摘要目的 以成人高胆红素血症为参照,探讨新生儿高胆红素血症对血清乙肝病毒表面抗原化学发光法检测的影响及消除方法.方法 病例对照研究.对2015年7月至2016年5月在首都医科大学附属北京儿童医院住院,并且血清总胆红素水平超过200 μmol/L的高胆红素血症新生儿血清200例,进行血清乙肝病毒表面抗原的检测,将阳性血清进一步经16 200×g高速离心或蓝光照射8h后平行上机检测,记录乙肝病毒表面抗原复测结果.其中复测阳性的血清进行血清乙肝病毒DNA载量测定并查询患儿母亲乙肝病毒检测结果.同期留取北京大学第一医院血清总胆红素水平超过200 μmol/L的成人血清标本136例作为参照,观察成人与新生儿高胆红素血症对血清乙肝病毒表面抗原测定的影响是否存在差异.结果 新生儿血清总胆红素中位数水平259.0 μmol/L (226.5,312.5);间接胆红素中位数水平244.1 μmol/L(212.5,295.8).成人血清总胆红素中位数水平356.4μmol/L(295.9,435.1),间接胆红素中位数水平137.1 μmol/L (107.8,172.7).测定血清乙肝病毒表面抗原成人均为阴性;新生儿有11例(5.5％)阳性,测定其血清乙肝病毒DNA载量均＜l00IU/ml,其中9例接种了乙肝病毒疫苗,2例接种情况不详.11例阳性新生儿中有10例患儿的母亲既往身体健康,1例为乙肝小三阳患者.新生儿11例阳性标本中有2例经高速离心后乙肝病毒表面抗原即转为阴性,4例经高速离心并且蓝光照射后转为阴性,5例经高速离心和蓝光照射后仍保持阳性.结论 新生儿高胆红素血症不同于成人,以间接胆红素升高为主,是造成新生儿血清乙肝病毒表面抗原化学发光法检测假阳性的主要原因之一.通过高速离心和蓝光照射的方法可以最大程度上消除血清间接胆红素对乙肝病毒表面抗原检测的影响.

abstractsObjective Investigate the effect of neonatal hyperbilirubinemia on the detection of HBsAg by chemiluminescence and its elimination methods.Methods Case control study.The HBsAg in human serum was detected in 200 cases of hyperbilirubinemia neonates who were hospitalized in Beijing Children's Hospital,Capital Medical University from July 2015 to May 2016 and whose serum total bilirubin level exceeded 200 μmol/L.The positive serum was further detected by 16 200×g high-spoed centrifugation or blue light irradiation for 8 hours,and the results of re-assay of HBsAg were recorded.The retest positive serum wastested for HBV DNA load and checked the results of their mother's examination in HBV.136 adult serum samples with total bilirubin levels exceeding 200 μmol/L in the Peking University First Hospital,were taken as reference to compare the influence of hyperbilirubinemia between adults and newborns on the determination of HBsAg.Results The median level of serum total bilirubin in neonates was 259.0 μ mol/L (226.5,312.5);median level of indirect bilirubin 244.1 μmol / L(212.5,295.8).Median level of serum total bilirubin in adults 356.4 μmol/L(295.9,435.1);median level ofindirect bilirubin 137.1 μmol/L (107.8,172.7).The HBsAg test was negative in adults,11 cases (5.5％) were positive in newborns,their" HBV DNA load was less than＜100 IU/ml.Among them,9 have inoculated hepatitis B vaccine and 2 were unknown.10 of 11 mothers of infants were healthy and 1 was positive for HBsAg,HBeAb,HBcAb.2 of the 11 positive specimens turned negative of HBsAg after high-speed centrifugation.In addition to high speed centrifugation,4 cases turned negative after blue light irradiation.5 cases remained positive after high speed centrifugation and blue light irradiation.Conclusions Neonatal hyperbilirubinemia,which is different from that of adults,is mainly caused by indirectly bilirubin increased,which is one of the main reasons for false positive detection of HBsAg by chemiluminescence in neonates.High-speed centrifugation and blue light irradiation can eliminate the influence of serum indirect bilirubin on the detection of HBsAg to the greatest extent.