【摘要】 目的　探讨抗戊型肝炎病毒（ＨＥＶ） ＩｇＧ和ＩｇＭ 抗体对诊断急性戊型肝炎（ＨＥ） 的意义。方法　应用酶联免疫法（ＥＩＡ） 检测我国７ 个城市共计１４３ 例散发性ＨＥ病人急性期血清和其中５６ 例病人的３５９ 份系列血清，以及４ 只实验感染ＨＥＶ猕猴的６８ 份系列血清的抗ＨＥＶＩｇＭ 和ＩｇＧ。结果　７个城市１４３ 例散发性ＨＥ 病人急性期血清抗ＨＥＶＩｇＧ 阳性率为１００ ．０％ ，明显高于抗ＨＥＶＩｇＭ（７３－４％ ） 。９７．２％ （１３９／１４３） 的急性ＨＥ 病人的血清抗ＨＥＶＩｇＧ 滴度≥１：４０；抗ＨＥＶＩｇＭ 检出率随抗ＨＥＶＩｇＧ 滴度增高而上升；未见单独抗ＨＥＶＩｇＭ 阳性者。抗ＨＥＶＩｇＧ于发病第２ 天即阳转，至病后１ 个月抗ＨＥＶＩｇＧ 累计阳转率为１００％ ；然后随病程延长该抗体的阴转率升高，至发病后６ 个月４３－３％ 病人抗ＨＥＶＩｇＧ 阴转。抗ＨＥＶＩｇＭ 虽也阳转较早，但于发病后１ 个月累计阳转率仅为７１．４ ％（４０／５６），且持续时间较短，至发病后１ 个月，３７．５％ 病人阴转。４ 只实验感染的猕猴抗ＨＥＶＩｇＧ 和抗ＨＥＶＩｇＭ 动态变化与急性ＨＥ病人类似。结论　抗ＨＥＶＩｇＭ 虽然对更多还原

【Abstract】 Objective To evaluate the significance of hepatitis E virus antibody (anti HEV) IgG and IgM for the diagnosis of acute hepatitis E. Methods Acute phase sera from a total of 143 patients with sporadic hepatitis E in 7 cities of China were determined for anti HEV IgM and IgG by using an enzyme linked immunosorbent assay (EIA). 359 serial sera of 56 patients with hepatitis E and 68 serial sera of 4 rhesus macaques experimentally infected with hepatitis E virus (HEV) were also detected for anti HEV IgG and IgM. Results In the 143 patients the positive rate of anti HEV IgG was 100.0%, which was significantly higher than that of anti HEV IgM (73.4%, 105/143). 97 2% of anti HEV IgG positive patients had a titer over 1:40. The positive rate of anti HEV IgM increased with the titer of anti HEV IgG in sera. It was 0%(0/4), 44.4%(8/18) and 80.2%(97/121), respectively in patients with the anti HEV IgG titer of 1∶20, 1∶40 and ≥1∶80 ( P <0.001). All the anti HEV IgM positive patients were also anti HEV IgG positive. No patients were found to be anti HEV IgM positive alone. Anti HEV IgG was detected as early as 2 days after onset of the disease, with a cumulative positive seroconversion rate of 100% by 1 month. The negative seroconversion rate of anti HEV IgG increased with course of the disease and 43.3% of the patients lost their anti HEV IgG by 6 months after illness. Though anti HEV IgM also seroconverted at the same time as anti HEV IgG, its cumulative positive seroconversion rate was only 71.4% and declined rapidly. Up to 37.5% of anti HEV IgM positive patients became negative by 1 month after onset. Similar antibody responses were observed in 4 rhesus macaques experimentally infected with HEV. Conclusion It is suggested that as a result of the poor sensitivity of currently available anti HEV IgM EIA kits, anti HEV IgG will be a more reliable marker for the diagnosis of acute hepatitis E as compared with anti HEV IgM.更多还原