中国八省市各级医疗机构确诊急性乙型肝炎实验室检测能力调查

医疗机构的乙型肝炎（乙肝）诊断能力是影响乙肝报告发病率的重要因素，我们在全国范围开展此次调查，以初步了解我国各级医疗机构急性乙肝实验室诊断能力。采用典型抽样在北京、吉林、浙江、山东、河南、广东、四川、甘肃8省／市抽取95家省、地、县、乡级医疗机构作为调查对象（各级比例为1：2：3．7：3．3），采取问卷和现场观察方法调查乙肝实验室人员配备、检测频度、设备配置、检测项目、检测试剂等情况。调查诊断急性乙肝的标准：乙肝两对半、ALT、抗-HBc IgM，同时检测抗-HAV IgM与甲肝鉴别诊断。     

甲型肝炎病毒隐性感染和病人不同隔离方式的效果观察

甲型肝炎(甲肝)抗-HAV IgM抗体检测方法的建立,为甲肝早期诊断提供了依据。本文就甲肝流行期间,通过对甲肝病人家庭成员抗-HAV IgM抗体,抗-HAV IgG抗体的检测,以了解甲肝病毒隐性感染状况,并对甲肝病人不同隔离方式的效果进行了观察。对象与方法 1.观察对象 1988年1月下旬至4月宁波市发生一次介毛蚶传播的甲肝暴发流行,发病率达971.9/10万,选择流行地区家庭     

检测唾液诊断甲型和乙型肝炎

由于相当多的甲型肝炎(HA)患者缺乏黄疸和其他一些临床特征,再加上不能对接触过患者的人员逐一进行血清学检查,因此使不少HA患者漏诊,造成HAV广泛传播,给控制HA爆发流行带来很大困难。为解决这一问题,作者采用检测病人唾液标本中的IgM抗-HAV和IgM抗-HBc来诊断急性HA和乙型肝炎(HB)。作者用三种方法收集唾液标本:(1)用无菌塑料壶收集唾液,为最常用的方法。(2)唾液收集器(Salivette):一种专门     

第二代抗-HCV试验诊断急性丙型肝炎的敏感性

用丙型肝炎病毒(HCV)非结构抗原进行的第一代抗-HCV试验往往在急性丙型肝炎患者起病后1～6个月进展为慢性疾病时才检出阳性,而大部分未进展为慢性丙型肝炎患者的抗-HCV仍为阴性.目前的第二代试验系统还包括HCV核心抗原.作者利用一项前瞻性多中心研究中的40例非甲非乙型肝炎患者(IgM抗-HBc和IgM抗-HAV均为阴性)的冷冻血清,对Abbott第二代抗-HCV酶免疫试验(EIA)诊断急性丙型肝炎的敏感性进行了评价.结果表明,29例患者(73%)在入院后     

甲型病毒性肝炎的早期诊断:ELISA法检测特异性IgM抗体的研究

本文采用一种ELISA法检测IgM抗-HAV。当在本实验系统中加入2-ME处理的阳性血清或阳性血清结合后再用羊抗人IgM进行阻断试验,结果均可使其OD值下降约78%;甲肝流行点急性期血清IgM抗-HAV检出率高达92.3%(48/52),而恢复期血清仅达17.1%(7/41);11份急性乙肝和33份脐血清检测结果均为阴性;本法与Abbott HAVAB-M试盒检测结果符合率达86%;若以Abbott RIA法为标准,本法的敏感性和特异性分别为91.2%和80%,且重复性良好,操作简便,成太低和无放射性危害等优点。     

在急、慢性丙型肝炎中的IgM抗-HCV

为了评估检测IgM特异性抗-HCV在诊断和监测丙型肝炎患者上可能的作用,作者发展了一种简单的改良抗-HCV免疫检测法,以检测IgM抗-HCV。对14例急性、97例慢性非甲非乙型肝炎患者作系列的血清IgG和IgM抗-HCV检测;对20例健康供血者、20例急性甲型肝炎患者和20例急性、30例慢性乙型肝炎患者作血清IgM抗-HCV检测。结果表明,非甲非乙型肝炎患者中,急性病例93％(13/14),慢性病例91％(88/97)检出IgG抗-HCV。101例IgG抗-HCV阳性的患者中,58例(57％)IgM抗-HCV阳性。健康供血者、急性甲型肝炎患     

美国甲型、乙型和非甲非乙型肝炎的发病调查

作者选择了美国5个县的全部肝炎病人的血清标本和流行病学资料,以期证实美国甲型、乙型和非甲非乙型肝炎的发病情况。急性期血清标本中 IgM 抗-HAV 阳性者诊断为甲型肝炎;HBsAg 或抗-HBc(IgM 型占优势)阳性者诊断为乙型肝炎;HBsAg 阳性和 IgM 抗-HAV 阳性者诊断为 HBsAg 携带者伴发急性甲型肝炎;无任何急性甲型和乙型肝炎血清学标记而有黄疸、谷丙转氨酶或谷草转氨酶≥100IU,又无其他确定的肝病原因者诊断为非甲非乙型肝炎。5个县在13～20个月期间共报告了3,749个肝炎病     

固相免疫吸附血凝抑制试验快速检测甲型肝炎IgM抗体

本文报告一种新建立的快速检测抗-HAV IgM的固相免疫吸附血凝抑制试验。本试验与ELISA对比检测血清标本336份,总符合率为99.4%。被检的甲肝感染者血清抗-HAV IgM滴度范围为1:20~1:327 680。阻断试验、2-ME破坏试验及非甲肝病人血清检测结果表明本试验具有良好的特异性。本试验不需标记抗体,不受类风湿因子的干扰,不需要特殊仪器,且经济简便,能在3小时内得出结果,可用作甲肝的早期诊断和流行病学监测,尤其适于基层单位应用。     

抗-HBc IgM的临床意义

近年来,国内外的一些研究表明,抗-HBc IgM 对乙型肝炎(以下简称乙肝)的诊断和鉴别具有重要意义。现就其临床意义作一系统叙述。一、急性乙型肝炎(一)HBsAg 阳性病例对经临床、生化和肝组织学检查证实为急性乙肝的82例 HBsAg 阳性患者观察表明,81例于发病开始即检出抗-HBc IgM(ELISA),仅1例未检出,对该例随访4     

暴发性或亚暴发性非甲非乙型病毒性肝炎中HCV和HEV的作用

作者对17例曾诊断为散发性非甲非乙型肝炎患者的HCV和HEV感染进行研究。这些病例为1983年～1991年迈阿密大学肝病中心收治的急性肝衰竭患者,其中4例为急性暴发性肝炎,13例为亚急性暴发性肝炎。全部病人IgM抗-HAV、HBsAg、抗-HBs、IgM抗-HBc、抗-CMV、抗-EBV和抗-HIV均阴性。3例有自身抗体(ANA、SMA、AMA);抗-肝肾微粒体抗体(LKM-1)和抗肝可溶性抗原抗体(SLA)均阴性。17例病人均有Ⅲ～Ⅳ级肝昏迷和明显的凝血障碍。本研究还包括20例已知HCV感染危险因素的肝硬变和慢性肝炎患者,其中11例经4-RIBA检出抗-HCV,9例可疑阳性。健康对照组10例抗-HCV阴性。     

河北地区TT病毒感染与不同型别病毒性肝病的关系

目的分析健康人群及肝病患者TTV感染状况。方法采用TTV（N22）区核苷酸序列设计引物，建立半巢式聚合酶链反应（Semi—nested PCR）方法，对309例7种不同人群血清检测TTV DNA。结果TTV在非甲一非戊型肝炎、肝硬化患者、丙型肝炎、急性甲型肝炎、急性乙型肝炎、慢性乙型肝炎和健康人群中感染率分别为75．00％（15／20）、75．00％（27／36）、61．90％（13/21）、58．06％（18／31）、52．78％（38／72）、45．61％（26／57）和38．89％（28／72）。肝硬化患者及非甲非戊型肝炎感染率明显高于健康人群（P〈0．01），也明显高于急、慢性乙型肝炎患者（P〈0．05）。21～30岁年龄组TTV感染率（39．06％）显著低于51～60岁年龄组感染率（68．75％）（P〈0．01），其他年龄间无差异。急性甲型肝炎、急性乙型肝炎和慢性乙型肝炎与丙型肝炎之间无统计学意义，性别之间亦无统计学意义。结论TTV在河北地区健康人群及肝病患者中有较高的感染率，TTV感染与不明原因ALT升高有一定的关系。     

杭州市病毒性肝炎分布特征及其防制对策的研究

本文报道了应用前瞻性调查方法，对1987年杭州市城区、水网区、半山区和山区确诊的急性病毒性肝炎1248例血清病原学分型及流行病学调查，结果甲肝占69．71％，乙肝占7．13％，非甲非乙肝占21．96％，甲、乙肝混合感染占1．20％。城、乡均以甲肝占首位，非甲非乙肝次之。甲肝流行的主要危险因素有：①家庭使用马桶、坐坑；②接触肝炎病人；③喝生水。非甲非乙肝以肠道外传播型为主，看牙病（拔牙）是主要危险因素，在此基础上提出相应对策。     

A school outbreak of parvovirus B19 infection investigated using salivary antibody assays.

An outbreak of parvovirus B19 infection at a primary school was investigated using saliva samples. Antibody capture immunoassays for salivary B19 IgG and IgM were developed using a recombinant B19 antigen and monoclonal antibody to B19 virus. Evaluation of the salivary IgG assay using paired serum and saliva samples from 43 staff at St Thomas'' Hospital showed that it had a sensitivity of 100% and a specificity of 95%. Evaluation of the salivary B19 IgM assay using 87 paired blood and saliva samples from a study of general practitioner rubella notifications showed it had a sensitivity of 60% and a specificity of 98%. Using the salivary assay the level of B19 IgG within 2 weeks of the start of the outbreak ranged from 5-33% in children and 29% in staff. By detecting salivary B19 IgM and/or B19 IgG seroconversions, attack rates of 8-50% in children in different classes and 47% in staff were observed. Household transmission was also studied and an attack rate of 45% was recorded in 11 susceptibles. After the outbreak, the level of B19 IgG in children with the highest attack rates was 60-70%, similar to that seen in adults in the UK. This study highlights the risk of B19 infection in an institutional setting and shows that saliva samples are a useful alternative to blood.     

老年人散发急性肝炎病原学及临床分析

目的 为探讨老年人散发急性肝炎病原学构成及临床特点，为老年人病毒性肝炎的防治提供依据。方法 对近年住院治疗的散发急性老年肝炎患者94例，用ELISA、PCR和DOT‘进行血清学分型并对其临床资料作初步分析。结果 甲、乙、丙和戊型肝炎分别占13．83％、3．19％、5．32％和65．95％，混合感染占17．02％。5型肝炎标志物阴性13．83％，其中药物性肝炎5例，占5．3％。老年人急性肝炎的特点为黄疸深，住院时间长，单一感染者均顺利恢复，混合感染16例中3例因肝衰竭而死亡。结论 本地区，老年人甲、乙、丙和戊型肝炎均有散发，多为单一感染，少数为混合感染，可能存在新的肝炎致病因子。老年人药物性肝炎应受重视。混合感染可能是老年肝炎患者死亡原因之一。     

Epidemiology of acute hepatitis among outpatients in the urban community of Lyon, 1983

We conducted in 1983 an hepatitis surveillance programme in collaboration with 93% of the medical analysis laboratories in Lyons' urban area (1,100,000 inhabitants) and diagnosed 1,002 cases of acute hepatitis (incidence : 90.5 cases/10(5) inhabitants; HAV : 50.4 cases/10(5) inhabitants; HBV : 12 cases/10(5) inhabitants; non A non B : 24 cases/10(5) inhabitants; drugs : 4.2 cases/10(5) inhabitants). HBs Ag was undetectable in 12% of acute hepatitis B. Hepatitis A accounted for 91% of children's cases and 48% of cases among adults between 20 and 40 years old. Epidemics were observed among children after summer holidays related to the return of migrants from trips to their native country. For acute hepatitis B and non A non B, classical epidemiological data were observed, but the prevalence of drug addicts and homosexuals was low.     

Salivary diagnosis of measles for surveillance: a clinic-based study in Niterói, state of Rio de Janeiro, Brazil.

This study was designed to investigate whether saliva could be a feasible alternative to serum for the diagnosis of recent measles infection in a clinic setting. Forty-two paired blood and saliva samples collected 1 to 16 days after onset of illness from 29 patients with clinical measles were tested for specific immunoglobulin (Ig) M by antibody-capture radioimmunoassay. Measles IgM was detected in all serum samples and in 39 (92.9%) saliva specimens. Between 1 and 3 weeks after illness onset, virus-specific IgM was detected in 100% of saliva samples. Measles IgM was also detected in 17 saliva specimens, not paired with blood samples, collected from study patients 5 days to 3 weeks after onset. Our results indicate that salivary IgM detection is a suitable non-invasive method for investigation of notified cases under conditions of routine clinic use.     

唾液传播乙型肝炎流行病学意义的研究

对71例乙型肝炎病人、33例HBsAg携带者、4例HBsAg阴性肝炎病人和正常健康人进行了唾液HBsAg、抗-HBs和抗-HBc的检测。结果表明，从乙型肝炎病人和HBsAg携带者的唾液中查出HBsAg（49.30%、39.39%）、抗-HBs（7.04%、6.06%）和抗-HBc（38.03%、27.27%）。并对4份HBsAg阳性唾液标本进行免疫电镜检查，其中2份标本可见直径20毫微米的成堆HBsAg颗粒。
为探讨唾液传播乙型肝炎的流行病学意义，我们采用前瞻性调查方法，经一年暴露期限，比较唾液HBsAg阳性组、阴性组以及健康对照组HBV感染率，结果提示，唾液传播乙型肝炎的作用并不十分明显。     

Hepatitis B and C virus infections among patients with gingivitis and adult periodontitis: seroprevalence and public health importance

The aim of the present case control study was to identify seroprevalence of hepatitis B and C virus (HBV and HCV) infections among one hundred cases with periodontal disease (71% gingivitis and 29% adult periodontitis) and one hundred controls with healthy gingiva matdhed for age and sex. Moreover, it aimed to detect hepatitis markers in saliva samples corresponding to the positive sera. Different risk factors associated with hepatitis infection and detectability rate of hepatitis markers were also studied. METHODOLOGY: enzyme linked immunosorbent assay (ELISA) technique was used to detect the presence of hepatitis B surface antigen (HBsAg), antibody to hepatitis B core antigen (anti HBc), e antigen (eAg) and antibody to hepatitis C virus (anti HCV) both in serum and saliva samples. HCV RNA was detected by polymerase chain reaction (PCR) technique. Oral examination was performed for assessment of simplified Oral Hygiene Index (OHI-S), Papillary Bleeding Index (PBI), probing pocket depth and loss of fibre attachment. RESULTS: cases with periodontal disease showed higher percentages of hepatitis exposure (hepex; anti HCV and/or anti HBc) and significantly higher anti HCV seropositivity than the controls (26% and 13% versus 22% and 8%, respectively). No difference in HBsAg carrier rate nor in anti HBc seropositivity was elicited. Furthermore, cases with periodontal disease showed higher detectability rate of HBsAg, anti HBc, anti HCV or both anti HCV and/or anti HBc in whole unstimulated saliva than the controls (100% vs 66.7%, 50% vs 23.5%, 23.1% vs 0.0% and 42.3% vs 18.2%, respectively). Stepwise logistic regression delineated two significant factors associated with the risk of hepatitis exposure, the first predictor was the rural residence and the second one was the history of blood transfusion (OR=3.10, 2.94, respectively). Periodontal disease, severity of bleeding and bad oral hygiene were associated with the risk of hepatitis infection and with the detectability of hepatitis markers in the whole saliva.     

Prevalence of chronic viral hepatitis in drug abusers

Authors examined the prevalence of hepatitis B, C and D viral infections in Hungarian drug users. Between January 1995 and October 1998 256 examinations were made (58% intravenous, 42% non intravenous drug user). Hepatitis C virus infection in 27 patients, hepatitis C and B virus infection in 4 patients, hepatitis B virus infection in 17 patients was detected. Every hepatitis B virus positive case was past infection. Hepatitis D virus infection was not detected. Clinically overt liver disease was proved in more than half of the hepatitis C virus infected patients. Because of insufficient collaboration only 11 were followed up. Liver biopsy was made in 5 cases. Interferon therapy was indicated in 3 cases. The 24% of intravenous drug users was anti-HCV seropositive contrary to 1.4% of non intravenous group. Anti-HCV seropositivity was proved in 38% in common needle users, while in disposable needle users only 3%. The prevalence of hepatitis C virus infection in intravenous drug users is rather frequent in Hungary too. The exact diagnosis of liver diseases is very difficult as for insufficient collaboration. The prevalence of hepatitis B virus infection in i.v. and non i.v. drug users is the same as in the normal population. The importance of information, especially to avoid common needle use is stressed.     

Non-A, non-B viral hepatitis in Egypt.

A study was carried out on 200 patients of ages 20-40 years suffering from acute viral hepatitis. Sera were tested for markers of hepatitis B (HBsAg, and IgM anti-HBc) and hepatitis A (IgM-anti-HAV) by the ELISA technique. Sera negative for the markers of both viruses: Hepatitis A (HAV) and Hepatitis B (HBV) were subsequently tested for IGM Heterophil antibodies against Epstein-Barr virus (EBV) by the Monospot slide test to diagnose acute infectious mononucleosis and tested for anti-CMV (IgM) by ELISA technique for the diagnosis of acute Cytomegalovirus (CMV) infection. Non-A, non-B hepatitis (NANB) was diagnosed by exclusion. The results of the study showed that 133 (66.5%) patients had evidence of HBV infection, while only 9(4.5%) were diagnosed as HAV infection. EBV and CMV were the possible etiological agents of acute viral hepatitis in (3.5%) and 1%) respectively. Accordingly the Non-A, non-B hepatitis in this study amounts to (24.5%) of the acute viral hepatitis.