van Deursen F J, Hino K, Wyatt D, Molyneaux P, Yates P, Wallace L A, Dow B C, Carman W F
Institute of Virology, University of Glasgow, UK.
J Clin Pathol. 1998 Feb;51(2):149-53. doi: 10.1136/jcp.51.2.149.
To assess the relevance of genetic variants of hepatitis B virus (HBV) and to demonstrate the usefulness of the polymerase chain reaction (PCR) in cases of HBV diagnostic difficulty.
Five serum samples from patients that presented diagnostic difficulty in routine laboratories were sent to a research laboratory for PCR, and if appropriate, S gene sequencing, in vitro expression, and antigenic analysis.
The demonstration of HBV in serum by PCR allowed a definitive diagnosis of current infection. One serum sample with poor reactivity in a diagnostic assay had a minor hepatitis B surface antigen (HBsAg) variant and another with very poor reactivity had multiple variants of HBsAg. Transient HBsAg reactivity was observed in a recently vaccinated patient. A hepatitis Be antigen (HBeAg) false positive reaction was noted in a patient from a well defined risk group for HBV. One patient who was strongly HBsAg/HBeAg positive, but anti-hepatitis B core antibody negative, was viraemic.
PCR may become the gold standard for the diagnosis of current HBV infection. HBV variants are responsible for a proportion of diagnostically difficult cases. Modification of commercial assays is necessary to increase the sensitivity of detection of such variants.
评估乙型肝炎病毒（HBV）基因变异的相关性，并证明聚合酶链反应（PCR）在HBV诊断困难病例中的实用性。
将五份在常规实验室诊断困难的患者血清样本送至研究实验室进行PCR检测，如有必要，进行S基因测序、体外表达和抗原分析。
通过PCR在血清中检测到HBV可明确诊断当前感染。一份在诊断检测中反应性差的血清样本存在一种轻微的乙型肝炎表面抗原（HBsAg）变异体，另一份反应性极差的血清样本存在多种HBsAg变异体。在一名近期接种疫苗的患者中观察到短暂的HBsAg反应性。在一名来自明确的HBV高风险组的患者中发现乙型肝炎e抗原（HBeAg）假阳性反应。一名HBsAg/HBeAg强阳性但抗乙型肝炎核心抗体阴性的患者存在病毒血症。
PCR可能成为诊断当前HBV感染的金标准。HBV变异体是部分诊断困难病例的病因。有必要改进商业检测方法以提高对此类变异体的检测灵敏度。
