[背景]戊型肝炎病毒(hepatitis E virus,HEV),是全球范围内病毒性肝炎重要病原体之一.HEV感染可以导致急性、慢性戊型肝炎以及许多肝外症状.研究者们开发了 HEV RNA、HEV抗原、HEV IgM和HEV IgG等多种实验室检测方法用于诊断HEV感染.[进展]不同HEV指标都有其独特的诊断价值,尤其是HEV抗原.HEV抗原检测的主要靶标为分泌型HEV抗原,而非传统的病毒衣壳蛋白.HEV抗原检测可用于急性与慢性HEV感染的检测,也可用于HEV感染后临床结局的预测以及区分急性与慢性HEV感染,尿液HEV抗原检测为HEV感染提供了一种无创的检测方式.HEV RNA检测在急性与慢性HEV感染以及出现肝外症状的人群中都具有重要的价值,被认为是HEV感染诊断的金标准.HEV IgM和HEV IgG分别是HEV近期感染和既往感染指标,持续时间较长,对HEV现症感染的指示较弱.[展望]随着检测技术的进步和检测新靶标的发现,HEV RNA和抗原作为现症感染的指标越来越受到重视,而HEV IgM和IgG血清学检测作为间接检测指标由于较成熟,商品化试剂较丰富,目前依然在临床检测中广泛使用.了解HEV感染的实验室诊断研究现状和发展动态,可为临床中HEV感染的诊断提供思路和参考.
Research progress in laboratory diagnosis of hepatitis E virus infection
[Objective]Hepatitis E virus(HEV)is one of the important pathogens of viral hepatitis worldwide,responsible for about half of acute viral hepatitis cases in some developing countries.HEV is the leading cause of acute viral hepatitis in China.In elderly people,pregnant women,and patients with leukemia and chronic liver disease,HEV may develop into fulminant liver failure.Patients with chronic liver disease and overlapping HEV infections are prone to liver decompensation and have a poor prognosis.In patients with chronic hepatitis B,especially those with chronic hepatitis B cirrhosis,overlapping HEV infection significantly increases the risk of death.The mortality rate among pregnant women infected with HEV is as high as 30％,and their fetuses are prone to adverse outcomes such as premature birth,low birth weight,miscarriage,and stillbirth.At present,researchers have developed various laboratory testing methods for diagnosis of HEV infection,divided into direct detection and indirect detection.The former includes immunoelectron microscopy observation,HEV RNA detection,and HEV antigen detection,while the latter includes HEV antibody(HEV IgM,HEV IgG and HEV IgA)detection and cellular immune response detection.[Progress]Immunoelectron microscopy plays a crucial role in the early detection and identification of HEV virus,but requires specialized instruments and equipment,making it unsuitable for current routine clinical diagnosis and limited to only laboratory research.HEV RNA detection is valuable in both acute and chronic HEV infections,as well as in populations with extrahepatic symptoms,and is considered the gold standard for the diagnosis of HEV infection.In recent years,HEV antigen detection methods have made many new advances,ranging from the identification of new targets to the discovery of their clinical applications.Researchers have found that the main target for HEV antigen detection is the free secretory protein pORF2s,which is the main form of HEV antigen in serum and is independent of the virus genome and particles,making HEV antigen an independent diagnostic indicator of HEV RNA.HEV antigen detection can be used for the detection of acute and chronic HEV infections,as well as for predicting clinical outcomes after HEV infection and distinguishing between acute and chronic HEV infections.Furthermore,researchers have found that HEV antigens accumulate in the kidneys and are eliminated in urine,allowing for the detection of high levels of HEV antigens in the urine of patients.Urine HEV antigen detection provides a non-invasive detection method for HEV infection diagnosis.Indirect detection methods for HEV include antibody testing and cellular immune testing.Antibody testing,which mainly involves HEV IgM and HEV IgG,is the most commonly used.These antibodies serve as indicators of recent and past HEV infections,respectively,and have a longer duration and weaker indication of current HEV infections.In immunosuppressed populations and some immunocompetent populations,HEV antibodies may be delayed or undetectable.Although there are currently various commercialized HEV IgM and HEV IgG antibody detection reagents,the detection performance of different reagents varies greatly,and their detection consistency is often inadequate.[Perspective]Different HEV indicators have their unique diagnostic values.HEV IgM and IgG serological testing,as indirect detection indicators,are still widely used in clinical testing due to their maturity and abundant commercial reagents.With the advancement of detection technology and the discovery of new targets,HEV RNA and antigens as indicators of current infections are gaining increased attention.Especially in recent years,the detection of HEV is becoming more recognized with the discovery of new targets and sample types,providing sensitive and convenient methods for HEV diagnosis.Urine HEV antigen detection provides a non-invasive detection method for HEV infection diagnosis,facilitating subsequent HEV detection and screening in a wider population.This article reviews the research and development trends in the laboratory diagnosis of HEV infection,providing insights and references for the diagnosis of HEV infection in clinical practice.
hepatitis E virus(HEV)diagnosisHEV antigenHEV antibodyHEV RNA
万方数据
维普
