Anastasiou Olympia E, Thodou Viktoria, Berger Annemarie, Wedemeyer Heiner, Ciesek Sandra
Institute of Virology, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany.
Department of Gastroenterology and Hepatology, University Hospital of Essen, 45147 Essen, Germany.
Pathogens. 2020 Feb 19;9(2):137. doi: 10.3390/pathogens9020137.
Reliable and cost-effective diagnostics for hepatitis E virus (HEV) infection are necessary. The aim of our study was to investigate which diagnostic test is most accurate to detect HEV infection in immunocompetent and immunosuppressed patients in a real world setting.
We performed a retrospective analysis of 1165 patients tested for HEV antibodies and HEV PCR at the same time point. Clinical, laboratory and virological data were taken from patient charts. HEV IgA was measured in a subgroup of 185 patients.
HEV RNA was detectable in 61 patients (5.2%); most of them (n = 49, 80.3%/n = 43, 70.5%) were HEV IgM+ and IgG+; however, 12 patients (19.6%) were HEV RNA positive/HEV IgM negative and 17 patients (27.8%) were HEV RNA positive/HEV IgG negative. Ten HEV RNA positive patients (16.4%) had neither HEV IgG nor IgM antibodies. Importantly, all of them were immunosuppressed. HEV IgA testing was less sensitive than HEV IgM for HEV diagnosis.
HEV infection can be overlooked in patients without HEV specific antibodies. Performing PCR is necessary to diagnose or exclude HEV infection in immunocompromised hosts. In immunocompetent patients, a screening based on HEV antibodies (IgG/IgM) is sufficient.
戊型肝炎病毒（HEV）感染需要可靠且经济高效的诊断方法。我们研究的目的是调查在现实环境中，哪种诊断测试对于检测免疫功能正常和免疫抑制患者的HEV感染最为准确。
我们对1165例同时进行HEV抗体和HEV PCR检测的患者进行了回顾性分析。临床、实验室和病毒学数据均取自患者病历。对185例患者的亚组进行了HEV IgA检测。
61例患者（5.2%）可检测到HEV RNA；其中大多数（n = 49，80.3%/n = 43，70.5%）HEV IgM和IgG均为阳性；然而，12例患者（19.6%）HEV RNA阳性但HEV IgM阴性，17例患者（27.8%）HEV RNA阳性但HEV IgG阴性。10例HEV RNA阳性患者（16.4%）既没有HEV IgG也没有IgM抗体。重要的是，他们均为免疫抑制患者。HEV IgA检测对HEV诊断的敏感性低于HEV IgM。
没有HEV特异性抗体的患者可能会漏诊HEV感染。对于免疫功能低下的宿主，进行PCR检测对于诊断或排除HEV感染是必要的。对于免疫功能正常的患者，基于HEV抗体（IgG/IgM）的筛查就足够了。
