丙型肝炎病毒抗体双抗原夹心法化学发光检测的应用

目的 探讨丙型肝炎病毒抗体双抗原夹心法化学发光检测的应用.方法 利用重组融合HCV抗原分别标记生物素及吖啶酯,建立起双抗原夹心法化学发光检测试剂盒,与间接法同时检测了866例阴性标本,440例阳性标本,3套BBI阳转血清盘.结果 双抗原夹心法与间接法灵敏度分别为100％、100％,特异性分别为99.9％、98.7％,特异性差别1.2％(95％可信区间:0.5％～2.1％),BBI阳转血清相对敏感性系数为-1.33.结论 双抗原夹心法特异性及早期感染检测能力优于间接法,将会成为丙型肝炎病毒抗体检测的主要方法.     

酶联法抗-HCV和HCV-cAg联检对丙型肝炎实验室诊断的应用价值

目的 探讨联合丙型肝炎病毒核心抗原(HCV-cAg)及抗-HCV抗体酶联免疫检测对丙型肝炎实验室诊断的应用价值.方法 289份血清标本按抗-HCV阳性、弱阳性、阴性及HCV-cAg阳性、弱阳性及阴性分组,用PCR扩增法检测其HCV RNA含量.结果 单项抗-HCV阳性及弱阳性标本其HCV RNA检测阳性符合率分别为87...     

丙型肝炎病毒抗体与核心抗原联合检测的诊断效能研究

目的 探讨丙型肝炎病毒抗体(HCV-Ab)与核心抗原(HCV-cAg)联合检测对丙型肝炎的诊断效能.方法 经重组免疫印迹试验确证的92例阳性标本,81例阴性对照标本,同时进行HCV-Ab和HCV-cAg检测,分析HCV-Ab检测法、HCV-cAg检测法及两者联合检测法的敏感性、特异性和ROC曲线下面积.结果 HCV-Ab检测法敏感性为79.3％,特异性为93.8％;HCV-cAg检测法敏感性为87.0％,特异性为90.1％;HCV-cAg与HCV-Ab联合检测法敏感性为92.4％,特异性为88.9％.三种试验比较,敏感性差异有统计学意义(P＜0.05),特异性差异无统计学意义(P＞0.05).三种方法ROC曲线下面积分别为0.866、0.885和0.906.HCV-cAg与HCV-Ab联合检测法,诊断准确性较高.结论 HCV-cAg与HCV-Ab检测方法的联合应用对于丙型肝炎的诊断效能较高.     

Clinical Utility of a New Automated Hepatitis C Virus Core Antigen Assay for Prediction of Treatment Response in Patients with Chronic Hepatitis C

Hepatitis C virus core antigen (HCV Ag) is a recently developed marker of hepatitis C virus (HCV) infection. We investigated the clinical utility of the new HCV Ag assay for prediction of treatment response in HCV infection. We analyzed serum from 92 patients with HCV infection who had been treated with pegylated interferon and ribavirin. HCV Ag levels were determined at baseline in all enrolled patients and at week 4 in 15 patients. Baseline HCV Ag levels showed good correlations with HCV RNA (r = 0.79, P < 0.001). Mean HCV Ag levels at baseline were significantly lower in patients with a sustained virologic response (SVR) than in those with a non SVR (relapse plus non responder) based on HCV RNA analysis (2.8 log₁₀fmol/L vs. 3.27 log₁₀fmol/L, P = 0.023). Monitoring of the viral kinetics by determination of HCV RNA and HCV Ag levels resulted in similarly shaped curves. Patients with undetectable HCV Ag levels at week 4 had a 92.3% probability of achieving SVR based on HCV RNA assay results. The HCV Ag assay may be used as a supplement for predicting treatment response in HCV infection, but not as an alternative to the HCV RNA assay.     

Immunodetection of a Hepatitis C Virus (HCV) Antigen and Th1/Th2 Cytokines in Cerebrospinal Fluid of Meningitis Patients

Abstract

Infection with hepatitis C virus (HCV) has become the most important public health problem in Egypt. HCV infection has been implicated in diseases of the central nervous system. Cerebrospinal fluid (CSF) and serum samples from 91 patients with meningitis (62 males and 29 females, mean age of 37 years) were investigated. Anti‐HCV antibodies and HCV antigen were evaluated in patients CSF and serum using enzyme linked immunosorbent assay. The levels (mean?±?SD?pg/ml) of Th1 cytokines (IFN‐γ and TNF‐α) and Th2 interleukines (IL‐10 and IL‐4) were also determined. The anti‐HCV antibodies were detected in high percentages both in CSF samples (71%) and in sera (90%). Also, the HCV antigen was detected in about 60% of tested CSF and serum samples. The levels of IFN‐γ and IL‐10 cytokines were significantly higher (P?<?0.05) in both serum and CSF of patients positive for HCV antigen than those negative. HCV antigen was detected in the CSF of meningitis patients with a significant upregulation of Th1 and Th2 responses. The high incidence of HCV infection may draw light on the etiological role of HCV in the pathogensis of meningitis diseases in our study group.     

丙型肝炎病毒抗原检测试剂在临床诊断中的初步应用

本文利用重组丙型肝炎病毒(HCV)多表位复合抗原免疫动物制备抗HCV多克隆抗体,建立HCAgELISA检测方法,对不同的临床样品进行检测,分析不同临床样品HCAg检出率,并与荧光定量PCR结果进行对比。95份HCAb阳性的样品中,51份样品HCAg阳性,阳性率为53.7%;88份重症肝病患者血清中检出HCAg阳性33份,阳性率为37.5%,均明显高于其它样品(P<0.05);73份肝功异常但HCAb阴性血清样品,检出HCAg阳性8份,阳性率为11.0%;HCAg与HCAb之间存在相关性(r=0.5076,P<0.01),HCAg与HCV-RNA符合率为85.7%。HCAg ELISA检测可作为临床HCV诊断的检测指标,为临床早期诊断及治疗预后提供依据。     

化学发光免疫分析法检测乙肝病毒感染性标志物的临床应用

目的 探讨化学发光免疫分析法检测乙肝病毒感染性标志物的临床应用效果.方法 抽取我院2013年1月至2014年1月接收的疑似乙型肝炎病人800例,采用化学发光免疫分析法(CLIA)和酶联免疫吸附试验法(ELISA)分别检测患者的乙肝病毒血清标志物.结果 HBsAg、HBeAg、HBeAb的检出率CLIA高于ELISA(P＜0.01),两种方法HBsAb、HBcAb的检出率无明显差异(P＞0.05);低水平HBsAg检测ELISA敏感性低于CLIA;ELISA检出的最低浓度为0.128IU/mL,CLIA法检出的最低浓度为0.0311U/mL.结论 采用CLIA检测乙肝病毒感染性标志物相比ELISA更准确,可有效应用于乙肝临床诊断和病情动态监测.     

乙型肝炎病毒表面抗原定量检测及临床意义分析

乙型肝炎病毒表面抗原（HBsAg）定量检测是临床治疗乙型肝炎的一个非常重要的指标,它不仅能区分乙型肝炎病程的各种分期,而且对药物治疗效果及预后有良好的预测作用.本文从乙型肝炎病毒表面抗原的结构、定量检测的方法学以及在临床中的应用等方面做一综述分析.     

利用双扩增聚合酶链反应检测非甲非乙型肝炎患者血清中丙型肝炎病毒RNA

利用丙型肝炎病毒（ＨＣＶ）５’－端序列合成两对引物，建立了灵敏、特异的ＨＣＶＲＮＡ双扩增聚合酶链反应检测方法。用此方法及第二代Ａｂｂｏｔｔ酶联抗－ＨＣＶ检测试剂盒，检测了４４例非甲非乙型肝炎患者血清及１０名抗－ＨＣＶ阴性健康人。在４４例患者中，４１例（９３％）ＨＣＶＲＮＡ阳性，３６例（８２％）抗－ＨＣＶ阳性，３３例（７５％）ＨＣＶＲＮＡ、抗－ＨＣＶ全部阳性。３例ＨＣＶＲＮＡ阴性，但抗－ＨＣＶ阳性，另外，有８例抗－ＨＣＶ阴性，ＨＣＶＲＮＡ阳性。１０名健康人ＨＣＶＲＮＡ均为阴性。结果表明，大部分（９２％）抗－ＨＣＶ阳性患者带有ＨＣＶ，但为了检测所有病毒血症患者，抗－ＨＣＶ检测是不够的，利用双扩增ＰＣＲ方法检测ＨＣＶＲＮＡ对于抗－ＨＣＶ阴性患者的诊断是非常有用的。     

丙型肝炎的病理观察

为确立我国丙型肝炎病理形态学特点，我们观察了７０例经临床确诊的丙型肝炎肝穿标本，其中８９％有输血及血制品使用史。按病程分为急性丙型肝炎２０例，慢性丙型肝炎５０例，其中合并乙型肝炎者７例。与乙型肝炎相比，丙型肝炎特征的组织学改变有：汇管区淋巴细胞集聚、小胆管损伤及较明显的肝细胞脂变。此外，急性丙型肝炎尚见片状的肝细胞明显大小不等，伴大泡脂变。慢性丙型肝炎伴小胆管损伤淋巴细胞集聚，以Ｔ细胞为主，致汇管区扩大为其特征。中度以上慢性活动型丙型肝炎常见宽大的汇管区－汇管区桥接坏死及纤维化，碎屑坏死相对较轻。本研究为丙型肝炎的病理诊断及与乙型肝炎的鉴别诊断提供了依据。     

应用非同位素原位杂交检测肝组织中丙型肝炎病毒基因的分布

为了研究丙型肝炎患者肝组织中丙型肝炎病毒（ＨＣＶ）基因的分布，我们应用地高辛标记的ＨＣＶ基因５＇端非翻译区的探针（长度为３２个寡核苷酸），对２４例急、慢性丙型肝炎患者活检的肝组织石蜡包埋切片进行了原位核酸杂交检测。结果显示：ＨＣＶ基因阳性的肝组织标本有１１例，检出率是４５．８％（１１／２４）。ＨＣＶ基因主要分布于肝细胞浆，偶见于肝细胞核内。此外在肝血窦的ｋｕｐｆｆｅｒ细胞、小血管内皮细胞和汇管区附近均有明显的ＨＣＶ基因阳性染色，而对照组均未发现ＨＣＶ基因阳性信号。     

前S1抗原与抗-HBc IgM检测结果探讨

检测患者乙型肝炎病毒前S1抗原（Pre-S1Ag）与抗-HBc IgM的水平,探讨两者与HBV急性感染的相关性,为乙型肝炎的早期诊治提供必要的理论依据。对90份临床标本分别采用PCR技术检测HBV-DNA载量阳性标本,采用固相R IA（SPR IA）检测HBeAg、抗-HBc IgM,采用胶体金免疫层析法检测Pre-S1Ag,并对结果进行分析。结果表明90份HBV-DNAPCR阳性标本中Pre-S1Ag阳性71份,HBeAg阳性60份,抗-HBc IgM阳性14份,其检测结果有显著性差异（P〈0.05）。血清Pre-S1Ag、抗-HBc IgM及HBeAg与HBV复制紧密相关。Pre-S1Ag明显优于抗-HBc IgM及HBeAg。因此,Pre-S1Ag的检测对乙型肝炎临床早期诊断、抗病毒治疗方案的选择和预后判断具有重要意义。     

Total HCV core antigen assay. A new marker of HCV viremia and its application during treatment of chronic hepatitis C

The present study assesses the clinical usefulness of the hepatitis C core antigen assay for monitoring of patients being treated for chronic hepatitis C virus (HCV) infection. Eighty-six serum samples were selected at random from 16 patients and levels of HCV RNA and HCV core antigen were determined simultaneously and in parallel to compare both techniques. The data obtained were compared by Pearson’s correlation and the coefficients calculated by Fisher transformation and by calculating the difference and standard error. A good linear correlation was observed between both techniques. Maximum correlation, with significant difference, was found between patients infected with the 1a genotype and other genotypes. In conclusion, the HCV core antigen assay is useful for the diagnosis of early infection; however, its use for determining the exact timing of viral elimination during treatment is clearly unsuitable.     

乙型和丙型肝炎病毒感染的免疫学研究进展

世界范围内持续感染乙型肝炎病者（HBV）、丙型肝炎病毒（HCV）的患者已超过5亿。这两种病毒在病原学上有许多共同特点，但在病毒学特点上以及在慢性肝炎的免疫逃逸机制上均有着显著的差别。在早期天然免疫应答方面，HBV感染最初几周并不引起肝脏基因表达的改变，而HCV则会引起许多肝内基因表达改变。在特异性免疫应答方面，HBV和HCV感染后机体清除病毒的途径主要有特异性CTL细胞的杀伤作用、CD4^＋细胞的辅助作用、抗体的中和作用或杀伤作用。相对于HBV来说，HCV在成人更多引起慢性肝炎。     

乙肝表面抗原吖啶酯化学发光定量免疫分析方法的建立

目的建立一种定量检测乙肝表面抗原(HBsAg)的化学发光免疫分析方法并评估其性能。方法利用双抗体夹心法实验原理,用吖啶酯标记多抗,用生物素标记两株单抗,通过磁颗粒链霉亲和素-生物素系统分离固相和液相完成检测。结果本方法的检测限为0.05IU/mL,线性范围为0.05~150IU/mL,可溯源至国际标准品,批内变异小于5%,总变异小于8%,浓度高达106IU/mL的强阳样本未出现HOOK效应;5套阳转盘对雅培Architect、西门子centaur和强生VITROS发光试剂相对敏感系数分别是3、0、-3;国家参考盘检出达标;与雅培Architect比较,2000例临床样本检测灵敏度为99.77%,特异性为100%,一致性达99.95%。结论本研究建立的HBsAg定量检测试剂,各项指标均满足临床检测的要求,灵敏度高,特异性好,适合临床推广应用。     

乙型肝炎病毒前S1抗原检测的临床意义

探讨乙型肝炎病毒前s1抗原（Pre-S1）检测在乙型肝炎病毒诊断中的临床意义。采用酶联免疫吸附试验（ELISA）和荧光定量聚合酶链反应技术（fluorescenee quantitative PCR,FQ-PCR）对650份HBV-M不同阳性模式及40份HBV—M全阴性模式血清标本进行乙型肝炎病毒Pre-S1、乙肝五项和HBV—DNA检测,并对三种检测结果进行统计学分析。在650份HBV—M不同阳性模式标本中,在119份大三阳标本中Pre—S1阳性检出率92．4％,HBV-DNA阳性检出率100％,在186份小三阳标本中Pre—SI阳性检出率42．5％,HBV—DNA阳性检出率63．4％,在21例HBsAg（＋）和HBcAb（＋）阳性组中Pres1阳性检出率47．6％,HBV．DNA阳性检出率66．7％;在297例HBsAb（＋）标本中Pre—S1阳性检出率0．4％,HBV-DNA阳性检出率0％,在268例HBV—DNA阳性的标本中Pre-S1阳性检出率79．3％。在40份HBV—M全阴模式中Pre-S1阳性检出率0％,HBV-DNA阳性检出率0％。Pre—S1在大三阳、小三阳及HBV-DNA阳性组阳性检出率明显高于阴性组（P〈0．01）,Pre—S1检测可补充和完善乙肝“两对半”检测的不足,尤其对HBeAg阴性或变异的HBV感染者能更好的反映病毒的复制状态和传染性。     

Behavioral and Healthcare-Associated Risk Factors for Chronic Hepatitis C Virus Infection in Korea

The risk factors related to hepatitis C virus (HCV) infection showed geographic and temporal differences. We investigated HCV-related risk factors in Korea where intravenous drug use (IVDU) is uncommon. The HCV-related risk factors were investigated in a prospective, multicenter chronic HCV cohort (n = 711) using a standardized questionnaire in four university hospitals. The results were compared with those of 206 patients with chronic liver diseases not related to either of HCV or hepatitis B virus infection (comparison group). The IVDU was found in 3.9% and remote blood transfusion (≥ 20 yr ago) in 18.3% in HCV cohort group, while that in comparison group was in none and 5.3%, respectively. In a multivariate logistic analysis, transfusion in the remote past (odds ratio [OR], 2.99), needle stick injury (OR, 4.72), surgery (OR, 1.89), dental procedures (OR, 2.96), tattooing (OR, 2.07), and multiple sexual partners (2-3 persons; OR, 2.14, ≥ 4 persons; OR, 3.19), were independent risk factors for HCV infection. In conclusion, the major risk factors for HCV infection in Korea are mostly related to conventional or alterative healthcare procedures such as blood transfusion in the remote past, needle stick injury, surgery, dental procedure, and tattooing although multiple sex partners or IVDU plays a minor role.     

丙型肝炎病毒抗体阳性人群中抗-HCV、HCV-cAg与HCV-RNA结果的相关性及其联合检测在临床应用价值的评估

目的探讨丙型肝炎病毒抗体阳性人群中抗-HCV、HCV-cAg与HCV-RNA结果的相关性及其联合检测在临床应用的价值,同时界定雅培I2000全自动化学发光仪检测抗-HCV真阳性95%时标本S/CO值的临界点。方法选取全自动化学发光仪检测的抗-HCV阳性血清样本179例(包括11例灰区标本),利用化学发光法检测HCV-cAg,利用RT-PCR法检测HCV-RNA,采用SPSS16.0软件对抗-HCVS/CO值绘制受试者操作特性(ROC)曲线,得到95%真阳性时抗-HCV结果的临界值(S/CO)。再对抗-HCV、HCV-cAg与HCV-RNA进行相关性分析。结果对179例样本进行抗-HCV、HCV-RNA及HCV-cAg的检测,其中HCV-RNA阳性43例,HCV-cAg阳性42例。在43例HCV-RNA阳性的标本中,抗-HCV的阳性检出率为93.02%,HCV-cAg阳性检出率为95.35%。抗-HCV灵敏度为93.02%,特异性为5.88%;HCV-cAg灵敏度为95.35%,特异性为99.26%。且HCV-cAg及抗-HCV阳性率随着HCV病毒含量升高而增高,RNA病毒含量越高,HCV-cAg及抗-HCV的阳性率也越高,差异具有统计学意义(P<0.05)。HCV-cAg联合抗-HCV检测与HCV-RNA的阳性符合率为100%,高于单独检测HCV-cAg或抗-HCV的阳性符合率95.35%、93.02%。以HCV-RNA检测为金标准,当抗-HCV的S/CO值>4.42时,真阳性率可达到95%。结论HCV-cAg与HCV-RNA检测的阳性符合率高达95.35%,故HCV-cAg可作为丙型肝炎早期诊断的特异性指标。为保证标本真阳性率达到95%,建议使用美国雅培I2000仪器进行丙肝抗体检测时,若抗-HCV结果(S/CO)小于4.42的标本,抗-HCV、HCV-cAg与HCV-RNA联合检测可有效降低丙型肝炎窗口期的漏检率,为丙型肝炎的早期发现、早期诊断、早期治疗提供有力证据。     

Detection of Occult Hepatitis C and Hepatitis B Virus Infections from Peripheral Blood Mononuclear Cells

Purpose: To investigate the problem of occult HCV & HBV infections in patients with persistently longstanding abnormal liver function test results of unknown etiology and to investigate occult HCV in patients with sustained virological response (SVR). Methods: The study included two groups; first group included 40 patients with persistently longstanding abnormal liver function test, in addition to 62 patients with history of hepatitis C who developed SVR. HCV RNA status was tested in serum by conventional RT-PCR and by real-time PCR in Peripheral Blood Mononuclear Cells (PBMCs). HBV DNA in PBMCs was done in first group only. Results: In first group, PCR in PBMCs was positive for HCV RNA in 4 patients with elevated liver enzymes and HBV DNA was positive in PBMCs in 3 patients. In patients with SVR, 7 patients were positive for HCV RNA in PBMCs. Conclusions: Patients with long-standing abnormal results of liver-function tests with unknown etiology may have HCV RNA or HBV DNA in their PBMCs in the absence of anti-HCV antibodies, HBV markers, serum HBV DNA and serum HCV RNA.In Patients with SVR, HCV RNA in PBMCs is recommended to detect residual infection especially in those with high serum HCV RNA levels before treatment.     

Diagnosis of Norwalk Virus Infection by Indirect Enzyme Immunoassay Detection of Salivary Antibodies to Recombinant Norwalk Virus Antigen

Simple diagnostic tests are needed for the detection of norovirus (NoV) outbreaks. Salivary antibody assays provide an attractive alternative to collecting and testing serum or stool samples. Antibodies to Norwalk virus (NV) in oral fluid samples were compared with NV antibodies in serum collected from 38 volunteers challenged with NV inoculum. Pre- and postchallenge (day 4, 8, 14, and 21) saliva and serum samples were examined by enzyme immunoassay (EIA) using recombinant NV antigen. Of 18 infected subjects (those who shed NV in stool or who demonstrated immunoglobulin G [IgG] seroconversion), 15 (83%) had ≥4-fold increases in NV-specific salivary IgA and 15 (83%) had ≥4-fold increases in NV-specific salivary IgG when prechallenge and postchallenge saliva samples were compared. When the results of the IgA and IgG assays were combined, all 18 infected subjects showed ≥4-fold increases in NV-specific salivary IgG or IgA postchallenge titers compared to their prechallenge titers. One of 19 uninfected subjects had a ≥4-fold increase in NV-specific salivary IgG. The sensitivity of the combined assay results was 100%, and the specificity was 95%. NV-specific salivary IgA titers peaked around 14 days postchallenge. NV-specific salivary IgG and serum IgG titers continued to rise through 21 days postchallenge. The application of this EIA to an elementary school outbreak indicated that 67% of the subjects with confirmed infections had >4-fold rises in anti-NoV IgA when an antigen in the same genetic cluster as the outbreak virus was used. This is the first documented mucosal antibody response to NoV in children. This EIA provides a useful approach for diagnosing NoV outbreaks.