Kumar Subrat, Ratho Radha Kanta, Chawla Yogesh Kumar, Chakraborti Anuradha
Department of Virology, PGIMER, Chandigarh-160012, India.
Hepatobiliary Pancreat Dis Int. 2007 Dec;6(6):596-9.
Viral hepatitis is one of the major causes of mortality and morbidity in developing countries. Hepatitis E virus (HEV) among the major etiological agents is responsible for both sporadic and epidemic outbreaks. The epidemic outbreak is water-borne whereas the sporadic outbreak is possibly through contact. Various diagnostic tools at times fail to pinpoint the cause of viral hepatitis. This study was carried out to evaluate the utility of ELISA and nested reverse transcriptase polymerase chain reaction (nRT-PCR) for the diagnosis of sporadic and acute viral hepatitis (AVH) caused by HEV in an endemic situation in North India.
Serum samples were collected from all the affected and suspected persons and subjected to serological detection of HAV IgM, HBsAg, HCV antibody and HEV IgM. The samples that were positive for HEV IgM were further processed for the detection of HEV RNA by nRT-PCR.
A total of 843 samples were collected from 685 patients with AVH, 70 patients with fulminant hepatic failure (FHF), 53 patients with chronic liver disease (CLD), 11 patients with antituberculosis therapy (ATT)-induced jaundice, and 24 pregnant women. The percentage of positivity for anti-HEV IgM was 58.3% in the pregnant women, 41.4% in the patients with FHF, 38.6% in the patients with AVH, 9.4% in the patients with CLD and 18.2% in the patients with ATT induced jaundice. 9.4% of HBsAg carriers were positive for anti-HEV IgM. Males outnumbered females (62.8% vs. 37.1%). Furthermore, the rates of fulminant and acute outbreaks of hepatitis with HEV RNA positivity were 41.4% and 9.4%, respectively.
Serological and molecular analysis should be combined for the diagnosis of viral infections, especially in endemic areas.
病毒性肝炎是发展中国家死亡和发病的主要原因之一。戊型肝炎病毒（HEV）是主要病原体之一，可导致散发性和流行性疫情爆发。流行性疫情爆发是经水传播的，而散发性疫情爆发可能是通过接触传播。各种诊断工具有时无法确定病毒性肝炎的病因。本研究旨在评估酶联免疫吸附测定（ELISA）和巢式逆转录聚合酶链反应（nRT-PCR）在印度北部地方性流行情况下诊断由HEV引起的散发性和急性病毒性肝炎（AVH）的效用。
从所有受影响和疑似患者中采集血清样本，进行甲型肝炎病毒IgM、乙肝表面抗原（HBsAg）、丙型肝炎病毒抗体和戊型肝炎病毒IgM的血清学检测。戊型肝炎病毒IgM呈阳性的样本进一步通过nRT-PCR检测戊型肝炎病毒RNA。
共从685例急性病毒性肝炎患者、70例暴发性肝衰竭（FHF）患者、53例慢性肝病（CLD）患者、11例抗结核治疗（ATT）引起黄疸的患者和24例孕妇中采集了843份样本。孕妇中抗戊型肝炎病毒IgM阳性率为58.3%，暴发性肝衰竭患者中为41.4%，急性病毒性肝炎患者中为38.6%，慢性肝病患者中为9.4%，抗结核治疗引起黄疸的患者中为18.2%。9.4%的乙肝表面抗原携带者抗戊型肝炎病毒IgM呈阳性。男性多于女性（62.8%对37.1%）。此外，戊型肝炎病毒RNA阳性的暴发性和急性肝炎发病率分别为41.4%和9.4%。
对于病毒感染的诊断，尤其是在地方性流行地区，应将血清学和分子分析相结合。
