Seroepidemiology of viral hepatitis: correlation with clinical findings

Antibody to hepatitis A antigen (anti-HA) is detectable in the serum shortly after infection with hepatitis A virus. The presence of IgM antibody indicates acute infection; IgG signifies past infection. Hepatitis B surface antigen (HBsAg) indicates infectiousness and is usually present when hepatitis B virus causes active liver disease; its antibody (anti-HBs) is neutralizing and confers immunity. Antibody to core antigen (anti-HBc) is an index of hepatitis B viral replication when present in high titers; in low titers it reflects past infection. Early presence of e antigen (HBeAg) indicates a high degree of infectivity, whereas presence of its antibody (anti-HBe) indicates a lesser degree. Although markers of non-A non-B hepatitis have been described, the definitive nature and number of the virus or viruses are not yet clear.     

光激化学发光法检测乙型肝炎病毒感染血清学标志的性能评价

目的评价光激化学发光法（LICA）对乙型肝炎病毒（HBV）感染血清学标志的检测性能。方法用乙型肝炎表面抗原（HBsAg）定值血清和质控品对LICA检测HBV感染血清学标志的试验性能进行评价;以化学发光微粒子免疫分析法（CMIA）为比较对象,对LICA检测453例临床样本HBV感染5项血清学标志的结果进行分析。结果 LICA对HBsAg的检测下限（LLD）为0.23 ng/mL,批内的总变异系数（CV）〈5%,平均回收率为99.88%。LICA与CMIA检测HBsAg、乙型肝炎表面抗体（抗HBs）、乙型肝炎e抗原（HBeAg）、乙型肝炎e抗体（抗HBe）的阳性率差异无统计学意义（P〉0.05）,2种方法的符合率〉95%,而LICA检测乙型肝炎核心抗体（抗HBc）阳性率低于CMIA,差异有统计学意义（P〈0.01）。结论 LICA检测HBV感染HBsAg、抗HBs、HBeAg、抗HBe 4项血清学标志具有良好的检测性能,与CMIA有很高的符合率。     

福州市平潭县乙型肝炎流行状况基线调查分析

目的 了解福州市平潭县乙型肝炎(乙肝)的实际发病情况,分析其流行因素,为进一步做好该县乙型肝炎的防治工作提供科学依据.方法 采用整群抽样法,以家庭为单位进行随机抽样,用酶联免疫吸附试验(ELISA)检测乙肝血清标志物,用EPIDATE 3.01建立数据库,并采用SPSS 11.0进行统计分析.结果 共调查465户1743人,乙肝病毒(HBV)感染检出率为61.3%.乙肝病毒表面抗原(HBsAg)阳性率为16.9%,乙肝表面抗体(抗-HBs)阳性率为43.1%,乙肝e抗原(HBeAg)阳性率为5.6%,乙型肝炎e抗体(抗-Hbe)阳性率为14.4%,乙型肝炎核心抗体(抗-HBc)阳性率为52.2%.共有18种感染模式,以5项全阴模式居首位.从年龄组分布来看,HBsAg阳性率呈中间高、两头低的趋势,0～9岁组的HBsAg阳性率最低,为3.5%;以20～60岁阳性率较高,分别为22.4%、22.6%、21.8%、21.3%.乙肝疫苗免疫史对HBsAg、抗-HBs、HBeAg、抗-Hbe、抗-HBc阳性率均有影响.有免疫史人群HBsAg阳性率、HBeAg阳性率、抗-Hbe阳性率、抗-HBc阳性率均低于无免疫史人群,抗-HBs阳性率则高于无免疫史人群,差异有统计学意义.HBsAg阳性率和HBeAg阳性率以商人为最高,抗-HBs阳性率商人最低.结论 成人是平潭县乙肝的主要感染者,该人群乙肝疫苗免疫预防接种率较低.除继续做好新生儿乙肝疫苗接种的同时,应广泛开展乙肝预防的宣传教育,对高危人群进行乙肝疫苗预防接种,降低乙肝发病率.     

Chronic hepatitis B and hepatitis B surface antigen carriers in university students

A study was made of latent hepatic diseases in university students. 1.4% to 1.6% of the students were positive for hepatitis B surface antigen (HBsAg), and 10.3% for anti-HBs. Of 28 students with HBs-antigenemia, 2 had chronic persistent hepatitis, and 3 minimal hepatitis, 23 being healthy carriers. Hepatitis B e-antigen (HBeAg) was detected in 44% of the students with HBsAg, and anti-HBe in 13%. Anti-HBe was significantly more frequently found in female students with HBsAg than in male students. Though most of the students with HBsAg had high titer of antibody to hepatitis B core antigen (anti-HBc), there were a small number of cases showing low titer. HBsAg and anti-HBs was detected in the same serum specimens of 2 carrier students. Liver damage was also found in 3 students without HBs-antigenemia.     

Decrease in female university students positive for hepatitis B e antigen

Since 1976 university students were screened for hepatitis B surface antigen (HBsAg) every year, and sera positive for HBsAg were tested for hepatitis B e antigen (HBeAg) and antibody to HBeAg (anti-HBe). Yearly changes in the prevalences of HBeAg in the male HBsAg carrier students were relatively small and statistically not significant. In the female HBsAg carrier students, however, HBeAg which was positive by immunodiffusion in 47% of the students in 1976-79 was not detected by radioimmunoassay in 1981 and 1982. The difference of the prevalences of HBeAg between 1976-79 and 1981-82 was statistically highly significant (p less than 0.001). It is suggested that seroconversion from HBeAg to anti-HBe in female HBsAg carriers is recently accelerated.     

Seroprevalence of hepatitis B and C viruses in patients with chronic kidney disease in the predialysis stage at a university hospital in Turkey

BACKGROUND: Hepatitis B (HBV) and C (HCV) viruses are the most common viruses that cause viral infections among the hemodialysis patients. OBJECTIVES: To assess the prevalence of HBV and HCV in predialytic chronic kidney disease (CKD) patients. DESIGN: A cross-sectional study. SUBJECTS: 171 consecutive predialytic CKD patients. MEASUREMENTS: Third-generation micro-ELISA assay was used for hepatitis B surface antigen (HBsAg), antibody to hepatitis B core (anti-HBc) and surface antibody (anti-HBs), secretory form of hepatitis B envelop antigen (HBeAg), antibody to secretory form of hepatitis B envelop antigen (anti-HBe), and ELISA for antibody to hepatitis C virus (anti-HCV). RESULTS: The main causes of CKD were 29.8% diabetic nephropathy, 19.9% chronic glomerulonephritis, 16.3% hypertensive nephrosclerosis, 14.0% unknown, 5.3% amyloidosis, 4.7% autosomal-dominant polycystic kidney disease, 4.1% chronic tubuluointerstitial nephritis, 3.5% malignancies, 1.7% benign prostatic hypertrophy, 0.6% Alport syndrome. The seroprevalence of hepatitis was: HBsAg 10.5%, anti-HBc 36.8%, anti-HBs 28.7%, HBeAg 5.3%, anti-HBe 32.7%, anti-HCV 7% and HBsAg+anti-HCV 0.6%. CONCLUSIONS: The seroprevalence of HBsAg and anti-HCV among predialytic CKD patients was similar to our patients in hemodialysis program.     

Hepatitis B antigens and antibodies in asymptomatic carriers and in chronic liver diseases.

88% of asymptomatic hepatitis B surface antigen (HBsAg) carriers and 97% of HBsAg positive patients with chronic hepatitis or non-alcoholic liver cirrhosis showed high titers of antibody to hepatitis B core antigen (anti-HBc). A high titer of anti-HBc, thus suggested to be an indicator of persistent hepatitis B virus infection, was found rarely in seronegative patients with chronic hepatitis, non-alcoholic cirrhosis, or alcoholic liver diseases. It was not revealed in idiopathic portal hypertension or Budd-Chiari syndrome. In asymptomatic HBsAg carriers of 20--29 years of age, hepatitis B e-antigen (HBeAg) was significantly more frequently found in males than in females. There were differences in sex ratio, age, and history of blood transfusion between B type and non-B type of chronic hepatitis and non-alcoholic liver cirrhosis.     

Hepatitis B e antigen in volunteer and paid blood donors

Sera from 200 volunteer donors and 200 paid blood donors, all positive for hepatitis B surface antigen (HBsAg), were tested for the presence of hepatitis B e antigen (HBeAg).HBeAg was detected in 31 HBsAg- positive paid donors (15%), and in 11 HBsAg-positive volunteer donors (5%) by agar gel diffusion. The presence of HBsAg was associated with higher titers of HBsAg. No significant difference was found in the prevalence of antibody to HBeAg (anti-HBe) in the two donor groups. Rheumatoid factor was not associated with the presence or absence of HBeAg or anti-HBe, indicating that HBeAg is probably not an anti-IgG. These data support the epidemiological evidence that paid blood donors appear to be more likely than volunteer donors to transmit hepatitis B virus infection to recipients of their blood.     

临产妇前S1抗原与乙型肝炎“两对半”联合检测的意义

目的探讨临产妇前S1抗原和乙型肝炎“两对半”组合模式的关系及其临床意义。方法用酶联免疫吸附试验（ELISA）法检测394例临产妇血清乙型肝炎病毒前S1抗原（PreS1）、乙型肝炎病毒表面抗原（HBsAg）、乙型肝炎病毒表面抗体（抗-HBs）、乙型肝炎病毒e抗原（HBeAg）、乙型肝炎病毒e抗体（抗-HBe）和乙型肝炎病毒核心抗体（抗-HBc）6种免疫指标的表达。结果HBsAg阳性血清141例，PreS1 99例（70.2％）。其中HBeAg阳性44例，PreS1检出39例（88.6％）；HBeAg阴性97例，PreS1检出60例（61．9％），两者比较差异有统计学意义（χ^2=10，38，P〈0．005）。HBsAg阴性血清中未检出PreS1。结论PreS1与HBeAg具有较好的相关性，是乙型肝炎病毒复制的可靠指标之一，与乙型肝炎“两对半”联合检测可更准确反映乙型肝炎病毒感染复制状况。     

Serological markers of hepatitis A and B virus infection in overseas students

Serological markers of hepatitis A and B virus infection were determined by radioimmunoassay in 83 overseas university students. Hepatitis B surface antigen (HBsAg) was detected in 8 students (9.6%), antibody to HBsAg and/or antibody to hepatitis B core antigen in 38 (46%), and antibody to hepatitis A virus (anti-HAV) in 74 (89%). These prevalences of hepatitis A and B markers were significantly higher than those in Japanese students. Liver function tests were abnormal in 7 overseas students (8%). Among groups of the overseas students, East Asian groups showed high prevalences of hepatitis B markers. High prevalances of anti-HAV were demonstrated not only in Asian groups but also in South American group.     

孕产妇HBV前S1抗原与相关血清标志物联合检测结果分析

目的了解孕产妇乙型肝炎(下称乙肝)病毒(HBV)感染情况,对孕产妇乙肝预防控制提供依据,并探讨HBV前S1抗原和乙肝血清标志物联合检测的关系及临床意义。方法采用酶联免疫吸附试验(ELISA)法对2 067例孕产妇进行血清HBV前S1抗原(PreS1-Ag)、HBsAg、抗-HBs、HBeAg、抗-HBe和抗-HBc进行检测,并对检测结果进行分析。结果 HBsAg阳性211例,阳性率10.21%。在211例HBsAg阳性血清中,PreS1-Ag阳性138例(65.40%),HBeAg阳性71例(33.65%),经χ2检验,二者差异有统计学意义(P<0.05);大三阳模式为HB-sAg(+)、HBeAg(+)、抗-HBc(+),HBsAg(+)、HBeAg(+),小三阳模式为HBsAg(+)、抗-HBe(+)、抗-HBc(+)的PreS1-Ag检测阳性率分别为80.39%、75.00%和64.04%,经χ2检验,3种模式之间差异无统计学意义(P>0.05)。其中71例HBeAg阳性血清标本,PreS1-Ag检出56例(78.87%);HBeAg阴性140例,PreS1-Ag检出82例(58.57%),二者比较差异有统计学意义(P<0.05)。HBsAg阴性血清中未检出PreS1-Ag。结论 PreS1-Ag检测比HBeAg更敏感,是HBV复制的可靠指标之一,与乙肝相关血清标志物联合检测可更准确反映HBV感染与复制状况,及时对孕产妇采取相关措施,对减少母婴传播乙肝,降低新生儿乙肝传播,提高优生优育有着重要意义。     

Viral hepatitis markers in Soviet and American blood donors

A cooperative study was undertaken to compare the frequency of hepatitis viral antigens and antibodies among blood donors in the Soviet Union and the United States. Age- and sex-stratified blood donors were identified and their sera tested for hepatitis B surface antigen (HBsAg), antibody to HBsAg (anti-HBs), antibody to the hepatitis B core antigen (anti-HBc), and antibody to the hepatitis A virus (anti-HAV). A total of 994 Soviet blood donor sera from five different regions and 1,178 American donor sera from six different regions were tested in the USA. Among the Soviet donors, 450 (45%) had some marker of exposure to the hepatitis B virus; while among the American donors, 94 (8%) did. Of the Soviet donors 848 (85%) were positive for anti-HAV, compared with 403 (34%) of the American donors. For 1,977 serum samples that were evaluated in both countries for HBsAg, techniques in the USSR identified 36 HBsAg-positive samples, while the technique in the USA found 38 HBsAg-positive samples; however, only 24 were judged to be HBsAg-positive by assays in both countries. Testing of these same 1,977 sera for anti-HBs revealed that the radioimmunoassay used in the USA identified many more antibody-positive donors than the immuno-autoradiography technique used in the Soviet Union. When a portion of the sera were tested by similar radioimmunoassay techniques in each country, there was comparability of results for anti-HBs, as well as for anti-HAV, and anti-HBc. The results permit calculation of age and sex prevalence of hepatitis B and hepatitis A serologic markers for blood donors within and between each country. They also allow comparison, on the same sera, of test methodologies in use in the Soviet Union and in the United States.     

不同方法学检测乙型肝炎血清标志物结果的评价分析

目的对酶联免疫吸附试验（ELISA）、时间分辨免疫荧光法（TRFIA）、化学发光法（CLIA）、电化学发光法（ECLIA）检测乙型肝炎血清标志物[乙型肝炎表面抗原（HBsAg）、乙型肝炎表面抗体（抗HBs）、乙型肝炎e抗原（HBeAg）、乙型肝炎e抗体（抗HBe）、乙型肝炎核心抗体（抗HBc）]的结果进行分析,评价不同方法学检测结果之间是否具有一致性。方法用ELISA、TRFIA、CLIA、ECLIA分别检测100例乙型肝炎病毒（HBV）感染者和50名正常体检者的乙型肝炎血清标志物。以ECLIA作为参考方法,通过Kappa检验评价不同方法学检测结果之间的一致程度。结果 4种方法检测乙型肝炎血清标志物的结果具有高度以上一致性,CLIA和ECLIA在检测敏感性上更有优势。结论目前广泛使用的检测乙型肝炎血清标志物的方法具有较好的一致性,为实验室结果互认提供了依据。其中ELISA适用于人群初筛,CLIA和ECLIA对于肝炎患者疗效判断更有价值。     

大中专学生乙型肝炎病毒感染血清标志组合模式的分析

目的 了解乙型肝炎病毒(HBV)在大、中专学生中感染现状及HBVM组合模式分布情况,探讨其流行规律,为制订乙肝预防策略提供依据。方法 应用ELISA法对3 293名学生进行了血清HBVM监测。结果学生HBsAg总携带率为13.12％,高于全国和本省平均感染水平,男生高于女生。抗-HBs、HBeAg、抗-Hbe和抗-HBc阳性率分别为32.49％、8.23％、9.69％、26.24％。HBV总流行率为48.10％。HBVM组合模式共14种,其中单项抗-HBs阳性占19.95％,大、小三阳分别占7.32％和3.98％。大、小三阳及抗-Hbe阳性者占HBsAg阳性人数的92.36％。结论 学校对健康人群应定期进行体检,检测HBVM及肝功能。对已感染HBV并具有一定传染性的人群,学校要做好管理工作;对HBsAg、抗-HBs和抗-HBc均阴性者加强乙肝疫苗接种。     

Hepatitis B core antibody screening of voluntary blood donors: an extended pilot study using a modified passive haemagglutination assay

Summary. Screening for hepatitis B surface antigen (HBsAg), even by the most sensitive techniques, fails to detect all carriers of the hepatitis B virus (HBV). The presence of hepatitis B core antibody (anti-HBc) in the absence of HBsAg is a common finding in donors implicated in cases of post-transfusion hepatitis B (PTHB), and viral DNA may also be demonstrated in many of these individuals. An extended pilot study of routine screening of all donations for anti-HBc in addition to HBsAg was introduced into the Mersey and North Wales Regional Transfusion Service in November 1991 to improve surveillance for carriers of HBV. In order to reduce costs a modified passive haemagglutination assay was evaluated and found to have a sensitivity of 99% and specificity of 98% compared with a conventional assay. In the first 6 months 60 530 donations were tested and 12 (0–02%) were found to have anti-HBc in the absence of HBsAg or adequate antibodies to HBsAg (anti-HBs). These sera will later be submitted for polymerase chain reaction (PCR) testing in order to determine their infectivity or otherwise by the detection HBV DNA sequences.     

Establishment of a new method for the detection of the affinity of antibody to hepatitis B e antigen by a routine quantitative system

BackgroundThe commonly used quantitative analyses for specific antibodies only involve measurement of the total antibody activity, and the binding affinity is rarely analyzed. We established a method for the detection of the affinity of the antibody to hepatitis B e antigen (anti-HBe).MethodsA method to detect anti-HBe affinity was established by using a routine quantitative system (Architect Analyzer). Serum samples were collected from hepatitis B patients with anti-HBe. On the basis of the other serologic markers in the samples, patients were divided into HBsAg positive and anti-HBs positive groups. The total anti-HBe activity and anti-HBe affinity were each measured.ResultsThe affinity of anti-HBe in the anti-HBs positive group was higher than that in the HBsAg positive group (P < 0.05); conversely, the total anti-HBe activity in the anti-HBs positive group was lower than that in the HBsAg positive group (P < 0.05).ConclusionsThe anti-HBe affinity arising from an immune response to HBV infection may vary significantly between different situations. This new approach will be suitable for determining antibody affinity in clinical laboratories.     

原发性肝癌患者病毒标志物检测及介入治疗对HBV DNA的影响

目的研究乙型肝炎病毒DNA和血清标志物与原发性肝癌的关系以及介入治疗前后HBV DNA和肝功能的变化。方法对151例肝癌患者做HBV-m,HBV DNA和AFP测定,对14例肝癌病人介入前后测HBV DNA和肝功能。结果肝癌患者HBV总感染率为96.68%,以HBsAg、抗HBe、抗HBc3c项同时阳性模式(俗称小三阳)最多见,占53.64%(81/151),其次为HBsAg、HBeAg、抗HBc 3项同时阳性(俗称大三阳)占20.52%(31/151)。小三阳中HBV DNA阳性占74.07%(60/81);AFP阳性率63.6%(91/143),介入治疗引起肝功能损害加重,HBV DNA水平升高,前者有显著性差异,后者无显著性差异。结论HBV感染与肝癌发生密切相关,而且以HBsAg、抗HBe、抗HBc 3项同时阳性模式最多见,该模式中大部分患者HBV DNA处于复制活跃状态;介入治疗引起肝功能损害加重,对HBV DNA水平的影响应引起重视。     

Recent changes in serological markers of hepatitis B virus infection in Japanese university students

University students were screened for serological markers of hepatitis B virus infection every year. Hepatitis B surface antigen (HBsAg) determined by reversed passive hemagglutination and antibody to HBsAg (anti-HBs) by passive hemagglutination were positive in 1.7% and 7.3% of the first-year students in 1978-80, respectively, and 1.1% and 3.8% in 1981-84. The difference in the prevalences of anti-HBs between 1978-80 and 1981-84 was statistically significant (p less than 0.001). Hepatitis B e antigen, which was positive by less sensitive immunodiffusion in 52% of HBsAg carrier students in 1976-79, was detected by more sensitive radioimmunoassay only in 19% in 1980-84. The difference was statistically significant (p less than 0.01). Recently changes in hepatitis B virus infection seem to be occurring in Japanese university students.     

HBsAg、抗HBe、抗HBc阳性患者PreS1-Ag与HBV复制的关系研究

目的探讨乙型肝炎病毒（HBV）表面抗原（HBsAg）、HBV e抗体（抗HBe）、HBV核心抗体（抗HBc）阳性患者HBV前S1抗原（PreS1-Ag）与HBV复制的关系。方法采用化学发光微粒免疫法（MEIA）、荧光定量聚合酶链反应（FQ-PCR）和酶联免疫吸附试验（ELISA）检测患者血清肝炎标志物、HBV DNA载量和PreS1-Ag,并分析HBV DNA载量和PreS1-Ag的相关性。结果456例HBsAg、抗HBe、抗HBc阳性患者标本中HBV DNA与PreS1-Ag的符合率为88.37%,两者阳性率间差异无统计学意义（P〉0.05）。HBV DNA载量和PreS1-Ag吸光度之间显著相关（r=0.979 9,P〈0.01）。对176例HBV DNA和PreS1-Ag均阳性的标本进一步进行分段分析,HBV DNA载量在2×10^3 - 7×10^4拷贝/mL之间及对应的PreS1-Ag吸光度在0.105-1.696之间的数据相关程度更为密切（r=0.993 9,P〈0.01）。结论PreS1-Ag可能是一个很好的反映HBV复制的指标。