Reactivation of hepatitis B virus infection with persistently negative HBsAg on three HBsAg assays in a lymphoma patient undergoing chemotherapy
Reactivation of hepatitis B virus infection with persistently negative HBsAg on three HBsAg assays in a lymphoma patient undergoing chemotherapy
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DOI：
10.1016/j.jcv.2009.11.024
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发表时间：
2010-02-01
影响因子：
8.8
通讯作者：
Chau, Tai-Nin
中科院分区：
文献类型：
--
作者：
Cheung, Wing-I.;Chan, Henry Lik-Yuen;Chau, Tai-Nin
在隐匿性乙型肝炎病毒（HBV）感染的患者中，当他们变得免疫功能低下时，可能会发生急性加重。通常，这些患者在发作期间出现乙型肝炎表面抗原（HBsAg）血清逆转。在这里，我们报告了一位隐匿性HBV感染的患者，他在弥漫性大b细胞淋巴瘤化疗后出现HBV恶化。HBV DNA的复燃在肝酶升高之前持续了20周。典型的情况是，尽管病毒血症很高，但使用三种不同的敏感HBsAg检测方法（即Architect、Murex和AxSYM）进行血清学检测显示HBsAg持续阴性。将索引患者的氨基酸序列与共识序列进行比较，发现s1区前有5个突变，s2区前有5个突变，S区有23个突变。6个氨基酸突变位于“a”行列式上，包括P120T、K122R、M133T、F134L、D144A和G145A。本例患者的突变体K122R、F134L和G145A未被先前的研究者检测对Architect和Murex检测的敏感性，可能代表这些检测的逃逸突变体。(C) 2009 Elsevier b.v.版权所有
In patients with occult hepatitis B virus (HBV) infection, acute exacerbation may occur when they become immunocompromised. Usually, these patients develop hepatitis B surface antigen ( HBsAg) seroreversion during the flare. Here we report on a patient with occult HBV infection, who developed HBV exacerbation after chemotherapy for diffuse large B-cell lymphoma. The resurgence of HBV DNA preceded the elevation of liver enzymes for 20 weeks. Atypically, despite high viraemia, serological tests showed persistently negative HBsAg using three different sensitive HBsAg assays (i.e., Architect, Murex and AxSYM). On comparing the amino acid sequence of the index patient with the consensus sequence, five mutations were found at pre-S1, five at pre-S2 and twenty-three mutations at the S region. Six amino acid mutations were located in the 'a' determinant, including P120T, K122R, M133T, F134L, D144A and G145A. The mutants K122R, F134L and G145A in our patient have not been tested for their sensitivity to Architect and Murex assays by the previous investigators and might represent the escape mutants to these assays. (C) 2009 Elsevier B. V. All rights reserved.