Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
Eur J Gastroenterol Hepatol. 2013 Jun;25(6):665-8. doi: 10.1097/MEG.0b013e32835df262.
The diagnosis of acute hepatitis A virus (HAV) infection is made on the basis of the presence of anti-HAV immunoglobulin M (IgM) antibodies in patients with clinical features of acute hepatitis. Some patients show a negative serology at initial presentation, which may complicate the diagnosis of hepatitis A (HA). The aim of this study was to examine the characteristics of HA patients with an initially negative anti-HAV IgM test result.
Patients with symptomatic acute hepatitis who underwent IgM anti-HAV testing at a single center were enrolled consecutively, with tests repeated in patients with negative initial serology.
A total of 684 patients with acute hepatitis were tested, of whom 620 patients were initially or eventually diagnosed with HA. Anti-HAV IgM was initially negative in 67 of the 620 HA patients (10.9%), but was later confirmed by subsequent retests. These patients had on average a shorter time lapse from the onset of symptoms to the initial test, a higher rate of fever, and lower alanine aminotransferase and bilirubin levels compared with those with a positive initial serology. Cutoff index (COI) values of anti-HAV IgM were correlated positively with the duration of time from the onset of symptoms to the initial test. Fever, lower bilirubin levels, and higher COI values were predictive of seroconversion to anti-HAV positivity in patients with a negative initial serology.
Taking into account the window period of HAV infection, anti-HAV IgM tests should be repeated, particularly in patients with features of the initial phase of hepatitis and a high COI value of anti-HAV IgM.
急性甲型肝炎病毒 (HAV) 感染的诊断基于具有急性肝炎临床特征的患者中存在抗-HAV 免疫球蛋白 M (IgM) 抗体。一些患者在初次就诊时表现出阴性血清学结果，这可能使甲型肝炎 (HA) 的诊断复杂化。本研究旨在研究最初抗-HAV IgM 检测结果阴性的 HA 患者的特征。
连续纳入在一家中心接受 IgM 抗-HAV 检测的有症状急性肝炎患者，对初次血清学结果阴性的患者重复进行检测。
共检测了 684 例急性肝炎患者，其中 620 例最初或最终诊断为 HA。620 例 HA 患者中有 67 例（10.9%）最初抗-HAV IgM 检测结果为阴性，但随后的重复检测结果为阳性。与初次血清学结果阳性的患者相比，这些患者从症状发作到初次检测的时间间隔平均更短，发热率更高，丙氨酸氨基转移酶和胆红素水平更低。抗-HAV IgM 的临界指数 (COI) 值与从症状发作到初次检测的时间间隔呈正相关。发热、较低的胆红素水平和较高的 COI 值可预测初次血清学结果阴性的患者发生抗-HAV 阳性血清转化。
考虑到 HAV 感染的窗口期，应重复进行抗-HAV IgM 检测，特别是在具有肝炎初始阶段特征和较高抗-HAV IgM COI 值的患者中。
