Hu Ke-Qin
Transplantation Institute and Division of Gastroenterology, Loma Linda University Medical Center and Jerry L. Pettis Memorial VA Medical Center, Loma Linda, California 92354, USA.
J Viral Hepat. 2002 Jul;9(4):243-57. doi: 10.1046/j.1365-2893.2002.00344.x.
Occult hepatitis B virus (HBV) infection is characterized by presence of HBV infection with undetectable hepatitis B surface antigen (HBsAg). Serum HBV level is usually less than 104 copies/mL in these patients. Diagnosis of occult HBV infection requires sensitive HBV-DNA PCR assay. Several possibilities have been hypothesized as the mechanisms of occult HBV infection. These include: (i) mutations of HBV-DNA sequence; (ii) integration of HBV-DNA into host's chromosomes; (iii) infection of peripheral blood mononuclear cells by HBV; (iv) formation of HBV-containing immune complex; (v) altered host immune response; and (vi) interference of HBV by other viruses. The precise prevalence of occult HBV infection remains to be defined. The clinical implications of occult HBV infection involve different clinical aspects. First of all, occult HBV infection harbours potential risk of HBV transmission through blood transfusion, haemodialysis, and organ transplantation. Second, it may serve as the cause of cryptogenic liver disease, contribute to acute exacerbation of chronic hepatitis B, or even fulminant hepatitis. Third, it is associated with development of hepatocellular carcinoma. Fourth, it may affect disease progression and treatment response of chronic hepatitis C. Most of the previous studies utilized retrospective observation without control groups, and lacked direct association of occult HBV infection with specific pathological changes and disease progression. Highly sensitive, quantitative, and functional molecular analyses of HBV, combined with a well-designed prospective clinical assessment will provide the best approach for the future study of occult HBV infection.
隐匿性乙型肝炎病毒（HBV）感染的特征是存在HBV感染，但检测不到乙型肝炎表面抗原（HBsAg）。这些患者的血清HBV水平通常低于104拷贝/mL。隐匿性HBV感染的诊断需要灵敏的HBV-DNA聚合酶链反应（PCR）检测。关于隐匿性HBV感染的机制有几种假设。这些包括：（i）HBV-DNA序列突变；（ii）HBV-DNA整合到宿主染色体中；（iii）HBV感染外周血单个核细胞；（iv）形成含HBV的免疫复合物；（v）宿主免疫反应改变；以及（vi）其他病毒对HBV的干扰。隐匿性HBV感染的确切患病率仍有待确定。隐匿性HBV感染的临床意义涉及不同的临床方面。首先，隐匿性HBV感染存在通过输血、血液透析和器官移植传播HBV的潜在风险。其次，它可能是不明原因肝病的病因，导致慢性乙型肝炎急性加重，甚至暴发性肝炎。第三,它与肝细胞癌的发生有关。第四，它可能影响慢性丙型肝炎的疾病进展和治疗反应。以前的大多数研究采用回顾性观察且无对照组，并且缺乏隐匿性HBV感染与特定病理变化和疾病进展的直接关联。对HBV进行高灵敏度、定量和功能分子分析，结合精心设计的前瞻性临床评估，将为隐匿性HBV感染的未来研究提供最佳方法。
