National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiamen, China.
PLoS One. 2010 Oct 21;5(10):e13560. doi: 10.1371/journal.pone.0013560.
Laboratory diagnosis of acute infection of hepatitis E virus (HEV) is commonly based on the detection of HEV RNA, IgM and/or rising IgG levels. However, the profile of these markers when the patients present have not been well determined. To clarify the extent of misdiagnosed sporadic hepatitis E in the initial laboratory detection, serial sera of 271 sporadic acute hepatitis cases were collected, detected and the dynamics of each acute marker during the illness course were analyzed. 91 confirmed cases of hepatitis E were identified based on the presentation of HEV RNA, IgM or at least 4 fold rising of IgG levels. 21 (23.1%) hepatitis E cases were false negative for the viral RNA and 40 (44.0%) for rising IgG, because occurrence of these markers were confined to acute phase of infection and viremia had already subsided and antibody level peaked when these patients presented. IgM was detected in 82 (90.1%) cases. It is the most prevalent of the three markers, because the antibody persisted until early convalescence. Nine cases negative for IgM were positive for rising IgG and one was also positive for the viral RNA; all of these nine cases showed high avid IgG in their acute phase sera, which indicated re-infection. In summary, it is not practicable to determine the true occurrence of sporadic hepatitis E. Nevertheless, it could be closely approximated by approach using a combination of all three acute markers.
实验室诊断急性戊型肝炎病毒（HEV）感染通常基于 HEV RNA、IgM 和/或 IgG 水平的检测。然而，当患者出现这些标志物时，其特征尚未得到很好的确定。为了明确在初始实验室检测中误诊散发性戊型肝炎的程度，我们收集了 271 例散发性急性肝炎病例的连续血清，进行了检测，并分析了疾病过程中每种急性标志物的动态变化。根据 HEV RNA、IgM 或至少 4 倍 IgG 水平升高的表现，确定了 91 例确诊的戊型肝炎病例。21 例（23.1%）戊型肝炎病例的病毒 RNA 检测呈假阴性，40 例（44.0%）的 IgG 水平升高呈假阴性，因为这些标志物的出现仅限于感染的急性期，当这些患者就诊时，病毒血症已经消退，抗体水平达到峰值。82 例（90.1%）病例检测到 IgM。它是三种标志物中最常见的一种，因为抗体一直持续到早期恢复期。9 例 IgM 阴性的病例 IgG 水平升高，1 例病毒 RNA 也呈阳性；这 9 例病例在急性血清中均表现出高亲和力 IgG，表明再次感染。综上所述，确定散发性戊型肝炎的真实发生情况是不可行的。然而，通过使用所有三种急性标志物的组合进行综合分析，可以接近真实情况。
