戊型病毒性肝炎的流行率及其血清学指标特征研究

Study on epidemiological prevalence and serological marker characteristics of hepatitis E infection

目的探讨戊型肝炎病毒(HEV)感染患者的流行情况及其血清学指标对HEV感染患者的筛查价值。方法回顾分析北京市解放军总医院第五医学中心和佑安医院2018年1月1日至2023年8月31日同时检测抗-HEV IgM和IgG的数据97440例,其中男性61005例,女性36435例,年龄(51.65±13.05)岁。根据抗-HEV特异性抗体阴阳性分为抗-HEV IgM阳性组(3588例)、抗-HEV IgG阳性组(18083例)和抗-HEV抗体阴性组(78892例),收集其患者的HEV RNA、肝功能、AFP、PIVKA-Ⅱ和PT检测结果及基本临床资料,统计HEV感染患者的流行情况,以及抗-HEV特异性抗体阴阳性与患者的各年龄段、HEV RNA及临床特征的关系。结果97440例同时检测抗-HEV IgM和IgG患者中,抗-HEV IgM阳性率为3.68%(3588/97440),抗-HEV IgG阳性率为18.56%(18083/97440)。2018—2023年间,北京2家医院整体来看抗-HEV IgM的阳性率依次为2.51%、2.53%、3.02%、4.59%、5.72%和4.26%(χ^(2)=1401.73,P<0.001),抗-HEV IgG阳性率依次为12.56%、12.32%、12.85%、22.65%、27.42%和26.66%(χ^(2)=1058.29,P<0.001),均是缓慢上升至2023年开始下降。就诊患者在1~30岁、>30~60岁和>60岁的抗-HEV IgM阳性率(2.28%、3.60%、4.47%)(χ^(2)=89.62,P<0.001)和IgG的阳性率(4.71%、17.86%、25.94%)(χ^(2)=2017.32,P<0.001)均随着年龄的增加而升高。抗-HEV IgM阳性组患者的年龄和ALB值低于IgG阳性组,而男性比例、TBIL、ALT、AFP和PT值高于IgG阳性组,差异有统计学意义(P均<0.05);抗-HEV IgM和IgG阳性组患者的年龄、男性比例、TBIL、ALT、AFP、PIVKA-Ⅱ和PT值均高于抗-HEV阴性组,两组ALB值均低于抗-HEV阴性组,都具有统计学意义(P均<0.05)。2162例HEV感染患者根据HEV RNA阴阳性分组,HEV RNA阳性组患者抗-HEV IgM单阳性、IgG单阳性、IgM+IgG双阳性和抗体阴性比例分别为5.42%(18/332)、3.62%(12/332)、90.36%(300/332)和0.60%(2/332);其中,HEV RNA阳性组抗-HEV IgM+IgG双阳性患者比例高于HEV RNA阴性组(χ^(2)=302.87,P<0.001),抗-HEV IgG单阳性(χ^(2)=174.36,P<0.001)和抗-HEV抗体阴性(χ^(2)=59.28,P<0.001)患者比例低于HEV RNA阴性组。此外,抗-HEV IgM阳性、IgG阳性和抗体阴性患者的HEV RNA的阳性率依次为29.23%(318/1088)、17.59%(312/1774)和0.65%(2/306)。结论就诊患者HEV感染率在2023年开始下降。HEV感染与年龄相关,老年人更易感。HEV感染时肝功能异常,黄疸多见。抗-HEV特异性抗体阴性不能说明没有HEV感染,还需检测HEV RNA和/或HEVAg来诊断。

Objective This study aims to explore the prevalence of hepatitis E virus(HEV)infection in patients and the screening value of serological indicators for HEV infection patients.Methods Retrospective analysis was conducted on 97440 cases of anti-HEV IgM and IgG simultaneously tested in two Beijing hospitals from January 1,2018 to August 31,2023.Among them,there were 61005 males and 36435 females,with an average age of 51.65±13.05 years old.According to the positivity of anti HEV specific antibodies,they were divided into anti-HEV IgM positive group(3588 cases),anti-HEV IgG positive group(18083 cases),and anti-HEV antibody negative group(78892 cases).Results of HEV RNA,liver function,AFP,PIVKA-Ⅱand PT were collected,and their basic clinical information were recorded.The prevalence of HEV infection in patients,as well as the relationship between the positivity of anti-HEV specific antibodies and the patient′s age group,HEV RNA,and clinical characteristics were analyzed.Results Among 97440 patients who tested anti-HEV IgM and IgG simultaneously,the positivity rate of anti-HEV IgM was 3.68%(3588/97440),and was 18.56%for anti-HEV IgG(18083/97440).The overall positivity rates of anti-HEV IgM in two Beijing hospitals from 2018 to 2023 were 2.51%,2.53%,3.02%,4.59%,5.72%,and 4.26%(χ^(2)=1401.73,P<0.001),while the positivity rates of anti-HEV IgG were 12.56%,12.32%,12.85%,22.65%,27.42%,and 26.66%(χ^(2)=1058.29,P<0.001).These rates showed a gradual increase until 2023 when a decline was observed.The positivity rates of anti-HEV IgM(2.28%,3.60%,4.47%)(χ^(2)=89.62,P<0.001)and IgG(4.71%,17.86%,25.94%)(χ^(2)=2017.32,P<0.001)increased with age in patients who aged 1-30,>30-60,and over 60 years old.The age and ALB values of patients in the anti-HEV IgM positive group were lower than the IgG-positive group,while the proportion of males,TBIL,ALT,AFP and PT values were higher than the IgG-positive group,and the differences were statistically significance(P<0.05).Furthermore,patients in both the anti-HEV IgM and IgG positive groups had higher age,male proportion,TBIL,ALT,AFP,PIVKA-Ⅱ,and PT values than the anti-HEV negative group.Additionally,both groups had lower ALB values than the anti-HEV negative group,all of which were statistically significant(P<0.05).2162 HEV infected patients were grouped based on HEV RNA positivity.The proportion of anti-HEV IgM single positive,IgG single positive,IgM+IgG double positive,and antibody negative patients in the HEV RNA positive group were 5.42%(18/332),3.62%(12/332),90.36%(300/332),and 0.60%(2/332),respectively.Among them,the proportion of anti-HEV IgM+IgG double positive patients in the HEV RNA positive group was higher than that in the HEV RNA negative group(χ^(2)=302.87,P<0.001),while the proportion of anti-HEV IgG single positive(χ^(2)=174.36,P<0.001)and anti-HEV antibody negative patients(χ^(2)=59.28,P<0.001)were lower than that in the HEV RNA negative group,both of which were statistically significant(P<0.001).In addition,the positive rates of HEV RNA in anti-HEV IgM positive,IgG positive,and antibody negative patients were 29.23%(318/1088),17.59%(312/1774),and 0.65%(2/306),respectively.Conclusion The HEV infection rate among patients declined in 2023.HEV infection is age-related,with older individuals being more susceptible.Abnormal liver function and jaundice were commonly observed during HEV infection.It is crucial to note that the absence of anti-HEV specific antibodies cannot rule out HEV infection;therefore,additional testing for HEV RNA and/or HEV Ag is necessary for accurate diagnosis.