Ðaković Rode O, Jemeršić L, Brnić D, Pandak N, Mikulić R, Begovac J, Vince A
University Hospital for Infectious Diseases, Mirogojska 8, 10000, Zagreb, Croatia,
Eur J Clin Microbiol Infect Dis. 2014 Dec;33(12):2231-6. doi: 10.1007/s10096-014-2187-7. Epub 2014 Jul 9.
We assessed hepatitis E virus (HEV) seroprevalence in patients with hepatic disorders as well as in human immunodeficiency virus (HIV)-infected patients and emphasised the issue of possible non-specific anti-HEV seroresponse and need for combining diagnostic methods for hepatitis E diagnosis. Over a two-year period, from March 2011 to February 2013, we determined anti-HEV immunoglobulin M (IgM) and IgG by enzyme immunoassays (EIA; Mikrogen, Germany) in 504 hepatitis patients negative for acute viral hepatitis A-C. Furthermore, 88 samples from randomly selected consecutive HIV-infected patients were also analysed. All EIA reactive samples were additionally tested by line immunoblot assays (LIA; Mikrogen, Germany). HEV nested reverse transcription polymerase chain reaction (RT-PCR) was carried out in 14 anti-HEV IgM LIA-positive patients. Anti-HEV IgM or IgG were detected in 16.9 % of patients by EIA and confirmed by LIA in 10.7 % [95 % confidence interval (CI) 8.3-13.7 %] of hepatitis patients. HEV RNA was detected in five patients. The agreement between EIA and LIA assessed by Cohen's kappa was 0.47 (95 % CI 0.55-0.75) for IgM and 0.83 (95 % CI 0.78-0.93) for IgG. Anti-HEV IgM and IgG seroprevalence in HIV-infected patients was 1.1 %, respectively. Our findings show a rather high HEV seroprevalence in patients with elevated liver enzymes in comparison to HIV-infected patients. Discordant findings by different methods stress the need to combine complementary methods and use a two-tier approach with prudent interpretation of reactive serological results for hepatitis E diagnosis.
我们评估了肝病患者以及人类免疫缺陷病毒（HIV）感染患者中戊型肝炎病毒（HEV）的血清流行率，并强调了可能存在的非特异性抗HEV血清反应问题以及联合使用诊断方法进行戊型肝炎诊断的必要性。在2011年3月至2013年2月的两年期间，我们采用酶免疫分析法（EIA；德国Mikrogen公司）对504例急性甲型至丙型病毒性肝炎检测呈阴性的肝炎患者进行了抗HEV免疫球蛋白M（IgM）和IgG检测。此外，还对随机选取的88例连续HIV感染患者的样本进行了分析。所有EIA反应性样本均进一步通过线性免疫印迹分析（LIA；德国Mikrogen公司）进行检测。对14例抗HEV IgM LIA阳性患者进行了HEV巢式逆转录聚合酶链反应（RT-PCR）检测。通过EIA在16.9%的患者中检测到抗HEV IgM或IgG，并经LIA在10.7%[95%置信区间（CI）8.3 - 13.7%]的肝炎患者中得到确认。在5例患者中检测到HEV RNA。通过Cohen's kappa评估，EIA与LIA在IgM方面的一致性为0.47（95% CI 0.55 - 0.75），在IgG方面为0.83（95% CI 0.78 - 0.93）。HIV感染患者中抗HEV IgM和IgG的血清流行率分别为1.1%。我们的研究结果显示，与HIV感染患者相比，肝酶升高患者中HEV的血清流行率相当高。不同方法得出的不一致结果强调了联合使用互补方法以及采用两层方法并谨慎解读反应性血清学结果以进行戊型肝炎诊断的必要性。
