血清学标志阴性的病毒性肝炎病原学研究

Etiological study on patients with seronegative viral hepatitis

目的 了解血清学标志阴性的病毒性肝炎病原学。方法 应用HBV、HCV、戊型肝炎病毒 (HEV)和庚型肝炎病毒 (HGV)核酸PCR检测 10 4例血清学标志阴性的病毒性肝炎病人 ,并用直接测序法对部分HCVRNA和HEVRNA逆转录PCR产物进行了核苷酸序列测定。结果 10 4例血清学标志阴性的病毒性肝炎病人中 ,HBVDNA、HCVRNA、HEVRNA和HGVRNA阳性率分别为 2 9 8%、3 8%、2 2 1%和 7 7% ,仅 36 6 % (38/ 10 4)病原不明 ,可诊断为非甲～非戊型肝炎。结论 在诊断非甲～非戊型肝炎并对其病原学进行研究时 ,除应检测已知肝炎病毒的血清学标志外 ,还应进行PCR检测 ,以排除已知肝炎病毒感染。

Objective To investigate the etiology of hepatitis patients who were seronegative for viral hepatitis A through E. Methods By using PCR, HBV DNA, HCV RNA, HEV RNA and HGV RNA were detected in sera of 104 patients with seronegative viral hepatitis. The partial nucleotide sequences of 2 HCV and 17 HEV isolates were analysed by direct sequencing. Results Among the 104 patients with seronegative viral hepatitis, the positive rates of HBV DNA, HCV RNA, HEV RNA and HGV RNA were 29 8%、3 8%、22 1% and 7 7%,respectively, with only 38 cases (36 6%) negative for the genome of all known hepatitis viruses. Conclusion In addition to serological tests, the polymerase chain reaction of all known hepatitis viruses should be used to make the diagnosis of non-A～E hepatitis.