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目的 了解一起戊型肝炎暴发的血清学特点。方法 对某单位在10 d内先后发病的5例急性黄疸性肝炎患者、在该单位食堂就餐的1 675人(暴发人群)及未就餐的邻近单位883人(对照人群)的血清在首发病例26 d后进行抗-HEV IgM和IgG检测,数据进行统计学分析。结果5例患者抗-HEV IgM和IgG均为阳性。暴发人群抗-HEV IgM和IgG的阳性率分别为8.7％和38.4％,而对照人群仅分别为0.1％和28.6％,差别均有非常显著意义。暴发人群145例抗-HEV IgM(+)中,ALT增高32例,明显高于IgM(-)及对照;而抗-HEV IgM(-)的ALT增高比例并不高于对照人群。4例患者系列血清检测见抗-HEV IgM逐渐下降,感染后4个月多数转阴,而IgG在感染后第2-3个月达高峰,随后缓慢下降。暴发人群中抗-HEV IgM(+)的IgG平均水平最高,IgM(-)而IgG(+)的IgC平均水平亦明显高于对照,提示暴发人群中既往感染者受到了免疫加强。暴发人群中抗-HEV IgM(+)者在性别及年龄组间差异无显著意义,但其中ALT增高男性的比例显著高于女性,而与年龄无关。结论 本次急性黄疸性肝炎的暴发由戊型肝炎病毒引起,与食源有关;抗-HEV IgM和IgG不仅可用于临床病例诊断,也可用于人群调查;感染危险性与年龄及性别无关,但男性ALT增高更常见。
Objective To understand the serological characteristics of hepatitis E outbreak. Methods A total of 5 cases of acute jaundice hepatitis patients with onset of disease within 10 days, 1 675 (outbreaks) and 883 non-dining neighboring units (control subjects) in the canteen were enrolled in this study. d after anti-HEV IgM and IgG detection, the data for statistical analysis. Results 5 patients were positive for anti-HEV IgM and IgG. The positive rates of anti-HEV IgM and IgG in outbreak were 8.7% and 38.4% respectively, while those in control group were only 0.1% and 28.6%, respectively. The differences were significant. Among the 145 outbreaks of anti-HEV IgM (+), ALT increased in 32 cases, which was significantly higher than that in IgM (-) and controls; however, the increase of ALT in anti-HEV IgM (-) was not higher than that in control subjects. Serum anti-HEV IgM levels were gradually decreased in 4 patients. Serum anti-HEV IgM gradually decreased after 4 months of infection, while IgG peaked at 2-3 months after infection, then decreased slowly. Outbreaks of anti-HEV IgM (+) in the highest average level of IgG, IgM (-) and IgG (+) of the average IgC was also significantly higher than the control, suggesting that the outbreak of previous infection in population were immunized. Outbreaks of anti-HEV IgM (+) in the gender and age groups no significant difference, but the proportion of ALT increased significantly higher in men than women, but not with age. Conclusions The outbreak of acute jaundice hepatitis is caused by hepatitis E virus, which is related to food sources. Anti-HEV IgM and IgG can be used not only for clinical diagnosis but also for population survey. The risk of infection is not related to age and sex but Increased ALT in men is more common.