散发性急性戊型肝炎血清抗体动态变化和肝脏超微…

为探讨散发性戊型肝为血清抗体动态变化，应用酶联免疫法（ＥＩＡ）检测了７例急性戊型肝炎抗戊型肝炎病毒（ＨＥＶ）ＩｇＧ和ＩｇＭ抗体、并对１例２进行了肝超微结构病理检测，结果表明，发病１０天至４５天内抗ＨＥＶ－ＩｇＧ和ＩｇＭ滴度最高，发病第４０天仍有肝细胞肿胀，胞浆空化和线粒体固缩等病理变化。患者轿清抗－ＨＥＶＩｇＭ滴度在４５天后逐渐下降，２个月内全中消失，抗－ＨＥＶＩｇＭ滴度在４５天后逐渐下降，２个月     

戊型肝炎患者血清IgG抗—HEV动态变化

应用酶联免疫吸附试验(ELISA)检测80例散发性戊型肝炎病人的系列血清表明,IgG抗-HEV于发病后第3天即可阳转,于发病后3～14天和15～30天,IgG抗-HEV累积阳转率分别为68.75％和93.75％。多数病人IgG抗-HEV持续时间较短,发病后4～6个月和1～2年分别有62.50％和95％的病人阴转。90％的病人IgG抗-HEV水平于30天内达到高峰,多数病人IgG抗-HEV水平在急性期较高,恢复期降至低水平。     

散发性急性肝炎抗甲型和戊型肝炎病毒IgM抗体的检测与分析

目的 了解北京地区散发性急性甲型和戊型肝炎的年龄分布、肝功能损伤和预后。方法 用酶免疫法（EIA）检测1995年1月至2000年6月北京地区散发性急性肝炎患者抗甲型肝炎病毒IgM(HAV-IgM)和抗戊型肝炎病毒IgM(HEV-IgM）。结果 在203例散发性急性肝炎患者中,有112例为甲和戊型肝炎病毒感染,合计阳性率占55.2％,其中甲型肝炎占22.2%,戊型肝炎占33％。甲、成语地炎患者均有不同程度肝脏损伤,约75％的患者有中至重度的肝功能损伤（ALT值＞500－≥3500U／ml）,比较重症甲型和戊型肝炎患者肝功能损伤程度（ALT值≥1000－≥3500U/ml）。甲型肝炎患者高于戊型肝炎。追踪患者系列血清及观察临床症状,患者均在2－3个月恢复,ALT转为正常,黄疸消退,未发现甲型和戊型肝炎慢性化病例。结论 散发性急笥肝炎患者一半以上是由肠道传染的甲型和戊型肝炎病毒感染引起,甲型肝炎发病年龄主要以青年居多,戊型肝炎发病主要以青壮年为主,大多数甲肝炎病毒感染引起,甲型肝炎发病年龄主要以青年居多,戊型肝炎发病主要以青壮年为主。大多数甲型和戊型肝炎患者有中至重度的肝功能损伤。在我国病毒性肝炎的防治策略上,对散发性的甲、戊型肝炎的预防应引起同样高度重视。     

戊型肝炎病人和实验感染戊型肝炎病毒的猕猴血清抗——H…

应用人工合成的戊型肝炎病毒（ＨＥＶ）基因组开放读码框架２（ＯＲＦ２）和３（ＯＲＦ３）两段多肽，分别建立了酶联免疫试验（ＥＩＡ），检测８５份实验感染ＨＥＶ的猕猴和１４３份戊型肝炎（简称戊肝）病人血清，结果两组抗－ＨＥＶ ＯＲＦ２阳性率分别为７０．８９％和６８．５３％，均显著高于抗－ＨＥＶ ＯＲＦ３，且前者阳转时间较早，持续阳性时间也较长。虽然多数（９７．３％）抗－ＨＥＶ ＯＲＦ３阳性血清，抗－ＨＥＶ     

戊型肝炎患者血清戊型肝炎病毒RNA的动态观察及意义

目前 ,国内外对戊型肝炎 (ＨＥ)患者病毒血症已有研究 ,各家报道有明显不同 ,我们采用逆转录 聚合酶链反应方法检测 32例ＨＥ患者系列血清 ,探明ＨＥ患者病毒血症持续时间和消长规律。检测对象为中国医大二院传染科1995年 1月至 1996年 10月期间住院患者 32例 ,临床诊断为戊型肝炎。分别收集患者病后 0～ 7ｄ、8～ 14ｄ、15～ 12ｄ、2 2～ 2 8ｄ系列血清共 12 5份 ,用异硫氰酸胍一步法抽提ＨＥＶＲＮＡ。引入一对外引物序列为 :外正向引物 (4 45 9 44 78) 5′ ＧＣＡＴＴＡＴＧＧＡＧＧＡＧＴＧＴＧＧ 3′,外反向引物 (4 877 485 8) 5′ Ｃ…     

戊型肝炎病毒IgM抗体的检测及临床意义

采用合成多肽抗原建立了检测戊型肝炎病毒－ＩｇＭ的酶联免疫吸附试验方法，成本低，操作简便，快速，重复性好，特异性强。与抗甲型肝炎病毒，乙型肝炎病毒，丙型肝炎病毒的ＩｇＭ抗体无交叉反应，排除了ＲＦ的干扰，且可被β－巯基乙醇抑制而不起反应。     

一起戊型肝炎暴发的血清流行病学调查

目的 了解一起戊型肝炎暴发的血清学特点。方法 对某单位在10d内先后发病的5例急性黄疸性肝炎患者、在该单位食堂就餐的1675人(暴发人群)及未就餐的邻近单位883人(对照人群)的血清在首发病例26d后进行抗-HEV IgM和IgG检测，数据进行统计学分析。结果 5例患者抗-HEV IgM和IgG均为阳性。暴发人群抗-HEV IgM和IgG的阳性率分别为8．7％和38．4％，而对照人群仅分别为0．1％和28．6％，差别均有非常显著意义。暴发人群145例抗-HEV IgM( )中，ALT增高32例，明显高于IgM(-)及对照；而抗-HEV IgM(-)的ALT增高比例并不高于对照人群。4例患者系列血清检测见抗-HEV IgM逐渐下降，感染后4个月多数转阴，而IgG在感染后第2～3个月达高峰，随后缓慢下降。暴发人群中抗-HEV IgM( )的IgG平均水平最高，IgM(-)而IgG( )的IgG平均水平亦明显高于对照，提示暴发人群中既往感染者受到了免疫加强。暴发人群中抗-HEV IgM( )者在性别及年龄组间差异无显著意义，但其中ALT增高男性的比例显著高于女性，而与年龄无关。结论 本次急性黄疸性肝炎的暴发由戊型肝炎病毒引起，与食源有关；抗-HEV IgM和IgG不仅可用于临床病例诊断，也可用于人群调查；感染危险性与年龄及性别无关，但男性ALT增高更常见。     

散发性戊型肝炎病毒感染的诊断

用基因工程重组的戊型肝炎病毒基因结构区第二码框架和第二读码框架具有免疫表位的嵌合抗原，建立了间接酶联免疫法，检测散发性急性肝炎病人血清中抗－ＨＥＶＩｇＧ和ＩｇＭ抗体。在４６例急性肝炎病人中出抗－ＨＥＶＩｇＧ抗体阳性７例，阳性率为１５．２２％，７例ＩｇＧ抗体阳性中，有５例ＩｇＭ抗体也阳性，占７１．４％。     

散发性戊型肝炎肝组织病理学及病毒学研究

目的研究散发性戊型肝炎(HE)肝组织病理特征、病毒分布及复制,探讨戊型肝炎病毒(HEV)致肝损伤机制.方法对36例发病急性期(20例)和恢复期(16例)穿刺肝组织,及18例慢性乙型肝炎(CHB)近期重叠HEV感染肝组织,作光、电镜组织学观察,原位杂交HEVRNA检测,Kupffer细胞免疫组化观察.结果HE急性期肝组织病变有其相对特征易见肝细胞羽毛状变性(100.0%)、毛细胆管内淤胆(75.0%)及双核、多核肝细胞(65.0%),肝细胞凋亡小体偏大且不整,Kupffer细胞增生突出等.HEVRNA分布于肝细胞胞质近核周处,急性期肝组织HEVRNA阳性率(100.0%)明显高于恢复期(12.5%,P<0.001),且阳性肝细胞及病毒拷贝数较多,恢复期肝组织趋于复常.CHB重叠HEV感染者肝组织炎症活动度较单纯CHB为重.结论散发性HE相对于其他病毒性肝炎有其病理学特征;HEV感染肝细胞并主要于发病急性期复制活跃;急性散发性HE恢复后转归良好;细胞免疫性肝损伤可能为HEV的主要致肝损伤机制,但不能排除存在病毒直接致肝损伤作用.     

血清学标志阴性的非甲～戊型肝炎的病原学研究

目的对血清学标志阴性的非甲～戊型肝炎进行病原学研究。方法用ＨＢＶＰＣＲ、ＨＣＶＲＴ－ＰＣＲ和ＨＥＶＲＴ－ＰＣＲ分别检测血清学标志阴性的非甲～戊型肝炎患者血清，并对其部分阳性产物进行克隆测序。结果８７例非甲～戊型肝炎血清ＨＢＶＤＮＡ均为阴性，９例（１０．３％）为ＨＣＶＲＮＡ阳性，部分经测序证实为ＨＣＶ１ｂ亚型；余７８例为ＨＢＶＤＮＡ和ＨＣＶＲＮＡ均阴性。该７８例中，１４例因无血清未作ＨＥＶＲＮＡ检测，余６４例中４９例（７６．６％）为ＨＥＶＲＮＡ阴性，１５例（２３．４％）为ＨＥＶＲＮＡ阳性。经序列分析显示，其中９例为典型的中国ＨＥＶ株基因序列，６例变异较大，与典型的中国株基因序列的同源性仅为８０％左右。４９例ＨＢＶＤＮＡ、ＨＣＶＲＮＡ和ＨＥＶＲＮＡ均阴性的血清中１６例（３２．６％）ＨＧＶＲＮＡ阳性。由此可见，该８７例中至少有９例为ＨＣＶ感染，１５例为ＨＥＶ感染，１６例为ＨＧＶ感染。结论对血清学标志阴性的非甲～戊型肝炎的病人应该用ＰＣＲ法进行病原学分型，以明确其诊断     

我国急性散发性戊型肝炎病毒部分核苷酸序列分析

用逆转录套式聚合酶链反应（ＲＴ－ｎＰＣＲ）自深圳、长春、杭州等地４１份急性散发性戊型肝炎病人血清中获得２８株ＨＥＶｃＤＮＡ，对其中３株ＨＥＶｃＤＮＡ的ＯＲＦ２基因片段，用荧光法直接测定其核苷酸序列，并与戊型肝炎病毒墨西哥株（Ｍ）、缅甸株（Ｂ）和新疆流行株（ＣＨ１·１）进行了比较，结果该３株散发性ＨＥＶ与Ｍ株的核苷酸序列同源性分别为８０．２％、７９．９％和７９．４％；与Ｂ流行株的同源性为９５．５％、９３．９％和９５．１％；与散发株的同源性为９３．４％、９２．３％和９３．８％；与ＣＨ１·１的同源性为９７．０％、９６．５％和９５．９；表明该３株散发性ＨＥＶ与ＨＥＶ（Ｂ）和ＣＨ１·１的核酸序列同源性较高，可能属同一亚型。     

Incidence and seroprevalence of hepatitis E virus infection in pregnant women infected with hepatitis B virus and antibody placental transfer in infants

BackgroundHepatitis E has poor outcomes in pregnant women. Superinfection of hepatitis E virus (HEV) in patients infected with hepatitis B virus (HBV) may worsen liver disease.ObjectivesTo estimate the incidence and seroprevalence of HEV infection among HBV-infected pregnant women, to investigate the transplacental transfer of maternal anti-HEV IgG, and to compare the maternal and neonatal outcomes in anti-HEV positive and negative pregnant women.Study designTotally 391 HBV-infected pregnant women were recruited from April 2012 to October 2014. Paired mothers and infants were followed up at an average 9.8 months postpartum. Anti-HEV IgG and IgM were tested by ELISA.ResultsOf the pregnant women, none was anti-HEV IgM positive and 42 (10.7%) were IgG positive. At the follow-up, 3 seronegative women converted to anti-HEV IgG positive, with an estimated incidence of 17 per 1000 person-years. No significant differences of gestational age, preterm birth rate, Apgar score and birthweight were observed between newborns of anti-HEV IgG positive and negative mothers. Of the 42 neonates born to anti-HEV IgG positive mothers, 38 (90.5%) had anti-HEV IgG in their cord blood. The neonatal and maternal anti-HEV IgG levels were positively correlated (r = 0.827, p < 0.05). All infants were negative for both anti-HEV IgM and IgG at the follow-up.ConclusionsHBV-infected pregnant women rarely have novel HEV infection during late pregnancy in Jiangsu, China. Maternal anti-HEV IgG efficiently transfers into the fetuses, and disappears in infants before 10 months old.     

122例急性戊型肝炎重叠感染患者的肝功能及临床特点分析

目的 比较分析单纯急性戊型肝炎与重叠感染患者的肝功能指标和临床特点.方法 以40例单纯急性戊型肝炎为对照,回顾性分析了122例重叠感染戊型肝炎患者的肝功能指标、临床资料.结果 单纯戊肝组、甲戊重叠感染组、乙戊重叠感染组,三组之间ALT、AST、TBIL、DBIL差异均无统计学意义(P0.05),急性戊肝组与乙戊重叠感染组,甲戊重叠感染组与乙戊重叠感染组的白蛋白、球蛋白有统计学差异(P<0.01);甲戊重叠感染、乙戊重叠感染与单纯戊肝相比较临床合并症多、并发症重.结论 戊型肝炎重叠感染,特别是乙戊重叠感染患者,要加强临床监测,提高早期预防并发症的意识,以降低病死率.     

人源抗戊型肝炎病毒单克隆抗体的获得与鉴定

目的　获得人源中和性抗戊型肝炎病毒 (HEV)单克隆基因工程抗体。方法　采用五轮筛选法 (逐轮降低抗原包被量 ,严格洗脱条件 ) ,以固相化的 4种含中和抗原表位的HEV代表株ORF2重组混合抗原淘筛本室构建的HEV患者外周血源的噬菌体抗体库。获得有特异结合活性的噬菌体抗体 ,酶切鉴定抗体基因插入。切去噬菌粒上衣壳蛋白gⅢ基因构建表达载体 ,在大肠杆菌中可溶性表达抗HEV抗体Fab段 ,ELISA、Westernblot检测抗体免疫学活性 ;测序分析抗体基因。结果　筛选出 4株与含中和抗原表位的HEV代表株ORF2重组混合抗原特异结合而与BSA、HBsAg无交叉结合反应的噬菌体抗体 ,可能为中和抗体。切去gⅢ基因 ,在大肠杆菌中表达可溶性抗体Fab段 ,表达量在细菌培养液上清和细菌裂解液中差异无显著性。可溶性抗体与含中和抗原表位的HEVORF2重组混合抗原有特异结合活性 ,与BSA、HBsAg无交叉结合反应。Westernblot显示在相对分子质量 (Mr)略大于 4 5× 10 3 处有一明显条带 ,与Mr4 8× 10 3 的Fab大小一致。DNA测序分析表明 ,Fab段VH 属于IgGVH3基因家族 ,VL 属于Vκ1基因家族。结论　利用噬菌体抗体库技术成功获得抗HEV的人源单克隆抗体。     

Paediatric liver transplanted patients and prevalence of hepatitis E virus.

BackgroundHepatitis E is an emerging disease in developed countries and is usually asymptomatic, particularly in children. Chronic infection is possible in immunocompromised individuals.In the context of a liver transplant, it can simulate a rejection. In this case, antiviral therapy may be considered, thus highlighting the need to diagnose hepatitis E virus (HEV) infection in this population.ObjectivesGiven the lack of data in France, we have studied the the prevalence of antibodies to HEV in the paediatric liver transplant population.Study designThis was a retrospective study, carried out in Lyon between 1st January 2010 and 31 May 2013. HEV serology (anti-HEV IgM &IgG) and HEV PCR were studied in 96 children who had undergone liver transplants (84 isolated liver and 12 combined liver and kidney transplants).ResultsEight patients (8.3%; 62.5% girls; mean age:12.3 years) were HEV seropositive. The mean period since their transplantation was 10 years (range:2–21.8 years). Biliary atresia was the principal indication for transplantation. Seven of these eight children had received liver transplants. There were no differences between the epidemiological and clinical data concerning these patients and the remainder of the study population, particularly with respect to immunosuppression(7/8 tacrolimus; 50% dual immunosuppression). No cases of chronic hepatitis E were found, but 1/8 had chronic cytolysis(EBV&adenovirus infection). In all the patients tested(4/8), seroconversion had occurred after the transplant. There was no significant differences between the age groups in this study.ConclusionsThis study showed that in France, the prevalence of antibodies to HEV in paediatric liver and combined liver and kidney transplant patients is 8.3%, as has been found by other European authors.     

Comparison of tests for antibody to hepatitis E virus

The results of serologic tests for hepatitis E virus have varied widely from laboratory to laboratory, making interpretation of seroepidemiologic studies difficult. The present study compares serologic results with different antigens and tests developed in two laboratories for their ability to diagnose hepatitis E and measure antibody prevalence in a high risk population in Saudi Arabia. The results confirm that tests based upon open reading frame (ORF) 3 of HEV are of limited value for seroepidemiologic studies, whereas ORF2-based antigens have broad utility and yield data that are reproducible in more than one laboratory. J. Med. Virol. 55:134–137, 1998. © 1998 Wiley-Liss, Inc.     

Liver histology in patients with sporadic acute hepatitis E: a study of 11 patients from South-West France

Hepatitis E virus is a ribonucleic acid (RNA) enterically transmitted virus that causes both epidemics and sporadic cases of acute hepatitis E in many countries of Asia and Africa. Domestically acquired (non-travel-associated) hepatitis E has been reported recently in many industrialized countries including the USA, Europe, and Japan. There is little information available on liver histology in these patients. We report a series of 11 patients with sporadic acute hepatitis E and needle liver histology in South-West France. Hepatitis E was diagnosed based on elevated transaminases (>10 upper limit normal) and the presence of specific serum antibodies (immunoglobulin-G class, present in all 11 patients) and/or viral RNA detection in serum and/or stools. Acute hepatitis lesions were observed in all cases with marked necro-inflammatory activity in nine patients. Confluent necrosis was present in five cases. Anisocaryosis and Kupffer's cell aggregates with siderosis were observed in most of the 11 patients. Cholangitis was frequent (9/11 cases). Cholestasis was observed in eight cases. Pseudo-glandular pattern was present in only one case but without zonal repartition. Characteristic pathological signs of acute hepatitis E were severe intralobular necrosis, polymorph inflammation, and acute cholangitis with numerous neutrophils.