Highly sensitive methods for the serological,diagnosis of hepatitis B and their clinico-epidemiological significance

A study was made of HB-virus infection markers in 438 patients of different age with hepatitis B. Highly sensitive methods based on the test systems manufactured in this country and abroad were employed. The authors established the diagnostic importance of HBV markers, studied the prevalence of those markers in parents of the diseased children of the first year of life, demonstrated the clinico-epidemiological importance of highly sensitive methods of serological diagnosis.     

不同检测方法对隐匿性乙型肝炎病毒感染的诊断价值分析

目的：探讨隐匿性乙型肝炎病毒（HBV）感染的不同诊断试验方法。方法选取该院行肝脏活检的患者68例,A 组12例为乙型肝炎表面抗原（HBsAg）阳性患者;B 组27例为乙型肝炎表面抗体（HBsAb）阴性、乙型肝炎核心抗体（HBcAb）阴性,且丙型肝炎抗体阳性的患者;C 组11例为 HBsAb 阳性,且 HBcAb 阳性的患者;D 组18例为 HBsAb 阴性、HBcAb 阳性的患者。检测外周血清乙型肝炎标志物,外周血单核细胞（PBMCs）,肝组织 HBV DNA 的表达。结果 A 组患者为显性乙型肝炎患者,经血清学、PBMCs 、肝组织 HBV DNA 检测均提示 DNA 阳性。 HBcAb 阳性的患者（C 、D 组）其隐匿性 HBV 感染的比例较 HBcAb阴性（B 组）的患者明显升高,差异有统计学意义（P＜0．05）。结论隐匿性 HBV 感染在人群中有一定的发病率,对于高危患者（合并丙型肝炎或 HBcAb 阳性）应常规检测 HBV DNA ,联合多种检测方法可提高隐匿性 HBV 感染的诊断率。     

邯郸市乙型病毒性肝炎血清流行病学调查

目的 了解邯郸市1～60岁人群乙型肝炎流行现状,为制定预防控制策略提供依据.方法 采用多阶段分层随机抽样的方法,抽取1584人进行血清流行病学调查,采用酶联免疫吸附测定法进行乙型肝炎病毒(HBV)标志物检测.结果 邯郸市1～60岁人群乙型肝炎表面抗原(HBsAg)、乙型肝炎表面抗体(抗-HBs)、乙型肝炎核心抗体(抗-...     

乙型肝炎病毒血清标志物与HBV-DNA关系探讨

目的探讨乙型肝炎病毒血清学标志物（HBV-M）含量与HBV-DNA载量之间的关系。方法运用电化学免疫发光法（ECLIA）和实时荧光定量PCR两种方法同时定量检测262份血清标本中血清标志物HBsAg、HBsAb、HBeAg、HBeAb、HBcAb含量和HBV-DNA载量,并对各项检测结果进行统计学分析。结果262份血清标本出现了9种血清模式,其中152份HBV-DNA阳性,对HBV-DNA阳性标本进行相关性分析,发现其与HBsAg、HBeAg、HBeAb呈正相关（1=0．207、0．542、0．607,P〈0．05）,且在HBeAg阳性组更显著（r=0．425、0．752、0．701,P〈0．01）。152份HBV-DNA阳性中79例HBeAg阴性,其中29例HBV-DNA载量对数值≥5,占HBeAg阴性者的36．7％;25例HBsAg〈2501U／mL,其中12例HBV-DNA载量对数值≥5,占48％。结论HBV血清标志物含量与HBV-DNA载量之I司有相关性,但是单一检查难以对体内HBV感染情况作出准确诊断,需要将HBV血清标志物检测与HBV-DNA载量两者联合检测,以准确判断HBV在体内的存在情况。     

The prevalence of hepatitis B serological markers in emergency physicians

Hepatitis B (HBV) is a well-documented, increasing occupational hazard to those in the medical and dental professions. While the prevalence of markers of hepatitis B in the general population in the United States is approximately 3% to 5%, the prevalence in the health professions has been found to be higher. The prevalence of markers in 260 emergency physicians, consisting of teaching and nonteaching staff and emergency medicine residents, was the focus of this study. Two hundred fourteen participants had not received hepatitis B vaccine; 46 had received the vaccine. Hepatitis B surface antigen (HBsAg), surface antibody (anti-HBs) and core antibody (anti-HBc) were tested. The overall prevalence of markers in the nonvaccinated group was 11.7% (25/214). Forty-one of 46 participants (89%) who had received hepatitis B vaccine demonstrated anti-HBs, evidence of immunity to hepatitis B. Thirty-nine of them had anti-HBs alone, and two had anti-HBs and anti-HBc. Of the five vaccinees who failed to demonstrate anti-HBs, one demonstrated anti-HBc alone. There was no statistically significant difference between the three groups in prevalence or type of markers. The prevalence of hepatitis B serological markers in this survey of emergency physicians was two and a half to four times that of the general population. Because of the increased risk of exposure to hepatitis B virus, early immunization against this disease through the use of hepatitis B vaccine should be considered by physicians in the practice of emergency medicine.     

乙型肝炎病毒DNA和血清学标志物的相关分析

目的 分析乙型肝炎病毒（HBV）DNA与HBV血清标志物之间的关系. 方法 应用酶联免疫吸附测定法(ELISA)和荧光定量PCR分别检测468例乙型肝炎患者血清标志物和HBV-DNA含量. 结果 HBsAg、HBeAg、抗-HBc抗体和Pre-S1Ag阳性患者组的HBV-DNA阳性率(50.6％,x2=56.2...     

乙型肝炎病毒核酸载量与血清学标志物相关性的研究

目的分析HBVDNA载量与血清学标志物的相关性。方法应用乙型肝炎病毒核酸试剂定量检测468份献血员样本HBVDNA含量,并分别定性或定量检测HBsAg、抗-HBs、HBeAg、抗-HBe、抗-HBc及抗-HBcIgM血清学标志物,计算不同病毒核酸水平样本中5个乙肝血清学标志物阳性率及HBsAg、抗-HBs水平的分布情况。结果HBVDNA阴性样本中HBsAg、抗-HBs、HBeAg、抗-HBe、抗-HBc阳性率分别为12.8%、39.8%、0、21.1%、49.6%,而HBVDNA阳性样本中HBsAg、抗-HBs、HBeAg、抗-HBe、抗-HBc血清学标志物阳性率分别为91.3%、0.7%、20.9%、65.0%、88.6%,血清学指标在不同HBVDNA水平的阳性率差异具有统计学意义(χ2=197.4,P<0.01)。HBVDNA载量与HBsAg水平成正相关性,与抗-HBs水平成负相关性。结论低水平的HBsAg在不同HBVDNA载量水平的样本均有分布,HBsAg检测能力需要进一步提高,另外在我国人群中存在低乙型肝炎病毒核酸水平携带者,乙型肝炎病毒核酸可以弥补血清学检测试剂的不足。     

乙型肝炎病毒血清标志物测定及结果解释的若干问题

我国人群乙型肝炎病毒（HBV）感染率高,HBV感染血清学标志物是临床实验室最主要的检测项目之一.经对乙型肝炎“两对半”、抗HBc IgM和HBV DNA检测及结果解释中存在的一些普遍问题进行阐述,并注意到可能存在的因试剂方法的局限性、病毒变异等所致假阴性和假阳性,以及对检测结果的进一步确认和适当的解释,对HBV感染血清标志物检测的正确使用有重要意义.     

Serum lipids in the diagnosis of severity of acute viral hepatitis A

The purpose of the study was to estimate the possibilities of developing a method for diagnosing the severity of acute viral hepatitis A (AVHA), by analyzing the serum lipid spectrum and evaluating the biological membranes in patients with this condition. The level of total lipids and the lipid spectrum were studied in the sera of 100 patients with AVHA. The most significant differences were found in the ratio of cholesterol esters (CE), lysophosphatidylcholine (LPC), and lysophosphatidylethanolamine (LPE), in the coefficient of phosphatidylcholine (PC)(2)/sphingomyelin (SM) x LPC. Thus, lipid metabolism changes in AVHA, which suggests that the percentage of CE and LPC and the coefficient PC2/SM x LPC might be used as additional tests to evaluate the severity of the disease.     

Guidelines for the laboratory diagnosis and susceptibility testing of methicillin-resistant Staphylococcus aureus (MRSA)

These evidence-based guidelines have been produced after a literature review of the laboratory diagnosis and susceptibility testing of methicillin-resistant Staphylococcus aureus (MRSA). We have considered the detection of MRSA in screening samples and the detection of reduced susceptibility to glycopeptides in S. aureus. Recommendations are given for the identification of S. aureus and for suitable methods of susceptibility testing and screening for MRSA and for S. aureus with reduced susceptibility to glycopeptides. These guidelines indicate what tests should be used but not when the tests are applicable, as aspects of this are dealt with in guidelines on control of MRSA. There are currently several developments in screening media and molecular methods. It is likely that some of our recommendations will require modification as the new methods become available.     

155例乙型肝炎血清学标志物少见模式的分析

目的对155例乙型肝炎血清学标志物(HBV-M)少见模式进行分析,探究可能原因。方法用酶联免疫吸附试验(ELISA)检测患者HBV-M,同时参考聚合酶链反应(PCR)HBV DNA检测的结果进行综合分析。结果发现155例少见HBV-M结果模式,主要表现为三组:HBsAg与抗-HBs同时阳性的HBV感染;抗-HBc阴性的HBV感染;HBsAg阴性的HBV感染。结论机体免疫反应的不同、ELISA检测方法本身的局限性、病毒变异都可能导致HBV-M检测结果出现少见模式,建议使用更为灵敏的化学发光法定量检测。     

时间分辨荧光法检测乙型肝炎病毒血清标志物的检出限探讨

目的确立时间分辨荧光方法检测血清乙型肝炎病毒(乙肝)表面抗原(HBsAg)、乙肝表面抗体(HBsAb)、乙肝e抗原(HBeAg)、乙肝e抗体(HBeAb)以及乙肝核心抗体(HBcAb)(俗称乙肝两对半)的检出限(LOD),以指导其检测结果的合理解释与应用。方法参考美国临床检验标准化委员会(CLSI)EP17-A文件提供的方案和相关文献,建立实验室时间分辨荧光分析仪检测血清乙肝两对半的空白限(LOB)及LOD。结果时间分辨荧光分析仪检测血清乙肝两对半中HBsAg、HBsAb、HBeAg、HBeAb、HBcAb的LOB分别为0.042 5ng/mL、0.500 5mIU/mL、0.000PEIU/mL、0.997DRU/mL、0.091DRU/mL;LOD分别为0.163ng/mL、1.203 mIU/mL、0.401PEIU/mL、1.756DRU/mL、0.350DRU/mL。结论时间分辨荧光方法检测血清乙肝两对半,均有较低的检出限,可较敏感地检出血清乙肝两对半中的各项抗原及抗体,早期指导临床对乙型肝炎病毒感染的诊断、疗效的观察及预后的判断。     

住院患者HBV血清标志物筛查70 582例结果回顾性分析

目的分析近6年来HBV血清标志物检出率变化情况.方法收集3家大型医院2003-2008年6年间排除肝炎及相关病区共70 582例住院患者.采用AxSYM微粒子酶免疫分析技术检测HBV血清标志物5项,包括HBsAg、HBeAg、抗-HBc、抗-HBe和抗-HBs结果及相关资料,并将每例5项标志物结果作为一种模式,对各项标志物及模式检出率逐年变化情况进行回顾性分析.结果 HBV血清标志物5项检出率由高到低依次为抗-HBc(55.17%)、抗-HBs(49.57%)、抗-HBe(28.42%)、HBsAg(8.92%)、HBeAg(2.12%),且6年来均呈逐渐下降趋势.HBsAg由2003年的9.30%降至2008年8.70%,1992年以后出生人群HBsAg检出率(2.28%)明显低于总人群检出率(8.92%),且逐年下降趋势明显,从2003年的3.57%降至2008年1.85%.每项标志物检出率男性(HBsAg、HBeAg、抗-HBc、抗-HBe和抗-HBs检出率依次为12.38%、2.72%、56.57%、41.50%、65.48%)均高于女性(HBsAg、HBeAg、抗-HBc、抗-HBe和抗-HBs检出率依次为7.25%、1.58%、53.43%、28.35%、50.00%),差异有统计学意义(x2值分别为509.74、105.78、69.66、1 321.61、1 726.91,P均＜0.01).在70 582例患者中,5项HBV血清标志物结果可归纳为26种模式,检出率≥1%的模式有8种,"全阴性"模式占第一位,6年间无明显变化.近6年来,人群不同年龄段不同检测模式检测结果不同,≤20岁人群以"全阴性"和"抗-HBs单独阳性"模式为主,＞20岁人群以"抗-HBc和(或)抗-HBe、抗-HBs阳性"等模式为主."HBsAg、HBeAg、抗-HBc阳性"和"HBsAg、抗-HBc、抗-HBe阳性"等模式检出率呈两端低、中间高分布,20～70岁人群检出率高.结论近6年HBV血清标志物检出率呈缓慢下降趋势,低龄人群HBsAg检出率明显下降.总人群HBV感染率依然较高,不断改进HBV血清筛查技术对于降低HBV感染率十分重要.