背景:自从Imbach[1]首次报道使用大剂量静脉注射免疫球蛋白(IVIg)治疗儿童特发性血小板减少性紫癜(ITP)以来,IVIg治疗的适应症越来越多。目前,IVIg输注已成为临床治疗的重要手段。抗-HBs和抗-HBc升高的现象引起的患者IVIg输注已经在杂志上报道,但是与实验室诊断相关的期刊上的类似报道很少。
方法:我们报告了一例免疫性血小板减少症(ITP)患者,该患者在接受静脉IVIg后干扰了乙型肝炎病毒(HBV)血清学检测。我们使用化学发光免疫分析法检测HBV的血清学标志物。用IU/mL代表HBsAg和HBsAb的检测数据,用截断值代表HBeAg的检测,HBeAb,和HbcAb。
结果:输注IVIg前HBV血清学标志物均为阴性。IVIG输注后一周,该项目再次测试,和HBsAb的结果,HBeAb,HBcAb阳性。随着输液后时间的增加,HBsAb,HBeAb,患者HBcAb逐渐降低。
结论:IVIg输注后,HBsAb的突然的积极变化,HBeAb,患者体内的HbcAb不是由HBV感染引起的,而是由外来抗体的输注引起的。本案例研究表明,在解释静脉IVIg治疗涉及病毒性乙型肝炎的患者的结果时,医生应特别小心。
BACKGROUND: Since Imbach [1] first reported the use of high-dose intravenous immunoglobulin (IVIg) in the treatment of idiopathic thrombocytopenic purpura (ITP) in children, indications for IVIg therapy have been increaseing. At present, IVIg infusion has become an important means of clinical treatment. The phenomenon of anti-HBs and anti-HBc elevation caused by IVIg infusion in patients has been reported in journals, but similar reports in journals related to laboratory diagnosis are rare.
METHODS: We reported a case of a patient with immune thrombocytopenia (ITP) which interfered with hepatitis B virus (HBV) serological detection after receiving intravenous IVIg. We used chemiluminescence immunoassay to detect serological markers of HBV. IU/mL was used to represent the detection data of HBsAg and HBsAb and cutoff value was used to represent the detection HBeAg, HBeAb, and HbcAb.
RESULTS: The serological markers of HBV were all negative before IVIg infusion. One week after IVIG infusion, the item was tested again, and the results of HBsAb, HBeAb, and HBcAb were positive. As the time increased after infusion, HBsAb, HBeAb, and HBcAb in the patient gradually decreased.
CONCLUSIONS: After IVIg infusion, the sudden positive change of HBsAb, HBeAb, and HbcAb in the patient\'s body was not caused by HBV infection, but caused by the infusion of foreign antibody. This case study shows that physicians should be particularly careful when interpreting results in patients treated with intravenous IVIg involving viral hepatitis B.