急性甲型肝炎病人粪便排毒和病毒血症分析

Analysis of Viremia and stools of acute hepatitis A patients

目的探讨急性甲型肝炎患者通过粪便排毒与病毒血症的关系,排毒方式与产生抗体的关系以及临床生化指标与排毒的关系。方法收集42例10～20岁在象山甲型肝炎大流行期间的急性甲型肝炎病人入院第2天的血清和粪便,ELISA法检测HAV-IgM抗体、血生化指标,RT-PCR法检测血清中和粪便中的HAVRNA。结果所有的病例HAV-IgM抗体为阳性,其OD值为2.0～4.2。所有病例出现了总胆红素(TBIL)、直接胆红素(DBIL)、丙氨酸转氨酶(ALT)和天冬氨酸转氨酶(AST)的升高。在粪便样品中共检测到阳性样品18份,占42.85%;在血清样品中共检测到阳性样品6份,占14.28%;在血清中HAVRNA阳性的病例其粪便HAVRNA也为阳性。结论在14.28%病例的血清中能检测到HAVRNA,说明这些患者的血液中仍存在感染性。病人是否排毒以及通过什么样的方式排毒,可能与病情的轻重无关。有病毒血症的病例都同时通过粪便排毒,通过粪便排毒的病例可以不产生病毒血症。

Objective To explore the relationships of HAV between in stools and in serums, between IgM antibody in serum and excretion of HAV and between biochemical indications of serum and excretion of HAV. Methods 42 cases of acute Hepatitis A were studied. Fecal specimens and serum specimens were collected in the second day after patients entered the hospital. IgM antibody, biochemical indications of serum, HAV RNA of stools and serums were detected. Results IgM antibody in all studied cases were positive. TBIL, DBIL, ALT and AST in all studied cases were increased. 42.85% of fecal specimens and 14.28% of serum specimens were detected HAV RNA by RT-PCR. Conclusions 14.28% of the studied cases are detected viremia and at the same time HAV is excreted by stools. It is possible that there is no relationship between the excretion of HAV and biochemical indications of serum.