評估B、C型肝炎和愛滋病毒篩檢在南台灣法醫解剖實務之生物安全性應用價值

Abstract

法醫病理醫師和法醫從業人員持續有得到血行傳播病毒感染的風險，範疇包括B型肝炎病毒、C型肝炎病毒和愛滋病毒。全世界至今已有兩位法醫病理醫師感染愛滋病，且被認為是源於工作時感染到。強調生物安全的最主要目的，是減少或消除潛在有害生物性物質之暴露。快速有效且在現場就可以篩驗的試劑可以幫助法醫師察覺潛在傳染性疾病之風險。這篇文章的主旨在於評估免疫色層分析試劑的成效，並比較台灣北部與南部在B型肝炎、C型肝炎和愛滋病血液性傳染疾病盛行率的差異。總體收集南部司法解剖之血液83例，時間自2010年9月到2011年9月。所收集血液以免疫色層分析試劑加以篩驗。One Step Hepatitis B surface antigen test device (廠牌為艾康)被用來篩驗B型肝炎HBsAg抗原。Hepatitis C Virus One Step Test device (廠牌為艾康)被用來篩驗anti-HCV抗體。檢體同時以Determine○RHIV-1/2 (廠牌為亞培) 和 HIV 1/2 Ultra Rapid test device (廠牌為艾康)來篩驗anti-HIV抗體。我們以即時定量聚合酶鏈鎖反應 (real-time polymerase chain reaction) 為黃金準則 (golden standard)。免疫色層分析試劑的成效並與即時定量聚合酶鏈鎖反應結果相比較。結果顯示C型肝炎快篩試劑的敏感性為80%、特異性為87%，B型肝炎快篩試劑不如C型肝炎快篩試劑，其敏感性為42.9%、特異性為97.4%。至於愛滋病即時定量聚合酶鏈鎖反應，我們送驗了41例檢體，因為41例皆未檢出HIV RNA，所以愛滋病毒快篩試劑的效度無法評估。另外，在南台灣HBV DNA死後盛行率為8.4%，HCV RNA死後盛行率為6%。相較之前北部研究，我們發現南台灣HCV RNA死後盛行率比北台灣低，HBV DNA死後盛行率南北則是類似。我們的研究顯示C型肝炎快篩試劑在死後血液檢體有較高之敏感性和特異性。至於B型肝炎快篩試劑，雖然敏感性數值相較較低，但特異性卻相對較高。我們總結為了避免在解剖時血行傳播病毒感染的風險，我們可以應用C型肝炎快篩試劑在篩驗C型肝炎感染，且應用B型肝炎快篩試劑在排除B型肝炎感染。

Forensic pathologists and forensic medicine personnel are at a continuous risk of acquiring blood-borne viral infections, including HBV, HCV and HIV. There have been two cases of HIV infections among forensic pathologists in the world, both of whom were identified as likely to having been infected in the work setting. A fundamental objective of biosafety is to reduce or eliminate exposure of potentially harmful biological agents. The availability of rapid, point-of-care tests may increase the awareness of the potential transmission by increasing opportunities for testing outside of traditional laboratory settings. The aims of this study were to evaluate the performance of the immunochromatographic test (ICT) and to compare the seroprevalence of HBV, HCV and HIV between Northern and Southern Taiwan. A total of 83 human blood samples were collected from cases autopsied in Southern Taiwan from September 2010 to September, 2011. The blood were screened for HBV, HCV, HIV using ICT tests. The One Step Hepatitis B surface antigen test device (ACON) was used for screening of HBsAg and Hepatitis C Virus One Step Test device (ACON) was used for screening of anti-HCV. The samples were stimultaneously screened for HIV-1/2 antibodies by using Determine○RHIV-1/2 (Abbott) and HIV 1/2 Ultra Rapid test device (ACON). We regarded real-time polymerase chain reaction as golden standard. Performance of the ICT tests were compared to real-time PCR. Results of the rapid ICT test are listed below. The sensitivity and specificity for the detection of anti-HCV were 80 and 87%. The sensitivity and specificity for the detection of HBsAg were less than that for anti-HCV, and were 42.9 and 97.4%. We only analyzed 41 samples for HIV RNA. Since HIV RNA was not detectable in 41 cases, the validation of HIV ICT test can’t be calculated from these study. Besides, the Southern Taiwan postmortem prevalence of HBV DNA and HCV RNA were 8.4% and 6% respectively. Compared to the previous study, we found that postmortem prevalence of HCV RNA was lower than Northern Taiwan. The postmortem prevalence of HBV DNA were similar between North and Southern Taiwan. Our study indicate that HCV ICT test has a high sensitivity and specificity in postmortem blood samples. As for HBV ICT test, the sensitivity of HBV ICT test seems low, but on the other hand its specificity is relatively high. We summarized the performance of the ICT tests in a couple of sentences. In order to avoid the risk of acquiring blood-borne viral infections during autopsy, we could apply HCV ICT test in screening HCV infection and HBV ICT kit to exclude HBV infection.