单项抗-HEV IgG阳性对急性戊型肝炎的临床诊断价值及临床特征分析

Clinical diagnostic value of single anti-hepatitis E virus IgG positive for acute hepatitis E

[目的]探讨单项抗-HEV IgG阳性对急性戊型肝炎(AHE)的临床诊断价值,并分析单项抗-HEV IgG阳性的AHE患者的临床特征。[方法]连续收集因肝功能异常就诊,戊肝抗体筛查仅单项抗-HEV IgG阳性,最终临床诊断为AHE的患者133例,收集其病史、病原学、临床表现、实验室及影像学检查等临床资料,根据是否合并有慢性肝病分为单纯AHE组和AHE伴慢性肝病组,对比分析其临床特征。[结果]133例患者中23例HEV RNA阳性。单纯AHE组68例;AHE伴慢性肝病组65例,合并的慢性肝病分别为慢性乙型肝炎26例(40%)、乙肝肝硬化17例(26.2%)、丙肝肝硬化9例(13.8%)、酒精性肝病13例(20%)。单纯AHE组患者总胆红素(TBIL)水平为(191.99±159.54)μmol/l,显著低于AHE伴慢性肝病组(309.95±170.42)μmol/l(P<0.05);单纯AHE组患者白蛋白(ALB)、凝血酶原活动度(PTA)及胆碱酯酶(CHE)分别为(33.03±5.02)g/L、(77.81±22.28)%、(4727.27±1850.47)U/L,显著高于AHE伴慢性肝病组(30.81±4.79)g/L、(47.00±21.98)%、(3451.24±1168.06)U/L,2组比较差异有统计学意义(P<0.05)。单纯AHE组肝衰竭发生率为4.4%,显著低于AHE伴慢性肝病组38.5%(P<0.05)。[结论]单独抗-HEV IgG阳性是AHE的一种特殊的血清学模式,对于单独抗-HEV IgG阳性且有急性肝炎的临床表现及肝功能异常,并能排除其他病因者可临床诊断AHE。与单纯AHE相比较,慢性肝病重叠感染HEV者肝功能损害更重,肝衰竭发生率更高,需引起重视。

[Objective]To evaluate the significances of single anti-hepatitis E virus IgG(anti-HEV IgG)positive for the clinical diagnostic value of acute hepatitis E.[Methods]The clinical data of 133 single anti-HEV IgG positive patients with abnormal liver function were collected in our department between January 2016-March 2018,and the etiology,clinical feathers were retrospectively analyzed.[Results]Sixty-eight patients with clinical diagnosis of acute hepatitis E,with an average age of(57.9±3.1)years,38 males and 30 females;65 patients of acute hepatitis E with chronic liver disease,with an average age of(49.7±2)years,54 males and 11 females.Compare with 68 patients with acute hepatitis E,the liver function of the 65 patients with acute hepatitis E with underlying chronic liver disease were more severe,the incidence of liver failure were higher.[Conclusion]Single anti-HEV-IgG positive is a special serological pattern of AHE,the diagnosis of acute hepatitis E with single anti-HEV IgG positive should be considered when there is a liver dysfunction,and no other etiological cuases.