity or HBV concentration. Re- suits HBsAg was detected in 156 of all 992 patients. In terms of HBeAg, 31 patients （ 19.87% ） were HBsAg＋ HBeAg＋ and the other 125 patients （80.13%）were HBsAg＋ HBeAg-. HBV-DNA was detected in 73.7% of HBsAg＋ patients, and the virus concentration ranged from 0 to 109 infectious dose/ml. HBV-DNA was undetected in 26.3% of HBsAg＋ patients. HBV-DNA was detected in 9% of HBsAg- patients, and the virus concentration ranged from 0 to 104 infectious dose/ml. The HBV concentration range was at 102 ~ 109 infectious dose/ml and at 0 - 106 infectious dose/ml in HBeAg＋ patients and in HBeAg- patients respec- tively. The DNA concentration in patients with HBeAg＋ was 103 times higher than that in HBeAg- patients. Conclusion Two types of HBV carrier state in hospital patients were found including occult infection as well as HBsAg-positive. The HBV-DNA concentration difference between two groups was 103 infectious dose/ml. Among the HBV carrier, HBeAg-positive patients had a strong infectivity. These data offered bases for making preventive measures for nursing staff.