Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron and Universitat Autonoma de Barcelona, Barcelona, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.
J Viral Hepat. 2020 Jul;27(7):747-753. doi: 10.1111/jvh.13285. Epub 2020 Mar 11.
Hepatitis E virus (HEV) is the leading cause of acute hepatitis worldwide. The minimum criterion for diagnosis of acute infection is detection of anti-HEV antibodies, although there are scant data on IgM duration. Our aim was to assess the persistence of HEV markers after acute self-limited hepatitis E. HEV serological tests (IgM by Mikrogen and Wantai and HEV-Ag) and HEV RNA were carried out in two cohorts: (a) patients with prior acute hepatitis E (ALT >10 x ULN plus positive IgM ± HEV RNA) currently self-limited and (b) 50 blood donors with positive HEV RNA. Among 25 cases of prior acute hepatitis E, after a median follow-up of 34 months, all presented undetectable HEV RNA. However, anti-HEV IgM remained detectable in 14 (56%) by Mikrogen, 6 (24%) by Wantai and none for HEV-Ag. Anti-HEV IgM tested positive in 80%-100% within the second year and 17%-42% over 3 years later, by Wantai and Mikrogen, respectively. Among HEV RNA-positive donors, 12 (25%) tested positive for either IgM by Mikrogen or Wantai, 9 (18%) for both and 18 (36%) for HEV-Ag. HEV-Ag positivity was more likely as HEV RNA was higher (14% if <2.2 log IU/mL; 64% if RNA ≥ 3.7). Overall, HEV-Ag performed best, with a positive predictive value of 100% and diagnostic accuracy of 57%. Anti-HEV IgM exhibited unexpectedly long persistence after a self-limited acute hepatitis E. HEV-Ag had the best performance and could be especially useful in settings where HEV RNA is not available.
戊型肝炎病毒（HEV）是全球急性肝炎的主要病因。急性感染的最低诊断标准是检测抗-HEV 抗体，尽管关于 IgM 持续时间的数据很少。我们的目的是评估急性自限性戊型肝炎后 HEV 标志物的持续存在。在两个队列中进行了 HEV 血清学检测（Mikrogen 和 Wantai 的 IgM 和 HEV-Ag）和 HEV RNA：（a）目前自限性的先前急性 HEV 患者（ALT >10 x ULN 加阳性 IgM ± HEV RNA）；（b）50 名阳性 HEV RNA 的献血者。在 25 例先前的急性 HEV 中，中位随访 34 个月后，所有患者的 HEV RNA 均无法检测到。然而，Mikrogen 检测到 14 例（56%）、Wantai 检测到 6 例（24%）的抗-HEV IgM 仍可检测到，而 HEV-Ag 则无。Wantai 和 Mikrogen 在第二年分别有 80%-100%和 17%-42%的患者抗-HEV IgM 检测阳性，3 年后。在 HEV RNA 阳性的供者中，Mikrogen 或 Wantai 检测到 12 例（25%）的 IgM 阳性，9 例（18%）两者均阳性，18 例（36%）HEV-Ag 阳性。HEV-Ag 阳性的可能性更大，HEV RNA 越高（如果 <2.2 log IU/mL，则为 14%；如果 RNA ≥ 3.7，则为 64%）。总体而言，HEV-Ag 表现最佳，阳性预测值为 100%，诊断准确性为 57%。抗-HEV IgM 在急性自限性戊型肝炎后表现出异常持久的存在。HEV-Ag 性能最佳，在无法获得 HEV RNA 的情况下特别有用。
