Izmirli Sena, Celik Deniz Gozde, Yuksel Pelin, Saribas Suat, Aslan Mustafa, Ergin Sevgi, Bahar Hrisi, Sen Sümeyye, Cakal Bulent, Oner Ali, Kocazeybek Bekir
Microbiology and Clinical Microbiology Department, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Transfus Apher Sci. 2012 Dec;47(3):283-7. doi: 10.1016/j.transci.2012.07.009. Epub 2012 Sep 26.
Diagnostic problems may be encountered in Hepatitis B virus (HBV) infections by serological tests and HBV DNA can be detectable in plasma and liver tissue while the HBsAg test is negative. This situation can be defined as occult or isolated Anti-HBc infections. Occult HBV infections may be divided into two categories by using hepatitis markers. One of them being that all hepatitis markers are negative and the other situation is having Anti-HBc +/- and Anti-HBs+patterns. These situations can be seen in isolated Anti-HBc cases.
In this study, we aimed to detect the ratio of occult HBV infections by investigating HBV DNA in four different groups. These groups are: (1) 20 isolated Anti-HBc positive individuals, (2) 23 individuals naturally immune to HBV infection, (3) 20 individuals with seronegative hepatitis markers and high ALT levels, and (4) 23 vaccinated individuals against HBV. In order to detect HBV DNA the real-time PCR kit (QIAGEN, Artus HBV RG PCR Kit, Germany) with high analytical sensitivity (≤3.8IU/ml) was used.
The reliability of the molecular methods was assessed by increasing the quantitation standards of internal, external and also positive controls. No HBV DNA was detected in any of the 86 individuals consisting of four study groups.
In conclusion, we did not detect occult HBV infection in our four study groups by using a high sensitivity real-time (RT) PCR method, while occult HBV infections with various frequencies were detected in other large, serial international studies in which highly sensitive analytical molecular methods were used. Although we also used a high standard molecular kit to detect occult HBV infections, we suggest that the reason for the absence of detection of occult HBV infections may be due to the small number of cases included in this study. However, it was assumed that the use of a nucleic acid amplification technology (NAT) with high analytical sensitivity in blood banks to prevent HBV transmission by blood transfusion is controversial due to both costs and diagnostic efficacy and for this reason we suggest that it will be useful to perform large serial studies regarding occult HBV infections in the future.
在乙型肝炎病毒（HBV）感染中，血清学检测可能会遇到诊断问题，并且在HBsAg检测呈阴性时，血浆和肝组织中可检测到HBV DNA。这种情况可被定义为隐匿性或孤立性抗-HBc感染。隐匿性HBV感染可通过肝炎标志物分为两类。其中一类是所有肝炎标志物均为阴性，另一类情况是抗-HBc+/-和抗-HBs+模式。这些情况可见于孤立性抗-HBc病例。
在本研究中，我们旨在通过调查四个不同组中的HBV DNA来检测隐匿性HBV感染的比例。这些组为：（1）20例孤立性抗-HBc阳性个体，（2）23例对HBV感染具有天然免疫力的个体，（3）20例肝炎标志物血清学阴性且ALT水平高的个体，以及（4）23例接种过HBV疫苗的个体。为了检测HBV DNA，使用了具有高分析灵敏度（≤3.8IU/ml）的实时PCR试剂盒（QIAGEN，Artus HBV RG PCR Kit，德国）。
通过提高内部、外部以及阳性对照的定量标准来评估分子方法的可靠性。在由四个研究组组成的86名个体中，均未检测到HBV DNA。
总之，我们使用高灵敏度实时（RT）PCR方法在四个研究组中未检测到隐匿性HBV感染，而在其他使用高灵敏度分析分子方法的大型系列国际研究中检测到了不同频率的隐匿性HBV感染。尽管我们也使用了高标准分子试剂盒来检测隐匿性HBV感染，但我们认为未检测到隐匿性HBV感染的原因可能是本研究纳入的病例数量较少。然而，由于成本和诊断效能，在血库中使用具有高分析灵敏度的核酸扩增技术（NAT）来预防输血传播HBV存在争议，因此我们建议未来开展关于隐匿性HBV感染的大型系列研究将是有用的。
