从业人员预防性健康检查甲型肝炎、戊型肝炎IgM抗体阳性者复检程序的探讨

Study on re-examination procedures of health-related employees with IgM antibodies to hepatitis A and hepatitis E in preventive health examination

目的探讨从业人员预防性健康检查甲型病毒性肝炎（甲肝）、戊型病毒性肝炎（戊肝）IgM抗体阳性者复检程序,为从业人员预防性健康检查合格证发放工作提供科学依据。方法在食品、公共场所等健康相关行业的从业人员健康检查中,筛查出的甲肝病毒（HAV）和戊肝病毒（HEV）IgM抗体阳性者,于第15～、45和90天复检,每次受检在2周内完成。采集受检者空腹静脉血3～5 ml,检测甲肝、戊肝IgM抗体、IgG抗体和丙氨酸氨基转移酶（ALT）。结果受检者HAV-IgM和HEV-IgM抗体阳性者,在第45天复检时Ig M抗体阴转例数最高,阴转率分别为57.1%和50.0%。将初次HAV-IgM和HEV-IgM抗体阳性的受检者安排于第45和第90天复检2次最为适宜。结论此复检方法,符合甲肝和戊肝的流行病学特点,依据IgG抗体和ALT检测结果,以及临床症状和体征,由主检医师进行综合判定是否发放＂健康证＂,可以解决工作中的难点,又保证工作的可操作性和科学性。

[Objective]To study the re-examination procedures of health-related employees with Ig M antibodies to hepatitis A and hepatitis E in preventive health examination, provide the scientific basis for issuing the health certificate. [Methods]The employees engaged in the food industry and public places,who have received the examination and were positive for Ig M antibodies to hepatitis A（HAV）and hepatitis E（HEV）,were given the re-examination on the 15 th,45th and 90 th day,and the re-examination was completed within two weeks. The fasting venous blood sample（3-5 ml） was collected,to detect the Ig M and Ig G to hepatitis A and hepatitis E,as well as serumalanine aminotransferase（ALT）. [Results]The employees with HAV-Ig M and HEV-Ig M showed the highest negative conversion rate at re-examination of the 45 th day, which was 57.1% and 50.0%respectively. The results indicated that it is appropriate that the employees with HAV-Ig M and HEV-Ig M receive the reexamination on 45 th and 90 th day after the initial test.[Conclusion]This method conforms to the epidemiological characteristics of hepatitis A and hepatitis E. According to the detection results of Ig G antibodies and ALT,as well as the clinical symptoms and signs,the chief physician can make a comprehensive judgement on issuing the health certificate. This method has the advantages of practicability,operability and scientificalness.