HBV感染体检人群中持续低水平HBsAg表达的临床特征和关联分析

StephenW

Exp Ther Med. 2020 Jan;19(1):19-32. doi: 10.3892/etm.2019.8217. Epub 2019 Nov 19.
Clinical characteristics and association analysis of persistent low-level HBsAg expression in a physical examination population with HBV infection.
Dai Y1,2, Che F1, Jiang X3, Cui D2, Zhou H1, Xu X4, Sun C1, Cheng J1,5,6.
Author information

1
    Department of Clinical Laboratory, The 903rd Hospital of The PLA, Hangzhou, Zhejiang 310013, P.R. China.
2
    Department of Laboratory Medicine, Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China.
3
    Department of Respiration, The 903rd Hospital of The PLA, Hangzhou, Zhejiang 310013, P.R. China.
4
    Department of Biotechnology, University of Tokyo, Tokyo 1138656, Japan.
5
    Department of Medical Laboratory, Faculty of Graduate Studies, Jiangsu University, Zhenjiang, Jiangsu 212013, P.R. China.
6
    Department of Medical Laboratory, Faculty of Graduate Studies, Bengbu Medical College, Bengbu, Anhui 233000, P.R. China.

Abstract

Certain patients with hepatitis B virus (HBV) infection present with persistently low levels of serum hepatitis B surface antigen (HBsAg) and have been indicated to have low rates of HBV nucleic acid replication. To explore the serological and molecular epidemiological characteristics of HBV population with low-level HBsAg in the present study, associated serum markers and virologic genotype detection were performed accordingly. Determination of HBV markers was performed using a chemiluminescence immunoassay from which 2,544 out of 45,256 adults who underwent routine health examination were tested positive for HBsAg. HBV DNA was detected by real-time fluorescent quantitative PCR. The patients were divided into low-level and high-level groups, according to their HBsAg levels (cut-off value, 10 IU/ml). The prevalence and levels of HBsAg positivity and HBV DNA in patients with HBV infection were analyzed by age, sex, serological pattern and clinical type. The fibrosis status of patients with low-level HBsAg was assessed by determining the aspartate aminotransferase-to-platelet ratio (APRI), and sequencing was employed to determine serotypes and genotypes. HBV-infected patients with low-level HBsAg (<10 IU/ml) accounted for 15.41% of the 2,544 HBsAg-positive patients, and the prevalence of HBsAg positivity exhibited a tendency to increase with age. The male-to-female ratio was ~1.9:1, and the average age was 54.98±16.28 years among HBV-infected patients with low-level HBsAg. The major serological pattern and clinical types were HBsAg/antibody against hepatitis Be antigen (anti-HBe)/antibody against hepatitis B core antigen (anti-HBc)-positive (94.90%) and chronic asymptomatic (ASC) (97.95%), respectively. HBV DNA exhibited a low-level of replication and the prevalence of HBV DNA positivity assessed by the routine method and by the enrichment method was 27.74% (97/392) and 45.92% (180/392), respectively. No significant differences among the age groups were identified in the different HBsAg level groups (P>0.05). The prevalence of HBV DNA positivity was associated with HBsAg only in patients with serological pattern HBV-M2 (HBsAg/anti-HBe/anti-HBc-positive) in the low-level HBsAg group (odds ratio: 1.30; 95% CI: 1.15-1.47; P<0.05). The APRI had no association with age, HBsAg, HBV DNA level or liver function index in ASC patients in the low-level HBsAg group (P>0.05). The prevalence of the serotype adw and genotype B was 85.53 and 89.47%, respectively. Further improvement in the systematic study of populations with low-level HBsAg has important clinical and epidemiological significance for improving the detection of HBV serological markers, elucidating the mechanisms leading to low-level HBsAg, overcoming immune tolerance to eliminate HBV infection and preventing HBV transmission.

Copyright: © Dai et al.
KEYWORDS:

hepatitis B surface antigen; hepatitis B virus DNA; hepatitis B virus infection; hepatitis B virus markers; physical examination population

PMID:
    31853269
PMCID:
    PMC6909745
DOI:
    10.3892/etm.2019.8217

StephenW

Exp Ther Med。 2020年1月； 19（1）：19-32。 Doi：10.3892 / etm.2019.8217。 EPUB 2019年11月19日
HBV感染体检人群中持续低水平HBsAg表达的临床特征和关联分析。
戴Y1,2，车F1，姜X3，崔D2，周H1，徐X4，孙C1，程J1,5,6。
作者信息

1个
解放军第903医院检验科，浙江杭州310013
2
浙江大学医学院附属第一医院检验科，浙江省临床体外诊断技术重点实验室，浙江杭州310003。
3
解放军第903医院呼吸科，浙江杭州310013
4
东京大学生物技术系，日本东京1138656。
5
江苏大学研究生院医学实验室系，江苏镇江212013
6
蚌埠医学院研究生院医学实验室，安徽蚌埠233000

抽象

某些患有乙型肝炎病毒（HBV）感染的患者存在持续低水平的血清乙型肝炎表面抗原（HBsAg），并已被证明HBV核酸复制率低。为了探讨本研究中低水平HBsAg的HBV人群的血清学和分子流行病学特征，相应地进行了相关的血清标志物和病毒基因型检测。 HBV标志物的测定采用化学发光免疫分析法，从接受常规健康检查的45256名成年人中，有2544名被测试为HBsAg阳性。通过实时荧光定量PCR检测HBV DNA。根据患者的HBsAg水平（临界值10 IU / ml）将其分为低水平和高水平组。通过年龄，性别，血清学模式和临床类型分析了HBV感染患者的HBsAg阳性率和HBV DNA水平。通过测定天冬氨酸转氨酶与血小板的比率（APRI）评估低水平HBsAg患者的纤维化状态，并通过测序确定血清型和基因型。低水平HBsAg（<10 IU / ml）的HBV感染患者占2544例HBsAg阳性患者的15.41％，并且HBsAg阳性的患病率呈随年龄增加的趋势。 HBsAg感染低水平患者中，男女之比约为1.9：1，平均年龄为54.98±16.28岁。主要血清学模式和临床类型分别为HBsAg /抗乙型肝炎抗原（抗HBe）/抗乙型肝炎核心抗原（抗HBc）阳性（94.90％）和慢性无症状（ASC）（97.95％） 。 HBV DNA的复制水平较低，通过常规方法和富集方法评估的HBV DNA阳性率分别为27.74％（97/392）和45.92％（180/392）。在不同的HBsAg水平组中，各年龄组之间没有显着差异（P> 0.05）。仅在低水平HBsAg组中血清型为HBV-M2（HBsAg /抗HBe /抗HBc阳性）的患者中HBV DNA阳性与HBsAg相关（赔率：1.30; 95％CI：1.15 -1.47； P <0.05）。在低水平HBsAg组中，ASC患者的APRI与年龄，HBsAg，HBV DNA水平或肝功能指数无关（P> 0.05）。血清型adw和基因型B的患病率分别为85.53和89.47％。对低水平HBsAg人群进行系统研究的进一步改进对于改善HBV血清学标志物的检测，阐明导致低水平HBsAg的机制，克服免疫耐受以消除HBV感染和预防HBV传播具有重要的临床和流行病学意义。

版权：©Dai等。
关键字：

乙型肝炎表面抗原；乙型肝炎病毒DNA；乙肝病毒感染；乙型肝炎病毒标志物；体检人群

PMID：
31853269
PMCID：
PMC6909745
DOI：
10.3892 / etm.2019.8217

StephenW

www.spandidos-publications.com/10.3892/etm.2019.8217/download