Laboratory of Digestive and Liver Physiopathology, Department of Gastroenterology and Hepatology, San Giovanni Battista Hospital, Turin, Italy.
Semin Liver Dis. 2012 Aug;32(3):220-7. doi: 10.1055/s-0032-1323627. Epub 2012 Aug 29.
The first step in the diagnosis of hepatitis delta virus (HDV) infection is testing HBsAg-positive individuals for the antibody to the HD antigen (anti-HD).In anti-HD-positive patients, the next step is testing for HDV RNA in serum to determine whether the antibody reflects an ongoing active HDV infection (HDV-RNA-positive) or represents a serologic scar to past HDV infection (HDV-RNA-negative). In the HDV-positive individual with liver disease, it is critical to distinguish acute HDV/hepatitis B virus (HBV) coinfection from chronic HDV superinfection in HBsAg carriers; the course, prognosis, and management of the two conditions are different. The differential diagnosis can be achieved through the scrutiny of the battery of HDV and HBV markers, which combine in patterns characteristic for each condition.Standardized competitive and μ-capture commercial assays are available to determine the IgG and IgM antibody to HDV. Several in-house assays were developed to determine HDV RNA in serum; the sensitivity threshold of current polymerase chain reaction-based assays is 10 copies of HDV RNA/mL. Unfortunately, HDV-RNA assays are not yet standardized and the results from different laboratories often are not comparable due to different sensitivities. The development of an international reference HDV-RNA standard remains an unmet diagnostic need.
诊断丁型肝炎病毒 (HDV) 感染的第一步是检测 HBsAg 阳性个体的 HD 抗原抗体 (抗-HD)。在抗-HD 阳性患者中，下一步是检测血清中的 HDV RNA，以确定抗体是否反映持续的活动性 HDV 感染 (HDV-RNA 阳性) 或代表过去 HDV 感染的血清学痕迹 (HDV-RNA 阴性)。在患有肝病的 HDV 阳性个体中，区分急性 HDV/乙型肝炎病毒 (HBV) 合并感染和 HBsAg 携带者中的慢性 HDV 再感染至关重要；这两种情况的病程、预后和处理方式不同。通过仔细检查 HDV 和 HBV 标志物的组合，可以实现这两种情况的鉴别诊断，这些标志物的组合具有每种情况的特征模式。有标准化的竞争和 μ 捕获商业检测法可用于确定针对 HDV 的 IgG 和 IgM 抗体。已经开发了几种用于检测血清中 HDV RNA 的内部检测法；基于聚合酶链反应的当前检测法的灵敏度阈值为 10 拷贝/mL 的 HDV RNA。不幸的是，HDV-RNA 检测法尚未标准化，由于灵敏度不同，不同实验室的结果通常不可比。开发国际参考 HDV-RNA 标准仍然是一个未满足的诊断需求。
