急性戊型肝炎血清抗-HEV IgM、IgG和HEV RNA动态变化及其诊断价值

Dynamic changes of serum anti-HEV IgM,anti-IgG and HEV RNA in patients with acute hepatitis E

目的分析急性戊型肝炎(AHE)患者血清抗-HEV IgM、抗HEV-IgG和HEV RNA变化规律。方法2016年1月~2018年3月北京佑安医院就诊的AHE患者217例,动态检测血清抗-HEV IgM、抗HEV-IgG和HEV RNA变化。结果首次检测血清抗-HEV IgM、IgG和HEV RNA均阳性31例(14.3%),抗-HEV IgM和IgG阳性99例(45.5%),抗-HEV IgM阳性8例(3.7%),抗-HEV IgG阳性72例(33.2%),抗-HEV IgM和HEV RNA均阳性3例(1.5%),抗-HEV IgG和HEV RNA均阳性2例(0.9%),抗-HEV IgM、IgG、HEV RNA均阴性2例(0.9%);在75例患者二次检测中,显示血清抗-HEV IgG阳性增多;在138例有准确的发病日期患者,在第1、2、3、4病周和第4病周后,血清HEV RNA阳性检出率分别为49.0%(25/51)、10.2%(6/59)、3.1%(1/32)、4.0%(1/25)和0.0%(0/0);血清抗-HEV IgM阳性检出率分别为70.6%(36/51)、69.5%(41/59)、65.6%(21/32)、48%(12/25)和56.5%(13/23);血清抗-HEV IgG阳性检出率分别为90.2%(46/51)、88.1%(52/59)、96.9%(31/32)、100%(25/25)和100.0%(23/23)。结论AHE患者血清抗-HEV IgM、IgG和HEV RNA存在一定的变化规律,血清抗-HEV IgG阳性,结合典型的急性肝炎过程和排除其他病因后,可以诊断为AHE。

Objective To investigate the dynamic changes of serum anti-HEV IgM,IgG and HEV RNA in patients with acute hepatitis E(AHE).Methord Serum anti-HEV IgM,IgG and HEV RNA loads were detected in a consecutive 217 patient with AHE,who were admitted to our Hospital between January 2016 and March 2018.Results At presentation,serum anti-HEV IgM,anti-HEV IgG and HEV RNA positive in 31 cases(14.3%),anti-HEV IgM and IgG positive in 99 cases(45.5%),anti-HEV IgM positive in 8 cases(3.7%),anti-HEV IgG positive in 72 cases(33.2%),anti-HEV IgM and HEV RNA positive in 3 cases(1.5%),anti-HEV IgG and HEV RNA positive in 2 cases(0.9%),and anti-HEV IgM,IgG and HEV RNA negative in 2 cases(0.9%);in 75 patients with second detection,the results showed that serum anti-HEV IgG positive increased;in 138 patients with accurate onset of the disease,serum HEV RNA positive at week one,two,three,four and after four were 49.0%(25/51),10.2%(6/59),3.1%(1/32),4.0%(1/25)and 0.0%(0/0);serum anti-HEV IgM positive were 70.6%(36/51),69.5%(41/59),65.6%(21/32),48%(12/25)and 56.5%(13/23);serum anti-HEV IgG positive were 90.2%(46/51),88.1%(52/59),96.9%(31/32),100%(25/25)and 100.0%(23/23).Conclusion Serum anti-HEV IgM,IgG and HEV RNA changes regularly in patients with AHE,which might help clinicians to make decisions for diagnosis and management.