散发性戊型肝炎的病原学和血清学研究

Study on etiology and serology of sporadic hepatitis E

目的研究散发性戊型肝炎（ＨＥ）患者病毒血症、粪便排病毒及抗体消长规律。方法采用逆转录套式聚合酶链反应（ＲＴｎｅｓｔｅｄＰＣＲ）动态检测血清和粪便ＨＥＶＲＮＡ，采用ＨＥＶＯＲＦ２、ＯＲＦ３合成多肽单独和联合ＥＩＡ法动态检测血清抗ＨＥＶ。结果血清ＨＥＶＲＮＡ阳性患者占７１％（４４／６２），平均持续时间为病后２０．６天（全程随访３２例）；粪便ＨＥＶＲＮＡ阳性标本中有９６．２％（２５／２６）出现在病后２０天内；血清抗ＨＥＶＩｇＭ和ＩｇＧ阳性率于发病半月内分别为７１．１％（３２／４５）和９７．８％（４４／４５），随病程的延长ＩｇＭ较早阴转。结论病毒血症和粪便排病毒主要出现在急性早期；联合检测ＯＲＦ２和ＯＲＦ３抗体可提高ＥＩＡ试验的敏感性。

Objective To study the viremia, fecal shedding of HEV and dynamics of anti HEV in the patients with sporadic hepatitis E.Methods HEV RNA was detected in serial samples of sera and feces by reverse transcription nested polymerase chain reaction (RT nested PCR). Anti HEV was detected in serial sera by enzyme linked immunosorbent assay (EIA) based on two synthetic peptides from ORF2 and ORF3 of HEV genome.Results Viremia of HEV RNA was detected in 71% (44/ 62) of patients, persisted for 20.6 days after the onset of disease on an average. 96.2% (25/ 26) of fecal specimens with HEV RNA were detected within 20 days after the onset of disease. The positive rates of anti HEV IgM and IgG with in 15 days after the onset of disease were respectively 71.1% (32/ 45) and 97.8% (44/ 45), which decreased more dramatically in IgM than in IgG with the course of the disease. Conclusion Viremia and fecal shedding are common during early acute phase of the disease. The sensitivity of EIA using both ORF2 and ORF3 peptides is higher than that of either alone. As a diagnostic marker of hepatitis E, Anti HEV IgM seems to be more specific and anti HEV IgG seems to be more sensitive.