戊型肝炎亚临床感染者血清中HEV抗体和粪便HEV RNA的动态变化

Dynamic changes of serum HEV antibody and fecal HEV RNA in subclinical HEV infections

目的调查北京铁路局天津铁路辖区内铁路系统从业人员戊型肝炎(戊肝)感染情况,探讨戊肝亚临床感染者血清中戊肝病毒(HEV)抗体和丙氨酸氨基转移酶(ALT)及粪便中HEV RNA的动态变化。方法选取2011—2013年在北京铁路局天津铁路疾病预防控制所进行预防性健康检查的从业人员抗HEV-Ig M阳性者共54人,并选取54名抗HEV-Ig M阴性者做对照,检测其血清中ALT和抗HEV-Ig G,计算其异常率和阳性率。对抗HEV-Ig M阳性者进行随访,观察其血清中ALT、抗HEV-Ig M、抗HEV-Ig G及粪便中HEV RNA不同时间的变化情况。结果抗HEV-Ig M阳性组血清中ALT水平、ALT异常率和抗HEV-Ig G阳性率与抗HEV-Ig M阴性组相比,差异无统计学意义(P>0.05)。抗HEV-Ig M阳性人群血清中抗HEV-Ig M和Ig G阳性率在初次检查后90 d内有显著性差异,此时粪便中可以检测到HEV RNA。结论辖区内HEV感染呈亚临床感染状态存在,初次检查后90 d内抗HEV-Ig M和Ig G及粪便中HEV RNA阳性率变化最明显。

[Objective]To investigate the hepatitis E infection situation of railway employees in the area under the jurisdiction of Tianjin Railway Center for Disease Control and Prevention of Beijing Railway bureau, research the dynamic changes of serum HEV antibody, alaninc aminotransferase （ALT） and fecal HEV RNA in subclinical HEV infection.[Methods]54 employees with positive anti HEV-IgM, who have received the preventive health examination in Tianjin Railway Center for Disease Control and Prevention of Beijing Railway Bureau from 2011-2013, were enrolled in this study, and 54 employees with negative anti HEV- IgM were collected in the control group. The levels of serum ALT and anti HEV-IgM were detected to calculate the ALT abnormal rate and positive rate of anti HEV-IgM. The employees with positive anti HEV-IgM were followed up to observe the changes of the serum ALT, anti HEV-IgM, anti HEV-IgG and fecal HEV RNA in different time.[Results]There were no significant differences in the serum ALT level, ALT abnormal rate and positive rate of anti HEV-IgG between anti HEV-IgM positive group and negative group.In employees with positive anti HEV-IgM, there was significant difference between the positive rate of anti HEV-IgM and anti HEV-IgG during the 90 days after the initial examination, and HEV RNA was detected in fecal samples during this time. [Conclusion]The subclinical HEV infection has been observed among railway employees in the area under the jurisdiction. The changes of positive rate of anti HEV-IgM, anti HEV-IgG and fecal HEV RNA during 90 days after initial examination are significant.