急性戊型肝炎抗-HEV-IgG及抗-HEV-IgM检测的临床意义

由于戊型肝炎病毒RNA(HEV RNA)检测手段较复杂,同时它在血清中存在的时间短,其结果受抽血时间影响较大,故戊型肝炎主要靠检测血清中抗-HEV-IgG及抗-HEV-IgM来进行诊断。其结果可分3种不同类型:即抗-HEV-IgG及抗-HEV-IgM双阳性,单纯抗-HEV-IgG阳性及单纯抗-HEV-IgM阳性。以往对抗-HEV-IgG及抗-HEV-IgM检测尽管有报道,但未见不同类型的观察,现就3种不同类型的检出率,检出时间及其与总胆红素(TBil),丙氨酸转氨酶(ALT)及血清总胆汁酸(TBA)等肝功能指标的关系报道如下。     

急性戊型肝炎临床分析221例

目的:观察和分析急性戊型肝炎的临床特点.方法:调查急性戊型肝炎患者221例的流行病学资料. 分别比较年龄18岁以下、18-60岁和60岁以上患者组, 单纯急性戊肝组和重叠慢乙型肝炎、酒精肝组以及单项抗-HEV-IgG阳性组与抗-HEV-IgM阳性组病例的病程、生化学指标、预后等方面的差异.结果:221例急性戊型肝炎患者中18岁以上者188例, 占84.8%; 男女之比3.92∶1; 职业分布特点是外出务工者108例, 占48.8%; 2-5月份发病患者数占当年发病患者数的67.8%, 随患病年龄增加, 表现出住院时间延长, 病死率增加, ALT、ALB水平呈下降趋势, 各组比较均有显著差异. 重叠乙型肝炎和酒精肝组的重肝发生率及死亡率分别为7.8%、1.9%和6.0%、3.0%, 明显高于单纯戊肝组的2.1%和0.7%. 抗-HEV-IgG阳性与抗-HEV-IgM阳性病例的临床表现和各项生化学指标比较无显著性差异.结论:急性戊型肝炎成年人多发, 外务工者高发, 有冬春发病高峰. 大多数患者预后良好, 老年戊型肝炎及在乙型肝炎、酒精肝基础上重叠戊肝病毒感染可能是影响患者预后的主要因素.     

散发性戊型肝炎的临床和流行病学特征分析

目的总结散发性戊型肝炎的临床表现和流行病学特征。方法回顾分析155例散发性戊型肝炎患者的流行病学资料、临床表现、实验室检测、治疗和转归。结果戊型肝炎全年散发，3、4、5月份为高发，尤以4月份发病为最高，占12．9％；男性多于女性，男女比例为5：1；中青年患者占83．7％；农民发病多于城镇人口；抗-HEV-IgM阳性者26例（16．7％），抗-HEV-IgG阳性49例（39．6％），两者同时阳性80例（51．7％）；甲戊型肝炎病毒重叠感染3例，乙戊型肝炎病毒重叠感染20例。老年患者及重叠HBV感染者病情重，病程长；单纯戊型肝炎无一例转为慢性肝炎。结论散发性戊型肝炎预后较好，乙、戊型肝炎病毒重叠感染及老年患者肝功能损害严重。     

检测戊型肝炎患者血清抗-HEV-IgM和抗-HEV-IgG的临床意义

随着戊型肝炎病毒(HEV)分子克隆成功,戊型肝炎特异性实验诊断方法有了很大发展。我们检测了52例散发性戊型肝炎患者的不同病日血清抗-HEV-IgM和抗-HEV-IgG,探讨其变化及临床意义。 资料和方法 一、病例选择 52例散发性戊型肝炎均符合以下诊断标准:(1)具有急性病毒性肝炎的临床症状和体     

戊型肝炎多重感染109例分析

我们于1993年4月～1994年4月对所有住院的病毒性肝炎者进行甲、乙、丙、丁、戊型血清病原学检测。其中抗-HEV-IgG阳性者222例,除113例单纯戊型肝炎感染外,尚有109例在甲型、乙型或丙、或丁型感染的基础上重叠戊型感染,多重感染率49.5％。为了了解戊型肝炎多重感染的临床特点,我们将单纯戊型感染组113例为一组,与多重感染109例为另一组做配对分析如下。     

非甲～非丙型急性肝炎抗-HEVIgM、IgG的血清学规律

目的探讨非甲～非丙型急性肝炎中抗-HEVIgM和抗-HEVIgG的血清学规律。方法由酶联免疫吸附方法 ,用戊型肝炎病毒基因开放读区2和3重组多肽抗原检测472例非甲～非丙型急性肝炎病人血清的抗-HEVIgM、IgG。结果出现戊型肝炎病毒血清学应答的病人有80.51%(380/472),抗-HEVIgM和IgG均阴性占19.49%(92/472)。在380例有戊型肝炎病毒血清学应答的病人中,抗-HEVIgM和IgG均阳性占57.11%(217/380);仅抗-HEVIgG阳性占31.84%(121/380);仅抗-HEVIgM阳性占8.95%(34/380);抗-HEVIgM阴性仅出现抗-HEVIgG从阴性转阳性占2.11%(8/380)。结论用戊型肝炎病毒基因开放读区2和3重组多肽抗原检测抗-HEVIgM、IgG存在4种阳性模式,抗体反应的敏感性有待提高。     

传染病和寄生虫病

中国医学文摘·内科学1996年第17卷第4期.283. &45第五次全国传染病与寄生虫病学术会议纪要/斯崇文刀中华传染病杂志一1995,13(4)一238~240 ,62646病毒性肝炎216例甲皱微循环检测的临床意义/金银杏…//交通医学一1995,9(4)一52~53 &47肝炎患者,06例戊型与甲、乙、丙各型肝炎病毒重至感染血清学分析/沙安莉…//中华传染病杂志一1995,13(4)一220~221 观察示此组抗一HEV阳性者占12.8%,抗-IIEV一 IgG阳性者占9.。%,抗一HEv一坛M阳性者占3.8肠。在n6例抗-HEV阳性者中,甲、乙、丙型肝炎病毒血清学标志全阴性而单项抗一HEV阳性和急性肝…     

184例戊型肝炎肝外脏器损害临床资料分析

戊型肝炎是由戊型肝炎病毒(HEV)引起的急性传染病,其临床表现与甲型病毒性肝炎相似,但本病黄疸型多见,病情较重,而且也有肝外系统损害表现。收集2000年1月至2002年12月单纯戊型肝炎患者资料184例,结果报告如下。 1 临床资料 1.1 一般资料 184例患者符合2000年9月全国传染病与寄生虫病学术会议修订的病毒性肝炎诊断标准。即抗-HEV-IgM阳性,结合临床作出诊断,并排除甲、乙、丙、丁、庚型肝炎病毒感染。其中男128例,女56例。急性黄疸型肝炎     

30例非甲～戊型肝炎中庚型肝炎病毒感染分析

了解庚型肝炎病毒在本地区非甲－戊型肝炎中的流行情况及其临床特征。方法用ＲＴ－ＰＣＲ和ＥＬＩＳＡ法对３０例非甲－戊型肝炎患者的血清进行ＨＧＶ－ＲＮＡ和抗－ＨＧＶ检测。结果３０例非甲－戊型肝炎患者中检出３例,ＨＧＶ－ＲＮＡ阳性,其中２例为急性肝炎,１例为慢性肝炎。     

抗戊型肝炎病毒E2 IgM诊断急性戊型肝炎的敏感性和特异性

目的评价抗戊型肝炎病毒（HEV）衣壳蛋白重组抗原E2 IgM（抗-E2 IgM）诊断急性散发性戊型肝炎的敏感性和特异性。方法用酶联免疫吸附法检测176份急性散发性戊型肝炎和191份急性散发性非甲～非戊型肝炎患者血清中抗-E2 IgM，与国产传统试剂和新加坡Genelabs试剂检测的IgM（GL—IgM）作比较；对抗-E2 IgM阳性血清检测血清中HEV RNA，采用logistic回归分析检测抗-E2 IgM和HEV RNA的相关因素。结果在176份急性戊型肝炎患者血清中，抗-E2 IgM的检出率为68．75％，国产传统试剂抗-HEV IgM检出率为56．25％，x^2IgM=6．49，P〈0．05。在191份急性非甲～非戊型肝炎血清中有37例（19．37％）抗-E2 IgM阳性，其中11例GL—IgM同时阳性；在158份抗-E2 IgM阳性血清中，有81例HEV RNA阳性（51．27％），其中急性戊型肝炎的阳性率为57．02％，急性非甲～非戊型肝炎的阳性率为32．43％，23例抗-E2 IgM阴性的急性戊型肝炎患者的血清，无一例检测到HEV RNA。Logistic多因素回归分析发现，抗-E2 IgM的检出率与发病至人院时间、年龄、血清胆红素、血清氨基转移酶水平无关，血清丙氨酸氨基转移酶水平与HEV RNA水平呈正相关（P=0．024）。结论抗-E2 IgM是HEV急性期感染敏感性和特异性强的血清学指标；HEV感染仍是部分临床诊断为急性非甲～非戊型肝炎的病因；持续HEV病毒血症可能是影响急性戊型肝炎病情的重要因素。     

Hepatitis E

Hepatitis E, previously known as enterically transmitted non-A, non-B hepatitis, is an infectious viral disease with clinical and morphologic features of acute hepatitis. Its causative agent, hepatitis E virus, consists of small, 32- to 34-nm diameter, icosahedral, nonenveloped particles with a single-stranded, positive-sense, 7.5-kb RNA. The virus has two main geographically distinct strains, Asian and Mexican; recently, novel isolates from nonendemic areas and a genetically related swine HEV have been described. HEV is responsible for large epidemics of acute hepatitis and a proportion of sporadic hepatitis cases in the Indian subcontinent, southeast and central Asia, the Middle East, parts of Africa, and Mexico. The virus is excreted in feces and is transmitted predominantly by fecal-oral route, usually through contaminated water. Person-to-person transmission is uncommon. Clinical attack rates are the highest among young adults. Recent evidence suggests that humans with subclinical HEV infection and animals may represent reservoirs of HEV; however, further data are needed. Diagnosis of hepatitis E is usually made by detection of specific IgM antibody, which disappears rapidly over a few months; IgG anti-HEV persists for at least a few years. Clinical illness is similar to other forms of acute viral hepatitis except in pregnant women, in whom illness is particularly severe with a high mortality rate. Subclinical and unapparent infections may occur; however, chronic infection is unknown. No specific treatment is yet available. Use of clean drinking water and proper sanitation is currently the most effective method of prevention. Passive immunization has not been proved to be effective, and recombinant vaccines for travelers to disease-endemic areas and for pregnant women currently are being developed.     

Hepatitis E

Hepatitis E refers to liver disease caused by the hepatitis E virus (HEV), a small, nonenveloped virus with a single-stranded RNA genome. The virus has four genotypes, but only one serotype. Genotypes 1 and 2 exclusively infect humans, whereas genotypes 3 and 4 also infect pigs and several other mammalian species. Though HEV does not grow well in cell culture, several aspects of its biology and pathogenesis have been worked out using animal models and cell transfection studies, and by analogy with other related viruses. HEV itself appears noncytopathic, and the liver injury during hepatitis E may be mediated by the host immune response. In areas with poor sanitation, HEV infection is common and presents as outbreaks and also as sporadic cases with acute self-limited hepatitis. The transmission is feco-oral, usually through contaminated drinking water. The disease often affects young adults and is particularly severe among pregnant women and persons with preexisting liver cirrhosis. In the developed world, the disease is being increasingly recognized. It occurs as occasional sporadic cases, most often among elderly men with coexisting illnesses. These appear to be related to zoonotic transmission. Chronic infection is known among immunosuppressed persons in these regions and may progress to liver cirrhosis. Serological tests for diagnosis of HEV exposure and recent infection, namely immunoglobulin (Ig)G and IgM anti-HEV, respectively, need further improvement in sensitivity and specificity, particularly when used in developed countries. Two recombinant protein vaccines have undergone successful human trials, but are not yet commercially available. Recent development of cell-culture methods for HEV should allow a better understanding of this enigmatic agent.     

Hepatitis E

Hepatitis E virus (HEV) was discovered during the Soviet occupation of Afghanistan in the 1980s, after an outbreak of unexplained hepatitis at a military camp. A pooled faecal extract from affected soldiers was ingested by a member of the research team. He became sick, and the new virus (named HEV), was detected in his stool by electron microscopy. Subsequently, endemic HEV has been identified in many resource-poor countries. Globally, HEV is the most common cause of acute viral hepatitis. The virus was not initially thought to occur in developed countries, but recent reports have shown this notion to be mistaken. The aim of this Seminar is to describe recent discoveries regarding HEV, and how they have changed our understanding of its effect on human health worldwide.     

Hepatitis E

Hepatitis E has a world-wide distribution and causes substantial morbidity and mortality in some developing countries, particularly among pregnant women. Hepatitis E virus (HEV) has recently been cloned and sequenced, and new diagnostic tests have been developed. These tests have been used to begin to characterize the natural history and epidemiological features of HEV infection. Experimental vaccines have also been developed that offer the potential to prevent hepatitis E. However, much remains to be learned about HEV, including the mechanisms of transmission, the reservoir(s) of the virus, and the natural history of protective immunity in order to develop effective strategies to prevent this disease.