无偿献血者乙肝病毒核酸筛查阳性人群的血清转换研究

目的 探讨无偿献血者乙肝病毒核酸筛查(NAT)阳性人群血清转换情况及特点,为血液安全和疾病预防提供参考.方法运用回顾性调查方法,采用美国Roche公司COBAS AmpliScreen系统筛查2006年8月到2007年8月东莞市无偿献血者28800份酶免阴性的血液标本,对筛查出的阳性人群进行NAT和血清学的跟踪分析.结果 NAT从28800份酶免检查阴性的标本共筛查出10个阳性一级混样池(pooling).经分拆检测,其中2个pooling分拆结果为阴性,其余8个pooling分别各拆分出1例阳性标本.对8份阳性标本随访:7例2、4、6、8、10周NAT随访结果均为阳性,1例为阴性;1例2周后HBsAg为阳性,其余7例HBsAg结果均为阴性.结论核酸检查具有较高灵敏度,但是同时也存在假阳性的可能;我国作为乙肝高发区对献血者HBV筛查仅检测HBsAg存在一定局限性;献血者工作生活质量,有无前瞻性治疗或预防措施对血清转换可能有一定的影响.

Study about seroconversion of HBV NAT screening-positive crowd from blood donors

OBJECTIVE: To investigate the characteristics of seroconversion of HBV NAT screening-positive crowd from blood donors in Dongguan city and provide reference for the safety of blood transfusion and disease prevention. METHODS: With retrospective survey, Nucleic acid testing (NAT) was used to analyze 28800 HBsAg-negative samples by ELISA from blood donors in Dongguan city from August, 2006 to August, 2007 with Roche Cobas AmpliScreen systems; and follow-up research including NAT for HBV-DNA, ELISA for HBsAg and multiple factors analysis for HBV infection was carried out on HBV NAT screening-positive crowd. RESULTS: 10 positive poolings were screened from 28800 samples; after further detection, 2 of these positive poolings were HBV-DNA negative and 8 HBV-DNA positive samples were found.The 10-week follow-up research on these 8 blood donors showed that 6 were HBV-DNA positive and HBsAg-negative at 2 weeks, 4 weeks, 6 weeks, 8 weeks, 10 weeks respectively, 1 was not HBsAg positive until 2 weeks and was positive on follow-up, and considered in "window period", 1 was HBV-DNA negative, HBsAg-negative on follow-up. Of these 8,7 were not only migrant laborers with poor condition of work, life and health but also in high risk of secondary infection for HBV, in addition they had little idea of therapy or prevention measures of HBV infection and the other 1 was HBV-DNA negative, HBsAg-negative on follow-up, who was in better condition than the above 7 donors. CONCLUSION: NAT is more sensitive than ELISA in screening HBV, but the probability of being false positive of NAT can not be ignored at the same time. On the hand, only screening HBsAg for HBV is relative limitation in high infection region of China. Some factors would have effect on the serum conversion of blood donors including the quality of work and life, therapy or prevention measures.