戊型肝炎诊断中血清学及核酸检测意义的研究

目的利用恒河猴感染模型评估血清学检测和核酸检测在戊型肝炎诊断中的临床意义。方法对86只戊型肝炎病毒(HEV)实验感染猴的系列血清和粪便标本，用反转录聚合酶链反应方法进行病毒学检测，用4种酶联免疫吸附抗体检测试剂(E2-IgM，E2-IgG，GL-IgG和YES—IgG)进行血清学检测。结果感染猴均产生E2-IgG抗体，除1只感染猴未检出粪便排毒和E2-IgM外，其余感染猴均出现粪便排毒和E2-IgM阳转。GL-IgG和YES-IgG的阳转率较低，而且与感染剂量相关。急性肝炎主要开始于感染后3～7周内。病毒学指标在潜伏早期即已出现，较疾病的发生约早2周，并在急性期迅速下降。E2-IgM在发病时已有约2／3阳转，并在发病后10周内完全转阴。E2-IgG几乎与E2-IgM同时阳转，在所有感染猴中持续存在，直至86周后仍无阴转。GL-IgG和YES-IgG抗体较E2抗体晚约1周，在感染后20周内已有过半数转阴。结论E2-IgM是一个良好的戊型肝炎急性感染诊断指标，E2—IgG是一个良好的戊型肝炎既往感染诊断指标，GL-IgG和YES—IgG抗体的阳转或双份血清滴度升高可以作为辅助诊断指标，病毒核酸检测仅在发病的极早期具有诊断价值。

Significance of serological markers and virological marker for hepatitis E in rhesus monkey model

Objective To evaluate the serological markers and biological marker in the diagnosis of hepatitis E infection in a rhesus monkey model. Methods 86 rhesus monkeys had been infected with different doses of HEV. Hence, they were taken sequential blood samples at intervals up to 86 weeks for 4 hepatitis E virus (HEV) specific antibody assays (E2-IgM, E2-IgG, GL-IgG, and YES-IgG), and nucleic acid assay. Results All the animals produced E2-IgG and all but one also produced E2-IgM and excreted the virus in stool, whereas positive rate of GL-IgG and YES IgG were low and correlated with virus level. Hepatitis occurred over a period of 4 weeks (between 3 to 7 weeks) after infection. Virological marker occurred mainly during incubation period and declined rapidly after onset of hepatitis. Seroconversion of E2-IgM occurred before onset of hepatitis in 70% monkeys and declined rapidly up to 50% of peak value after 4 weeks. E2-IgM seroconversion was closely paralleled by E2-IgG; however, E2-IgG persisted in all animals for the entire duration of experiment of up to 86 weeks. Production of GL-IgG and YES-IgG was delayed by one week after the E2 antibodies, these antibodies showed a transient occurrence and seroprevalence declined to 50% of the peak value over a period of 12 weeks. Conclusion E2-IgM might be used as a suitable acute hepatitis E marker, and E2-IgG as a suitable epidemiological marker. The seroconversion or liter elevation of GL-IgG and YES-IgG antibodies probably used to confirm the infection. The viral markers are optional for early diagnosis.