HBsAg阴性preS1Ag阳性的HBV携带者血清学标志物及其HBV DNA动态观察

目的探讨HBsAg(-)/HBeAg( )/HBcAb( )/preS1Ag( )少见血清学模式形成的原因,了解该少见模式乙肝病毒携带者体内血清学标志物及其HBVDNA变化情况。方法采用ELISA、电化学发光免疫分析法(ECLIA)、巢式PCR和实时荧光定量PCR,对该少见模式乙肝病毒携带者HBV血清学标志物和HBVDNA进行检测,每隔3个月复查一次,持续15个月。结果在研究的时间内,国产ELISA试剂盒检测结果均为HBsAg(-)/HBeAg( )/HBcAb( )/preS1Ag( );电化学发光免疫分析法检测HBsAg均为阳性,并随时间延续HBsAg水平逐渐下降;巢式PCR与实时荧光定量PCR检测HBVDNA为阳性,病毒载量上下波动。结论该乙肝病毒携带者血清学少见模式HBsAg为假阴性,动态观察HBsAg与HBVDNA水平,了解HBV复制情况,可为临床诊治提供可靠的依据。

Serological Markers and HBV-DNA in HBV Carriers with Rare Serological Pattern of Negative HBsAg and Positive preS1Ag

Objective To examine the cause of rare serological pattern in a HBV carrier with HBsAg(-)/HBeAg( )/HBcAb( )/preS1Ag( ),and study the alterations of HBV serological markers and HBV-DNA level in the carriers.Methods Serological markers were analyzed by enzyme-linked immunosorbent assay(ELISA).The levels of HBsAg and HBV DNA were quantitatively determined by electrochemiluminescence immunoassay(ECLIA) and real-time polymerase chain reaction(PCR) technique,respectively.Nested PCR was used for HBV-S gene amplification.Results A rare serological pattern with HBsAg(-)/HBeAg( )/HBcAb( )/preS1Ag( ) was confirmed by ELISA method.However,HBsAg was detected by ECLIA,and the level of HBsAg was progressively reduced.The level of HBV DNA was fluctuating,as measured by real-time PCR or nested PCR.Conclusion The HBV carrier with a rare serological pattern was partly due to the mutation of HBV-S gene.It is necessary to improve the sensitivity of ELISA kit for HBsAg and also to develop diagnostic kits for the measurement of HBV-S mutants.Measurement of both HBsAg and HBV DNA would facilitate diagnosis and management of hepatitis B.