三种戊型肝炎诊断试剂可靠性的研究

目的评价不同戊型肝炎诊断试剂对临床急性戊型肝炎诊断的可靠性。方法用273份健康人血清和525份肝炎患者血清对三种戊型肝炎诊断试剂进行比较。结果E2-IgM试剂用于急性戊型肝炎诊断的特异度为100．0％，显著优于GL-IgM试剂(96．7％)和GL—IgG试剂(85．4％)。E2-IgM，GL-IgG试剂用于急性戊型肝炎诊断的灵敏度(分别为97．9％、93．8％)，均显著高于GL-IgM(72．9％)。在65例GL-IgM阳性而E2-IgM阴性的患者中，有58例(89．2％)同时为抗甲型肝炎病毒IgM抗体阳性，提示GL—IgM试剂的检测受其他IgM抗体的干扰较大。结论E2-IgM是良好的戊型肝炎急性诊断指标。     

两种戊型肝炎IgG抗体检测试剂的比较

目的比较2种国产戊型肝炎IgG抗体诊断试剂(E2-IgG和X-IgG)的特异性与敏感度。方法利用2种试剂对2006年江苏省某市普通人群的流行病调查血清标本460份和经过巢式逆转录聚合酶链式反应(nest-RT-PCR)鉴定为HEV核酸阳性的临床戊型肝炎患者血清标本72份进行平行检测,并以免疫印迹实验(Westernblot,WB)和中和单抗阻断试验进行验证。结果1.460份流行病调查血清标本中WB阳性188份。2.188份WB阳性标本中E2-IgG的检测敏感度为99.5,特异度为99.6,阳性预测值99.5,阴性预测值99.6,准确性99.6;X-IgG的检测敏感度为21.3,特异度为97.4,阳性预测值85.1,阴性预测值64.1,准确性66.3。3.E2-IgG阴、阳性A450/A620值的分布在临界值附近分界明显,小于临界值的A450/A620值取对数后呈正态分布,而阳性血清A450/A620值的高低与其WB的反应强度正相关。4.E2-IgG阳性、X-IgG阴性的血清共148份,中和单抗阻断阳性率为98,WB阳性率99.3。5.经PCR鉴定为HEV核酸阳性的急性戊型肝炎患者血清中E2-IgG敏感度98.6,X-IgG敏感度80.6(χ2=10.7,P<0.01)。结论E2-IgG在不同人群中均能较好的反映体内戊型肝炎抗体存在的真实情况。     

东莞市石龙镇宾馆职工戊型肝炎病毒感染的流行病学调查报告

目的 研究东莞市石龙镇宾馆职工戊型肝炎病毒感染的现状。方法 分别对584例不同年龄组男、女职工进行戊肝-IgG和戊肝-IgM的检测。结果 戊型肝炎病毒感染率为7．19％，男性高于女性，20～29年龄组高于其它年龄组。结论 东莞市石龙镇宾馆职工戊型肝炎病毒感染率接近全国感染水平，且以年青人的感染率最高，男性明显高于女性。     

分子与血清学检测确诊2017年西非塞拉利昂1例猴痘病毒感染病例

目的 对发生在西非塞拉利昂南部的疑似猴痘病毒感染者进行实验室确诊。 方法 采集疑似感染病人感染后12 d和55 d的血清,利用猴痘特异性引物进行实时定量PCR检测,并对病人血清中痘苗病毒IgG、IgM和猴痘病毒IgG抗体进行ELISA检测,并结合其流行病学信息进行诊断结果 实时定量PCR检测该病人感染12 d后血清为猴痘病毒核酸阳性;ELISA检测病人感染后12 d和55 d血清,痘苗病毒IgG、IgM为阳性;猴痘病毒IgG抗体检测均为阳性,且55 d较12 d抗体滴度有4倍升高(3 200/800)。 结论 病人血清的核酸检测和血清学检测结果为阳性,结合病人的临床特征和野生动物接触史,确诊该病人为猴痘病毒感染。     

戊肝诊断研究获重要进展

据健康报　（记者李水根）戊型肝炎目前在我国已是常见的传染病，但其诊断尤其是散发性戊型肝炎的诊断却是难题．由浙医一院阮冰博士和马亦林教授等组成的研究小组经４年努力，建立起戊型肝炎的实验室和临床诊断方法，并对各种血清标志物进行了全病程动态观察．国内著名传染病学专家对他们的工作进行鉴定时认为，这些研究成果对我国戊型肝炎的诊断和防治均具重要的指导意义．研究人员在４年中建立了６２例散发性戊型肝炎患者的系列血清库，并收集了２６例戊型肝炎患者的系列粪便标本，对散发性戊型肝炎患者的病毒血症、粪便排毒以及抗体消长…     

巴基斯坦的流行性戊型肝炎血清学反应的类型及抗HEV的证据

作者对巴基斯坦肝炎暴发期间(1987年3月1日至4月22日)临床诊断为肝炎的133例住院患者,采用ELISA法进行了血清杭HEVIgM和IgG的动态观察,其中122例(92％)诊断为戊型肝炎,包括1例乙、戊混合感染。在该122例HEV感染者中,入院前2周血清抗HEVIgM和IgG的阳性率分别为91％和71％(5/7),5～7周达100％。抗体滴度的峰值出现在入院后2～4周,在入院后第20个月,检测33例患者的IgM抗体均阴转,     

HEV-IV型感染猕猴的血清学及肝脏组织学的动态变化

目的 观察戊型肝炎病毒IV基因型(HEV—IV)静脉接种猕猴后其粪便、血清学及肝脏组织学的动态变化。方法 用逆转录PCR检测实验动物接种前、后粪便悬液及血清HEV RNA，用酶联免疫法(ELISA)检测血清抗HEV IgM及抗HEV IgG．并同步观察其血生化及肝脏组织学的变化。结果 接种后第30天2只实验动物均出现明显消化道症状，粪便及血清中均检出HEV RNA，随之ALT、AST同步升高，血清抗HEV IgM和IgG显现阳性,肝脏组织学也相继出现不同程度病理改变。发病后第60天各项生化指标恢复正常。结论 云南猕猴是HEV IV感染的较好的动物模型。     

生猪屠宰销售职业人群戊型肝炎病毒感染的危险因素研究

目的　生猪屠宰销售职业人群戊型肝炎病毒的感染情况 ,流行特征及研究工作时间长短与戊型肝炎病毒感染的关系。方法　 2 0 0 3年在浙江省北部地区采用横断面调查方法 ,调查 2 1- 6 1岁生猪屠宰销售人员 189人 ,用ELISA法检测该人群中HEV -IgG和HEV -IgM抗体水平 ,同时调查相关的职业危险因素。 结果　在调查的 189名与生猪屠宰销售相关的职业人群中 ,抗HEV -IgG和抗HEV -IgM阳性者分别为 14 6例和 5例 ,人群总感染率分别为 77 2 5 %和 2 6 5 %。在 189例抗HEV -IgG阳性者中有男性 139例 ,女性为 7例 ,男女的感染率分别为 77 6 5 %和 70 0 0 % ,戊肝感染和性别没有关系。 5例HEV -IgM阳性者都为男性。戊肝感染可见于各个年龄段 ,但流行率分布不平衡 ,差异有显著性 (χ2 =11 2 2 ,P =0 0 11) ,随着年龄的增长感染率有上升的趋势 ,但是到 4 5岁以后戊肝感染率保持在一个相对稳定水平。戊肝感染随着职业人群和猪接触的年限增加而呈现上升趋势 (χ2 =9 5 74 ,P =0 0 0 2 )。结论　浙江省生猪屠宰销售人员的感染率高于当地人群。和密切猪接触是戊型肝炎感染的危险因素之一 ,同时与猪接触的工作年限也是戊肝感染的危险因素。戊肝感染随着年龄的增加而感染率上升 ,4 5岁以后维持一个相对稳定状态。     

戊型肝炎及重叠乙型肝炎感染患者丙氨酸转氨酶变化

目的　观察戊型肝炎及重叠乙型肝炎感染患者丙氨酸转氨酶 (ALT)变化。方法　将戊型肝炎抗体阳性及重叠乙型肝炎感染患者 2 73例分为 5组。A组 12 7例 ,为戊型肝炎病毒 (HEV) IgG阳性 ;B组 9例 ,为HEV IgM阳性 ;C组 64例 ,为HEV IgM和HEV IgG均阳性 ;D组 3 2例 ,为HEV IgM和HEV IgG均阳性并重叠乙型肝炎感染 ;E组 41例 ,为HEV IgG阳性并重叠乙型肝炎感染。另选戊型肝炎抗体阴性的非乙型肝炎患者 5 0 0例作为对照组。用速率法测定各组ALT值。结果　各组ALT异常增高百分率及异常增高者ALT值分别为 :A组 2 1例 ( 16.5 %) ,ALT( 183± 89)U /L ;B组 3例 ,ALT( 2 0 3± 112 )U /L ;C组 16例 ( 2 5 .8%) ,ALT( 2 17± 119)U/L ;D组 11例 ( 3 4.4%) ,ALT( 2 3 4± 12 8)U/L ;E组 13例 ( 3 1.7%) ,ALT( 2 10± 98)U/L ;对照组 5 1例 ( 10 .2 %) ,ALT( 112± 68)U/L。戊型肝炎抗体阳性各组ALT异常增高率与对照组间差异有显著性 (P <0 .0 5 ) ,戊型肝炎抗体阳性各组ALT异常增高者ALT值与对照组间差异有显著性 (P <0 .0 5 )。结论　戊型肝炎抗体阳性组ALT异常增高率和增高者ALT值均较对照组有明显增高 ,HEV IgM阳性或重叠乙型肝炎感染较单纯HEV IgG阳性者 ,ALT增高明显     

戊型肝炎

一次戊型肝炎暴发的血清学调查呻秀嫒等（北京北京铁路局中心卫生防疫站100038）；《中国卫生检验杂志》，2005，15（3）：274-275【目的：了解戊型肝炎病毒临床型和亚临床型感染情况。方法：应用酶联免疫法（ELISA）检测戊型肝炎暴发机构职工的血清抗-HEV IgG。结果：戊型肝炎暴发机构1611名职工中，     

Type-IV Indian swine HEV infects rhesus monkeys

In contrast to countries reporting zoonotic spread of hepatitis E virus (HEV), distinct genotypes circulate in humans (genotype 1) and pigs (genotype 4) from India indicating rarity of such spread. Pigs were refractory to human HEV. As rhesus is an excellent animal model for human HEV, an attempt was made to infect rhesus monkeys with swine HEV. Experimental infection of both the rhesus monkeys with swine-HEV as evidenced by seroconversion to anti-HEV antibodies and presence of viraemia suggests possibility of human infections or differential susceptibility. Comparison of Open Reading Frame-2 and hypervariable regions of HEV genomes showed identity of swine and monkey-derived HEV.     

Swine hepatitis E virus in rural southern China: genetic characterization and experimental infection in rhesus monkeys (Macaca mulatta)

BACKGROUND: In rural areas of southern China, where hepatitis E is endemic, residents generally rear pigs in pigsties near their houses. The study was conducted to assess the possibility that hepatitis E virus (HEV) infections in this region are acquired primarily through contact with swine. METHODS: One hundred twenty swine fecal samples collected from pigsties located in eight rural communities of southern China were tested for HEV RNA. The swine HEV isolates were analyzed genetically and were experimentally inoculated into rhesus monkeys to determine the potential risk of cross-species infection. RESULTS: Twenty-nine of the 120 swine fecal samples were positive for HEV RNA. The nucleotide sequences of these swine HEV strains shared 85%-99% identities with the local human genotype 4 isolates and belonged to two subgroups of genotype 4. Importantly, swine HEV strains representing both subgroups induced hepatitis in rhesus monkeys by inoculation with the virus, evidenced by elevated serum alanine transaminase (ALT), viremia, fecal viral shedding, anti-HEV seroconversion, and liver histopathological changes. CONCLUSIONS: Swine may be the principal reservoir for human HEV infection in rural southern China.     

Antibodies against hepatitis E virus in old world monkeys

SUMMARY. To examine whether Indian monkeys are infected with hepatitis E virus (HEV) in nature, serum samples from wild rhesus (Macaca mullata) , bonnet (M. radiata) and langur (Presbytes entellus) monkeys were screened for anti-HEV IgG antibodies in recombinant antigen-based ELISA assays. The positivity rates were 36.7%. 19.1% and 2% respectively. The protection of such antibodies against human HEV was studied in four rhesus monkeys. Of the two rhesus monkeys with anti-HEV titres of 100 and 1000 respectively which were inoculated with the KOL-91 strain of HEV, the former demonstrated a 10-fold rise in anti-HEV titres. Anti-HEV titre in the second rhesus monkey remained unchanged. Neither of the monkeys showed any rise in serum alanine transaminase (ALT) or presence of virus in the faeces, as tested by polymerase chain reaction (PCR). Two other rhesus monkeys with anti-HEV titres of 10000 and 100 respectively were inoculated with the AKL-90 strain of HEV. Serum ALT levels and anti-HEV titres remained unchanged in the first monkey. Excretion of virus in faeces was not noted (PCR). The second monkey developed a typical HEV infection. HEV infection could be produced in anti-HEV negative control monkeys inoculated with both strains of HEV. These results show that either human or simian HEV, or a closely related agent, is circulating among Indian macaques. Titre-dependent protection of naturally occurring anti-HEV antibodies supports this view.     

Hepatitis E seroconversion in United States travelers abroad

Sporadic cases of symptomatic hepatitis E virus (HEV) infection have been reported in United States travelers to developing countries, including Mexico and Pakistan. To evaluate the risk of exposure in United States travelers, 356 patients seen in our Travel Clinics were tested for antibodies to HEV before and 6 weeks after traveling. Samples obtained 6 months after traveling were available for 211 travelers. IgG and IgM antibodies to HEV were assayed with HEV ELISA diagnostic kits containing 3 recombinant antigens expressed in Escherichia coli representing immunodominant epitopes within open reading frames 2 and 3 of HEV. Nine patients were IgG seropositive in specimens obtained before travel. Four individuals seroconverted. In all 4 patients, IgG seroconversion was demonstrated in samples obtained at least 6 months after return. Samples obtained 6 weeks after return were seronegative for HEV in all 3 patients for whom such samples were available. Travel destinations were diverse: Thailand, China, Russia, and Peru. These data are consistent with an infection acquired while traveling. None of the seropositive subjects reported any symptoms of hepatitis before or after travel. In the absence of overt disease, these results imply that exposure to HEV resulted in subclinical infections.     

抗戊型肝炎病毒IgG和IgM抗体对诊断急性戊型肝炎的意义

目的 探讨抗戊型肝炎病毒（ＨＥＶ）ＩｇＧ和ＩｇＭ抗体对诊断急性戊型肝炎（ＨＥ）的意义。方法 应用酶联免疫法（ＥＩＡ）检测我国７个城市共计１４３例散发性ＨＥ病人急性期血清和其中５６例病人的３５９份系列血清,以及４只实验感染ＨＥＶ猕猴的６８份系列血清的抗－ＨＥＶＩｇＭ和ＩｇＧ。结果 ７个城市１４３例散发性ＨＥ病人急性期血清抗－ＨＥＶＩｇＧ阳性率为１００．０％,明显高于抗－ＨＥＶＩｇＭ（７３．４％）,９     

Shift of hepatitis E virus RNA from hepatocytes to biliary epithelial cells during acute infection of rhesus monkey

Hepatitis E virus (HEV) has been considered to be the major cause of enterically transmitted non-A, non-B hepatitis in developing countries. However, little is known about viral replication and localization in the liver. The aim of this study was to examine the distribution of HEV-infected cells in experimentally infected animals. Seven captured wild rhesus monkeys were inoculated intravenously with faecal extract derived from a Myanmar strain of HEV. Animals were killed at different time-points of clinical illness: during early infection, during prehepatitis with viral-like particles in bile, during acute hepatitis and during convalescence. Intrahepatic localization of HEV was analysed using non-isotopic thymine dimer in situ hybridization (NITDISH). Both plus and minus strands of HEV RNA were found in hepatocytes during the early infection period. Staining in the submembranous cytoplasmic region of hepatocytes was observed. In the prehepatitis period, both plus and minus strand HEV RNAs appeared in the canalicular side of isolated bile epithelial cells. Subsequently, HEV RNA became universally distributed in the cytoplasm of medium-size bile epithelial cells. After recovery, HEV RNA disappeared.     

Consecutive evaluation of immunoglobulin M and G antibodies against hepatitis E virus

Hepatitis E virus (HEV) infection is sporadic in the Guangzhou city southern China. However, the evaluation of antibodies to HEV during consecutive time periods after infection has not been reported. We utilized enzyme immunosorbent assay (ELISA) to detect IgM and IgG anti-HEV in consecutive serum specimens from patients with acute hepatitis E and compared that data with detection rates of IgM and IgG anti-HAV in patients with acute hepatitis A. IgM anti-HEV can be detected as early as 4 days after onset of disease symptoms in some patients. The detection rate of IgM anti-HEV is significantly higher in specimens collected within 4 weeks (95%) of onset than in those specimens collected 4 to 18 weeks after onset (67.6%) (P<0.005). IgM anti-HEV had a similar pattern to IgM anti-HAV and can be used as a marker of acute HEV infection. In contrast with IgG anti-HAV, 56.8% of the specimens did not contain detectable levels of IgG anti-HEV (P<0.005). One should be cautioned against making a diagnosis of HEV infection solely by the currently available assays for IgG anti-HEV. In conclusion, IgM anti-HEV can be used as a reliable and sensitive marker for recent HEV infection, but serum specimens should be collected within 4 weeks after onset of symptoms to avoid false-negative results. In contrast, we should be aware of the failure to develop IgG anti-HEV in some patients. These patients carry the risk of reinfection.