摘要
目的探讨HEV核酸(HEV RNA)、HEV抗原(HEV Ag)、HEV抗体(HEV IgM抗体和HEV IgG抗体)在临床诊断HEV感染中的作用。方法收集在北京大学人民医院进行HEV IgM抗体和HEV IgG抗体检测的13992例标本,其中1924例HEV IgM抗体或HEV IgG抗体阳性。分别采用荧光PCR法进行HEV RNA和基因型检测,酶联免疫吸附试验方法进行HEV Ag、HEV IgM抗体和HEV IgG抗体检测,并检测ALT、AST、TBil和DBil水平。计量资料两组间比较采用Mann-Whitney U检验。结果1924例标本中HEV IgM抗体阳性152例(7.9%),HEV IgG抗体阳性1897例(98.6%),HEV RNA阳性62例(3.2%),HEV Ag阳性55例(2.9%)。HEV IgM抗体阳性组中HEV RNA阳性率为40.8%(62/152),HEV Ag阳性率为36.2%(55/152)。HEV RNA阳性组中HEV Ag阳性率为88.7%(55/62)。HEV RNA阳性组(n=62)ALT、AST、TBil、DBil水平高于HEV RNA阴性组(n=90)(Z值分别为-7.609、-6.942、-5.815、-6.130,P值均<0.001),HEV Ag阳性组(n=55)ALT、AST、TBil、DBil水平明显高于HEV Ag阴性组(n=97)(Z值分别为-6.413、-5.786、-5.199、-5.545,P值均<0.001)。巢式PCR扩增测序结果显示58例HEV RNA阳性,4例阴性。HEV IgG抗体阳性高水平明显降低HEV Ag检测的S/CO值,甚至出现阴性结果。结论与HEV抗体相比,HEV Ag可以提高戊型肝炎的诊断水平,具有一定的临床意义;高水平的转氨酶或胆红素可以辅助诊断HEV感染;高水平的HEV IgG抗体会降低HEV Ag检测值,检测时应注意HEV Ag阴性时HEV IgG抗体值。
Objective To investigate the role of hepatitis E virus nucleic acid(HEV RNA),hepatitis E virus antigen(HEV Ag),hepatitis E virus antibodies(HEV IgM antibody and HEV IgG antibody)in the clinical diagnosis of hepatitis E virus infection.Methods A total of13992 specimens,for which the detection of HEV IgM antibody and HEV IgG antibody were performed in Peking University People’s Hospital,were collected,among which 1924 had positive HEV IgM antibody or HEV IgG antibody.Quantitative real-time PCR was used to determine HEV RNA and HEV genotype,and enzyme-linked immunosorbent assay was used to detect HEV Ag,HEV IgM antibody,and HEV IgG antibody and measure the levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil),and direct bilirubin(DBil).The non-parametric rank sum Mann-Whitney U test was used for comparison of continuous data between groups.Results Among the 1924 specimens with positive HEV IgM antibody or HEV IgG antibody,152(7.9%)had positive HEV IgM antibody,1897(98.6%)had positive HEV IgG antibody,62(3.2%)had positive HEV RNA,and 55(2.9%)had positive HEV Ag.Among the 152 specimens with positive HEV IgM antibody,62(40.8%)had positive HEV RNA,and 55(36.2%)had positive HEV Ag,and among the 62 specimens with positive HEV RNA,55(88.7%)had positive HEV Ag.The HEV RNA-positive group with 62 specimens had significantly higher levels of ALT,AST,TBil,and DBil than the HEV RNA-negative group with 90 specimens(Z=-7.609,-6.942,-5.815,and-6.130,all P<0.001),and the HEV Ag-positive group with 55 specimens had significantly higher levels of ALT,AST,TBil,and DBil than the HEV Ag-negative group with 97 specimens(Z=-6.413,-5.786,-5.199,and-5.545,all P<0.001).Nested PCR amplification and sequencing showed that in the HEV RNA-positive group with 62 specimens,58 had positive HEV RNA and 4 had negative HEV RNA.The high level of positive HEV IgG antibody significantly reduced the S/CO value of HEV Ag detection and even yielded a negative result.Conclusion Compared with HEV antibodies,HEV Ag can
作者
李晓鹤
王江华
季颖
刘艳
朱凌
贾玉缘
王震宇
史羿君
张海莹
饶慧瑛
LI Xiaohe;WANG Jianghua;JI Ying(Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases,Peking University Hepatology Institute,Peking University People’s Hospital,Beijing 100044,China)
出处
《临床肝胆病杂志》
CAS
北大核心
2020年第1期98-101,共4页
Journal of Clinical Hepatology
基金
国家自然科学基金青年基金(81802047,81870406)
北京市自然科学基金(7182174)
“十三五”期间国家传染病防治科技重大专项(2017ZX10202202)
2016年北京大学人民医院研究与发展基金(RDY2016-13)
关键词
戊型肝炎病毒
RNA
抗原
抗体
诊断
hepatitis E virus
RNA
antigens
antibodies
diagnosis
