S基因变异与隐匿性HBV感染的关系.docVIP

  S 基因变异与隐匿性 HBV 感染的关系# 戴钰，李旭，张振华** （安徽医科大学第一附属医院感染科，合肥 230022） 摘要：隐匿性 HBV 感染是指肝脏或血清中 HBV DNA 阳性，而血清常规 ELISA 检测 HBsAg 阴 性的慢性 HBV 感染，其存在和临床意义已经被许多研究所证实。目前已有大量研究开始关注 隐匿性 HBV 感染的发生机制，尤其是 S 基因变异与隐匿性 HBV 感染的关系成为其中的重点， 大量研究表明从隐匿性 HBV 感染者肝脏和/或血清中分离出的乙肝病毒可能存在 S 基因变 异，体内和体外研究证实 S 基因变异可能导致乙肝病毒低水平复制；HBsAg 的表达和/或分 泌出现障碍；抗原抗体亲和力下降，中和反应异常，出现 HBsAg 假阴性；降低病毒的免疫 原性，导致免疫逃逸。本文就国内外乙型肝炎病毒 S 基因变异对隐匿性 HBV 感染的发生和 影响的若干研究进行综述。 关键词：乙型肝炎病毒；隐匿性；基因变异 中图分类号：R512.6 The relationship of occult infection and mutations in the S gene region of hepatitis B virus DAI Xu, LI Xu, ZHANG Zhenhua (Department of infections diseases,the first affiliated hospital,Anhui Medicai University, HeFei 230022) Abstract: Occult hepatitis B virus infection is characterised by the presence of HBV DNA in liver or serum of individuals testing hepatitis B surface antigen (HBsAg) negative by currently available assays. Its existence and clinical relevance are reported on many researches. Nowadays, large numbers of studies attended the molecular and immunopathogenetic mechanisms associated with occult hepatitis B, in particular, the relationship of the S gene mutation and occult HBV infection. A large number of studies indicate that hepatitis B virus strains from liver and / or serum from the occult HBV infection of occult hepatitis B infection patients may exist S gene mutation. Some studies in vivo and in vitro confirm that the S gene mutation may lead to low-level replication of hepatitis B virus; HBsAg expression and / or secretion of obstacles; decrease affinity of the HBsAg and anti-HBs and false negative of HBsAg; reduce virus immunogenicity and lead to immune escape. This review focuses on the relationship of occult infection and mutations in the S gene region of hepatitis B virus. Keywords: Hepatitis B virus; Occult; Gene variation 我国是乙型肝炎病毒（HBV）感染的高流行区，虽然近年来，由于乙肝疫苗接种减少 了母婴传播，人群 HBsAg 携带率下降，但一般人群的乙肝表面抗原（HBsAg）阳性率仍有 9.09%[1]，且 HBV 变异株增加。因此，及时发现和控制 HBV 携带者，科学管理传染源，对 于 HBV 的进一步传播和流行有着重要的意义。传统认为血清中的乙型肝炎表面抗原 （HBsAg）阳性和病