CAJ | 학술논문

目的推算基因4型戊型肝炎患者发病后病毒血症的持续时间,为戊型肝炎流行病学传播研究提供基础数据,进而评价戊型肝炎患者在I临床症状期之后的潜在传染性.方法采集华东地区162份戊型肝炎住院患者入院后的首份血清.通过套式RT-PCR方法检测HEV RNA,采用生存分析中的乘积极限法(Kaplan-Meier法)估计患者发病后病毒血症的持续时间.结果 162份血清中101份检出HEV RNA,总检出率为62.35%,经同源性比较均为基因4型HEV.114例男性中检出74例,占64.91%,48例女性中检出27例,占56.25%,两者比较,差异无统计学意义(χ21.08,P=0.30).Kaplan-Meier法分析后发现,基因4型HEV病毒血症在患者发病后维持时间的中位数为24 d(95%CI:18～30 d),即50%的患者病毒血症可持续阳性直到发病后24 d.第75和25百分位数分别为14 d和31 d.男性与女性患者的病毒血症维持时间差异无统计学意义(Breslow检验P=0.98,Tarone-Ware检验P=0.91).结论基因4型戊型肝炎患者中75%的病毒血症可以持续到发病后的2周,部分戊型肝炎病毒血症可持续至1个月以上.提示即使患者临床症状和生化指标已转归正常,仍然存在病毒血症,可以成为传染源.
목적 추산기인4형무형간염환자발병후병독혈증적지속시간,위무형간염류행병학전파연구제공기출수거,진이평개무형간염환자재I림상증상기지후적잠재전염성.방법 채집화동지구162빈무형간염주원환자입원후적수빈혈청.통과투식RT-PCR방법검측HEV RNA,채용생존분석중적승적겁한법(Kaplan-Meier법)고계환자발병후병독혈증적지속시간.결과 162빈혈청중101빈검출HEV RNA,총검출솔위62.35%,경동원성비교균위기인4형HEV.114례남성중검출74례,점64.91%,48례녀성중검출27례,점56.25%,량자비교,차이무통계학의의(χ21.08,P=0.30).Kaplan-Meier법분석후발현,기인4형HEV병독혈증재환자발병후유지시간적중위수위24 d(95%CI:18～30 d),즉50%적환자병독혈증가지속양성직도발병후24 d.제75화25백분위수분별위14 d화31 d.남성여녀성환자적병독혈증유지시간차이무통계학의의(Breslow검험P=0.98,Tarone-Ware검험P=0.91).결론 기인4형무형간염환자중75%적병독혈증가이지속도발병후적2주,부분무형간염병독혈증가지속지1개월이상.제시즉사환자림상증상화생화지표이전귀정상,잉연존재병독혈증,가이성위전염원.
Objective To determine the persistence time of genotype 4 hepatitis E (HE) viremia after the onset of clinical symptoms in HE patients and provide essential data for study on HE epidemiologieal transmission, so that to evaluate potential contagiousness of HE patients after clinical stage. Methods The first serum samples from 162 HE patients after hospitalized in Eastern China were collected and tested for hepatitis E virus (HEV) RNA by nested reversed transcription- polymerase chain reaction (RT-PCR). The persistence time of HEV viremia after the onset of clinical symptoms was estimated with Kaplan-Meier survival analysis. Results HEV RNA was detectable in 101 out of 162 serum samples with positive rate of 62.35%, which was all grouped to genotype 4 by homology analysis. Furthermore, HEV RNA was detectable in 74 (64.91%) out of 114 male and 27 (56.25%) out of 48 female, which was not significantly different (χ2 = 1.08, P=0. 30). Kaplan-Meier survival analysis showed that the median persistence time of HEV genotype 4 viremia was 24 days after the onset of clinical symptoms (95% CI: 18-30 days), which meant that the viremia of 50% HE patients remaining detectable up to 24 days after the onset. The 75% and 25% percentiles were 14 days and 31 days, respectively. There was no significant difference of viremia persistence time between male and female (Breslow test: P=0.98, Tarone-Ware test: P=0.91). Conclusions The viremia of 75% patients with HEV genotype 4 infection could persistent until 2 weeks after the onset of clinical symptoms and that of some patients could persistent over 1 month. It is indicated that the viremia is still persistent and HE patient could be a reservoir even after the clinical symptoms disappeared and biochemical marks normalized.