目的:旨在评估维持性血液透析(MHD)患者中隐匿性乙型肝炎病毒(HBV)感染(OBI)情况. 方法:对2014年12月至2015年12月四川省人民医院血液透析中心的MHD患者采用ELISA法检测HBV标记物,并对HBsAg(-)/HBcAb(+)患者进行实时定量荧光PCR(real-time PCR)检测HBV-DNA,了解OBI的患病率.结果:(1)入选本中心MHD患者330例,平均年龄60.66± 14.32岁,男性55.7％,女性44.3％;HBV患病率为7.3％ (24/330),54.5％(180/330)为既往感染过HBV[HBsAg(-)/HBcAb(+)];(2)共收集到165例既往感染过HBV患者的血浆标本进行HBV-DNA检测,发现7例阳性,水平均很低(＜20 IU/ml),所以OBI的患病率对于进行检测的患者来说为4.2％(7/165),对于整个透析中心患者来说为2.2％(7/315);(3)将7例OBI患者作为观察组,剩下158例HBV-DNA(-)患者作为对照组进行比较发现,男性OBI比例更高(P=0.042),疫苗接种可预防OBI(P=0.010);(4)单一HBcAb(+)患者(6.5％)比HBcAb(+)/HBsAb(+)患者(3.8％)具有更高的OBI患病率,但两者间无明显统计学差异(P=0.617). 结论:本组MHD患者中54.5％既往感染过HBV,目前OBI患病率为2.2％,且HBV-DNA水平低下,但仍有引起病毒传播的风险,特别是单一HBcAb(+)患者.%Objective:To investigate the prevalence of occult hepatitis B virus (HBV) infection (OBI) in maintenance hemodialysis (MHD) patients.Methodology:MHD patients in our dialysis units from December 2014 to December 2015 were enrolled.HBV marker was examined by ELISA.The sera from HBcAb (+)/HBsAg (-) individuals were tested for HBV-DNA by a real-time quantitative PCR to investigate the prevalence of OBI.Results:(1) They were three hundred and thirty patients,55.7％ were male and 44.3％ were female with a mean age of 60.7±14.3 years.24 (7.3％) patients had chronic HBV infection (HBsAg positive).180 (54.5％) patients were HBcAb (+)/HBsAg (-) which suggested past infection.(2)Plasma samples of 165 patients with past HBV infection were obtained for HBV-DNA detection.Elevated HBV-DNA level (＜20 IU/ml) was detected in 7 (4.2％) patients,therefore the prevalence of OBI was 2.2％ (7/315) in all the dialysis patients.(3)Comparing the 7 patients with OBI,it was found that male were more prone to OBI (P=0.042),and vaccination may be effective in preventing OBI (P=0.010) in the 158 patients who were HBV-DNA negative.(4)The prevalence of OBI in HBcAb (+)/HBsAb (-) patients (6.5％) was higher than that in HBcAb (+)/HBsAb (+) patients (3.8％),but the difference was not significant (P=0.617).Conclusion:54.5％ of MHD patients in our center had evidence of past HBV infection,and the prevalence of OBI was 2.2％ with very low level of HBV-DNA.However,there may be a potential risk that the patients with OBI may transmit infection within dialysis units,especially when the patient was HBcAb (+)/HBsAb (-).
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