在淋巴瘤患者缺乏乙型肝炎核心抗原的致命乙型肝炎再激活
Solenn Klutsch1, Céline Boschi2,3,4, Anne Motte2,3
1Assistance Publique-Hôpitaux de Marseille, (AP-HM), Centre Hospitalo-Universitaire Timone, service d'Hépatologie, Marseille, France.
即使没有可检测的抗HBc抗体,B型肝炎病毒 (HBV) 的重新激活也可能发生在免疫受损患者中. 这一案例凸显了在接受血液病治疗的患者中检测过去的HBV感染和预防重新激活的挑战.
科学领域:
- 肝病学
- 病毒学
- 免疫学
背景情况:
- 在曾经感染HBV的免疫功能低下患者中,B型肝炎病毒 (HBV) 的重新激活是一个严重的风险.
- 检测过去的HBV感染通常基于抗HBc抗体等血清标志物.
- 缺乏抗HBc抗体是罕见的,但使HBV重新激活的风险评估复杂化.
研究的目的:
- 在严重免疫缺陷的患者中报告HBV重新激活的病例.
- 调查HBV基因组与免疫逃脱和改变的血清标志物相关的突变.
- 强调在特定患者群体中诊断过去的HBV感染和管理重新激活风险的挑战.
主要方法:
- 一名接受化疗 (包括Rituximab) 的淋巴瘤患者的病例报告.
- 对HBV标志物的血清检测 (HBsAg,抗HBc).
- 下一代测序用于完整的HBV基因组分析.
主要成果:
- 患者呈现HBV再激活 (HBsAg阳性),但缺乏可检测的抗HBc抗体.
- 在HBV基因组测序中发现了HBsAg免疫逃生突变和W28*前核突变.
- 没有发现与抗HBc缺乏相关的核心基因突变.
结论:
- 抗HBc抗体的阴性不排除过去的HBV感染或免疫受损患者的重新激活的风险.
- 在过去感染HBV且抗HBc无法检测的患者中,评估和监测HBV再激活风险具有挑战性.
- 这一案例强调了在为血液病治疗的患者,特别是具有异常血清特征的患者中保持警的必要性.
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