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选择最适当的 HDV 感染的试验,对其解释需要对临床背景有清楚了解,尤其疑及急、慢性 HDV 感染时。对疑似急性 HDV 共同感染病例,应送验总抗-HD 和抗-HD IgM。此外,在感染早期,可应用 EIA 检测 HDAg,这种病人血清中也应有抗-HBcIgM。HDV 重叠感染较易被认识,多数病人抗-HD IgM 及总抗-HD滴度升高。因这种感染发生在慢性 HBV 感染的基础上,故抗 HBc IgM 在血清中缺如。慢性 HDV 感染最易诊断,因为这些病人血清中有高滴度的抗-HD。诊断可由免疫染色显示肝内 HDAg 的存在而证实。血清中 HDV RNA 的检测,可能是进行性HDV 感染最敏感的方法,该试验除研究实验室应用外,临床尚不普及。因此,这一技术仅用于常规检测不能证实诊断的病人。此外,检测血清中 HDV RNA 可能是监察治疗和明确该病自然史的有用工具。免疫印迹法检测 HDV抗原血症在临床实践中显然有诊断价值。
The choice of the most appropriate test for HDV infection requires a clear understanding of the clinical setting, especially when it comes to acute and chronic HDV infections. For cases of suspected co-infection with acute HDV, total anti-HD and anti-HD IgM should be sent. In addition, EIA may be used to detect HDAg early in the infection, and anti-HBcIgM should also be present in the patient’s serum. HDV overlap infection is more easily recognized, and most patients have increased anti-HD IgM and total anti-HD titers. Because this infection occurs on the basis of chronic HBV infection, anti-HBc IgM is absent in serum. Chronic HDV infections are most easily diagnosed because of the high titer of anti-HD in these patients’ sera. Diagnosis can be confirmed by immunostaining for the presence of intrahepatic HDAg. Detection of HDV RNA in serum may be the most sensitive method of progressive HDV infection, which is not yet clinically popular except for laboratory applications. Therefore, this technique is only used for routine tests that do not confirm the diagnosis. In addition, detecting HDV RNA in serum may be a useful tool to monitor treatment and to clarify the natural history of the disease. Western blot detection of HDV antigenemia in clinical practice is clearly diagnostic value.