抗戊型肝炎病毒E2 IgM诊断急性戊型肝炎的敏感性和特异性  

IgM to recombinant antigen E2 of HEV envelope protein is a sensitive and specific serological marker in diagnosis of acute hepatitis E

作　　者：郑玲[1] 柳丽娟[1] 胡莹盈[1] 王艳丽[1] 温珠妹[1] 张宇[1] 陈惠聪[1] 张启云[1] 江家骥[2] 

机构地区：[1]福州市传染病医院,350025 [2]福建医科大学附属第一医院肝病中心

出　　处：《中华肝脏病杂志》2005年第8期590-593,共4页Chinese Journal of Hepatology

基　　金：福建省科技重大专项课题(2004YZ01-3)福州市科技发展基金(2002-21)

摘　　要：目的评价抗戊型肝炎病毒(HEV)衣壳蛋白重组抗原E2 IgM(抗-E2 IgM)诊断急性散发性戊型肝炎的敏感性和特异性。方法用酶联免疫吸附法检测176份急性散发性戊型肝炎和191份急性散发性非甲～非戊型肝炎患者血清中抗-E2 IgM,与国产传统试剂和新加坡Genelabs试剂检测的IgM(GL-IgM)作比较;对抗-E2 IgM阳性血清检测血清中HEV RNA,采用logistic回归分析检测抗-E2 IgM和HEV RNA的相关因素。结果在176份急性戊型肝炎患者血清中,抗-E2 IgM的检出率为68.75%,国产传统试剂抗-HEV IgM检出率为56.25%,X2IgM=6.49,P<0.05。在191份急性非甲～非戊型肝炎血清中有37例(19.37%)抗- E2 IgM阳性,其中11例GL-IgM同时阳性;在158份抗-E2 IgM阳性血清中,有81例HEV RNA阳性(51.27%), 其中急性戊型肝炎的阳性率为57.02%,急性非甲～非戊型肝炎的阳性率为32.43%,23例抗-E2 IgM阴性的急性戊型肝炎患者的血清,无一例检测到HEV RNA。Logistic多因素回归分析发现,抗-E2 IgM的检出率与发病至入院时间、年龄、血清胆红素、血清氨基转移酶水平无关,血清丙氨酸氨基转移酶水平与HEV RNA水平呈正相关(P=0.024)。结论抗-E2 IgM是HEV急性期感染敏感性和特异性强的血清学指标;HEV感染仍是部分临床诊断为急性非甲～非戊型肝炎的病因;持续HEV病毒血症可能是影响急性戊型肝炎病情的重要因素。Objective To evaluate the sensitivity and specificity of IgM to recombinant antigen E2 of HEV envelope protein in the diagnosis of acute sporatic hepatitis E. Methods anti-E2 IgM was detected in sera samples from 176 cases of acute sporatic hepatitis E and 191 cases of acute non A-E hepatitis by ELISA and was compared with HEV IgM detected by some domestic and Genelabs （GL） kits. HEV RNA was also detected in sera positive for anti-E2 IgM.Logistic regression was used to analyze factors associated with the detection of anti-E2 IgM and HEV RNA. Results Anti-E2 IgM was found in 68.75% of the serum samples from the 176 patients of acute hepatitis E and the positive rate of HEV IgM detection by domestic kits was 56.25% （x^2IgM=6.49, P〈0.05）. There were 37 （19.37%） anti-E2 IgM positive cases in those 191 sera of the actue non A-E hepatitis, out of which 11 cases were also detected as positive by the GL kit. Of the 158 anti-E2 IgM positive sera, HEV RNA was found in 81 （51.27%）, among which 57.02% was positive in acute hepatitis E and 32.43% in acute non A-E hepatitis. No HEV RNA was found in the anti-E2 IgM negative sera from the cases of acute hepatitis E. By logistic regression analysis, no variance relative to the detection of anti-E2 IgM was found with the time interval from onset to hospitalization, age, levels of bilirubin, ALT and AST of the serum. Only the level of serum ALT was found being significantly associated with the detection of HEV RNA （P=0.024）. Conclusions （1） anti-E2 IgM is a sensitive and specific serological maker for diagnosing an acute infection of HEV. （2） HEV is still the pathogen of some cases diagnosed clinically as non-A-E hepatitis. （3） Persistent HEV viremia is possibly an important factor influencing the severity of acute hepatitis E.

关 键 词：抗戊型肝炎病毒E2 IGM 急性戊型肝炎 敏感性 特异性 肝炎抗体 血清学 

分 类 号：R512.6[医药卫生—内科学]