Qin Y, Liao P
Acta Virol. 2018;62(2):115-121. doi: 10.4149/av_2018_210.
Hepatitis B (HB) is a worldwide public health problem, closely related with liver cirrhosis and hepatocellular carcinoma (HCC). The implementation of universal hepatitis B virus (HBV) vaccination programs has led to significant reduction in incidence of acute and chronic HB, liver cirrhosis and HCC. However, this success is now being threatened by the discovery of HBV vaccine breakthrough infection caused by the S gene mutants of HBV, high maternal viral load and virus-induced immunosuppression. An alteration in the antigenicity and immunogenicity of hepatitis B surface antigen (HBsAg) due to S gene mutations may compromise detection of HBsAg (diagnosis-escape mutants), treatment with hepatitis B-specific immunoglobulin (HBIG), and even cause infections in individuals who are antihepatitis B surface antigen (anti-HBs) antibody-positive after immunization (vaccine-escape mutants). By surveilling for S gene mutants of HBV among vaccinated population, we will have a better understanding of the mechanism of HBV vaccine breakthrough infection; potentially providing new ideas for designing better diagnostic assays and effective vaccines for prevention and treatment of HBV. This review attempts to briefly summarize the status and role of S gene mutations, B-cell epitopes and T-cell epitope mutants, and surveillance of mutant HBV variants in a hospital setting.
乙型肝炎（HB）是一个全球性的公共卫生问题，与肝硬化和肝细胞癌（HCC）密切相关。普遍接种乙型肝炎病毒（HBV）疫苗计划的实施已导致急性和慢性HB、肝硬化及HCC的发病率显著降低。然而，现在这一成功正受到HBV S基因突变、高母体病毒载量和病毒诱导的免疫抑制导致的HBV疫苗突破性感染的威胁。由于S基因突变导致的乙型肝炎表面抗原（HBsAg）的抗原性和免疫原性改变可能会影响HBsAg的检测（诊断逃逸突变体）、乙型肝炎特异性免疫球蛋白（HBIG）的治疗，甚至会导致免疫后抗乙型肝炎表面抗原（抗-HBs）抗体阳性个体发生感染（疫苗逃逸突变体）。通过在接种疫苗人群中监测HBV的S基因突变，我们将更好地了解HBV疫苗突破性感染的机制；有可能为设计更好的诊断检测方法和预防及治疗HBV的有效疫苗提供新思路。本综述试图简要总结S基因突变、B细胞表位和T细胞表位突变体的现状及作用，以及在医院环境中对突变HBV变体的监测情况。
