病毒性肝炎HAV，HBV，HCV，HDV和HEV重叠感染的研究

采用ＥＬＩＳＡ法检测了１０８例乙型肝炎病毒（ＨＢＶ）感染者血清中的五种肝炎病毒──甲型（ＨＡＶ）、乙型（ＨＢＶ）、丙型（ＨＣＶ）、丁型（ＨＤＶ）和成型（ＨＥＶ）肝炎病毒的标志物,并采用ＰＣＲ技术检测了患者血清ＨＢＶＤＮＡ、ＨＣＶＲＮＡ及ＨＤＶＲＮＡ。结果五种肝炎病毒重叠感染者３５例（３２．４％）,单纯ＨＢＶ感染者７３例（６７．６％）。ＨＢＶ、ＨＡＶＭ重感染率为４．６％,ＨＢＶ、ＨＣＶ二重感染率为９．２％,ＨＢＶ、ＨＤＶＭ重感染率为１４．８％,ＨＢＶ、ＨＥＶ二重感染率为１．９％,ＨＢＶ、ＨＣＶ和ＨＤＶ三重感     

乙型肝炎病人重叠感染丙型肝炎的评价

应用ＥＬＩＳＡ和ＰＣＲ法检测５０２例乙肝病人血清,４０１例ＨＢｓＡｇ阳性血清中,有１１４例（２８．４％）抗－ＨＣＶ和ＨＣＶＲＮＡ双项阳性,２５例（６．２％）ＨＣＶＲＮＡ单项阳性;２１例（５．２％）抗－ＨＣＶ单项阳性。将ＨＢｓＡｇ乙肝病人分成ＨＢＶＤＮＡ,ＨＢｅＡｇ阳性组和ＨＢＶＤＮＡ,ＨＢｅＡｇ阴性组。前者抗－ＨＣＶ阳性率为１１．６％～２０．５％,ＨＣＶＲＮＡ阳性率为１６．２％～２０．５％。后者抗－ＨＣＶ阳性率为２０．２％～５５．６％,ＨＣＶＲＮＡ阳性率为２３％～６０．３％。结果说明长期携带ＨＢＶ者和慢性乙肝病人均可重叠ＨＣＶ感染。ＨＢＶＤＮＡ阳性组抗－ＨＣＶ和ＨＣＶＲＮＡ阳性率明显高于ＨＢＶＤＮＡ阳性组     

HBsAg携带者重叠感染HCV、HDV的血清学调查

对３６２名无症状高滴度ＨＢｓＡｇ携带者用ＲＩＡ法检测ＨＢｅＡｇ、Ａｎｔｉ－ＨＢｅ、Ａｎｔｉ－ＨＣＶ、Ａｎｔｉ－ＨＤＶ。结果表明,ＨＢｅＡｇ阳性率随ＨＢｓＡｇ滴度的增高而增加,且有显著性差异（Ｐ＜０．０５）。重叠感染以ＨＢＶ＋ＨＣＶ最高,占２７．６％;其次是ＨＢＶ＋ＨＤＶ,占９．１％;ＨＢＶ＋ＨＣＶ＋ＨＤＶ最少,占６．４％。但是,以上重叠感染率均与ＨＢｓＡｇ滴度及／或ＨＢｅＡｇ阳性率高低无关（Ｐ＞０．０５）。调查显示,无症状ＨＢｓＡｇ携带者中ＨＢＶ＋ＨＣＶ,或ＨＢＶ＋ＨＤＶ,或ＨＢＶ＋ＨＣＶ＋ＨＤＶ的重叠感染均可发生。     

两例丙型肝炎病毒(HCV)和乙型肝炎病毒(HBV)重叠感染者的HCV核心区cDNA序列分析

从临床肝病患者中选择两例ＨＣＶ和ＨＢＶ重叠感染者ＨＳＱ和ＳＺＨ,他们血清中的生化指标丙氨酸转氨酶（ＡＬＴ）持续异常,肝活检病理示有严重的肝损伤。在ＡＬＴ异常期,血清学检测结果为ＨＢｓＡｇ、ＨＢｅＡｇ阳性,抗ＨＣＶＩｇＧ（包括Ｃ２２、Ｃ３３ｃ）阴性,但套式ＰＣＲ检测ＨＣＶＲＮＡ阳性,核心区ｃＤＮＡ序列分析发现该区有１个密码子（ＧＧＣｎｔ３８５—３８７）缺失,对应缺失的氨基酸是甘氨酸（ＧＬＹ）,从血清学检测和序列分析结果推测,在ＨＣＶ和ＨＢＶ重叠感染中,ＨＢＶ和ＨＣＶ均可处于持续复制状态,抗ＨＣＶＩｇＧ抗体阴性可能是ＨＣＶ的多蛋白前体翻译和病毒颗粒装配受到ＨＢＶ干扰的结果。     

逆转录-聚合酶链反应技术诊断丙型肝炎病毒感染

本文采用逆转录－聚合酶链反应（ＲＴ-ＰＣＲ）技术对２１２例住院及门诊病人其中肝病患者９８例（慢性肝炎４３例、肝炎后肝硬化４７例、原发性肝细胞癌８例）进行ＨＣＶ－ＲＮＡ检测。结果９８例慢性肝病患者血清中ＨＣＶ-ＲＮＡ-ＰＣＲ阳性２７例（２７．６％）,１１４例非肝病患者血清中ＨＣＶ-ＲＮＡ-ＰＣＲ阳性９例（７．９％）,两组间差异非常显著（Ｐ（０．０１）,各种肝病患者的ＨＣＶ-ＲＮＡ-ＰＣＲ阳性率均高于非肝病组。６８例患者同时进行了ＨＣＶ-ＲＮＡ-ＰＣＲ检测和抗－ＨＣＶ检测,２５例抗－ＨＣＶ阳性的患者中ＨＣＶ－ＲＮＡ-ＰＣＲ,２１例阳性（８４％）,４３例抗－ＨＣＶ阴性的患者中ＨＣＶ-ＲＮＡ-ＰＣＲ,９例阳性（２０．１％）、有输血及血制品史者４８例,其中ＨＣＶ-ＲＮＡ-ＰＣＲ阳性１６例（３３．３％）,１６４倒无输血史者中ＨＣＶ-ＲＮＡ-ＰＣＲ阳性２０例（１２．２％）,两组间差异非常显著（Ｐ（０．０１）。结果表明：１．ＨＣＶ感染与慢性肝病有密切联系,说明ＨＣＶ感染是慢性肝炎、肝硬化、肝癌的致病因素;２．ＨＣＶ-ＰＣＲ法具有特异性好、灵敏度高、简便快速等特点,弥补了抗－ＨＣＶ检测的不足之处,是目前确定ＨＣＶ感染的主要手段;３．ＨＣＶ感染与输血关系密切,因此对献血员进行常规ＨＣＶ检测对预防由输血所致ＨＣＶ感染有着极其重要的临床意义。     

中国河南株丁型肝炎病毒全基因组的cDNA克隆和序列分析

从我国河南－抗丁型肝炎病毒抗原（ａｎｔｉ－ＨＤＡｇ）及丁型肝炎病毒（ＨＤｖ）ＲＮＡ双阳性的ＨＢｓＡｇ携带者血清中提取ＲＮＡ,采用人工合成的引物进行逆转录和聚合酶链反应（ＰＣＲ）,获得了贯穿ＨＤＶ全基因组的６个相互重叠的ｃＤＮＡ片段。经双脱氧末端终止法进行核苷酸序列分析,得到了长度为１６７４ｂｐ的我国人河南株ＨＤＶｃＤＮＡ全序列。计算机分析表明,该株与我国台湾株（ＨＤＶＩＡ型）、美国－１株（ＨＤＶＩＢ型）、日本－１株（ＨＤＶⅡ型）和秘鲁－１株（ＨＤＶⅢ型）的核苷酸同源性分别为的９４．３％、８６．８％、７５．４％和６６．３％,氨基酸序列的同源性分别为８９．７％、８５．１％、７１．９％和６４．６％,并在核苷酸和推导的ＨＤＡｇ氨基酸序列中分别发现了５个和２个集中保守的区域。这些区域均与ＨＤＶ的某些重要功能密切相关。     

丁型肝炎病毒基因组和抗原研究进展

丁型肝炎病毒（ＨＤＶ）属于缺陷性ＲＮＡ病毒。ＨＤＶ ＲＮＡ是由单链基因组ＲＮＡ和互补的反基因组ＲＮＡ组成的闭合环状分子,具有酶活性,能自身催化断裂,进行滚环式复制。反基因组上的可读框编码大小两种抗原。ＨＤＶ的装配需要乙型肝炎病毒（ＨＢＶ）的帮助,其包膜是ＨＢＶ表面抗原。ＨＤＶ感染者可同时有ＨＢＶ感染,这种双重感染可加重肝脏损害和病情。     

中国五省市甲型肝炎病毒基因分型的研究

为了解甲型肝炎（甲肝）病毒（ＨＡＶ）在中国几个城市的基因型分布,选择浙江杭州、江苏启东、安徽铜陵、云南昆明和上海市等的甲肝病人粪便标本或血清标本,以逆转录－套式聚合酶链反应（ＲＴ－ｎＰＣＲ）扩增合成ＨＡＶ ＶＰ１／２Ａ交接区基因区,并进行直接核苷酸序列分析和差异比较。结果表明,从这些城市甲肝病人分离到的１７株ＨＡＶ株均属基因Ⅰ型,为ＩＡ和ＩＢ亚型;所有ＨＡＶ株间核苷酸差异均小于１５％,但约５０％Ｈ     

用人工合成的丁型肝炎病毒抗原多肽检测丁肝病毒IgM抗体及其初步应用

用人工合成的丁型肝炎病毒抗原（ＨＤＶ－Ａｇ）肽建立了检测抗ＨＤＶ－ＩｇＭ抗体的ＥＬＩＳＡ方法,本法操作简便、快速,重复性好,特异性强,与抗ＨＡＶ－ＩｇＭ、抗Ｈｋ－ＩｇＭ、抗ＨＢｓ－ＩｇＭ、抗ＨＣＶ－ＩｇＩ、抗ＣＭＶ－ＩｇＭ、抗ＲＶ－ＩｇＭ、类风湿因子（ＲＦ）及抗核抗体（ＡＮＡ）阳性血清均不起反应,且可被２－巯基乙醇阻断而不起反应。经初步临床应用,３１例正常人血清抗ＨＤＶ－ＩｇＭ全部阴性,２８例慢活肝患者检出率为３２．１％（９／２８）,１７例慢迁肝患者血清阳性率为１１．８％（２／１７）１８例肝癌和肝硬化病人血清阳性率为２２．２％（４／１８）这三组病人与正常对照者相比较均有显著性差异（Ｐ＜０．００１）。此外,抗ＨＤＶ－ＩｇＭ阳性血清的ＡＬＴ值均明显高于正常参考范围,提示在ＨＤＶ感染过程中,患者肝细胞进一步受损。实验结果证明,抗ＨＤＶ－ＩｇＭ是诊断ＨＤＶ感染的重要指标,对ＨＤＶ感染早期诊断具有重要价值。     

抗原捕获聚合酶链式反应（AC－PCR）直接分型检测单纯疱疹病毒

用抗单纯疱疹病毒（ＨＳＶ）型共同性ｇＣ和ｇＤ羊克隆抗体（ＭｃＡｂ）,包被即Ｅｐｐｅｎｄｏｒｆ管,捕捉ＨＳＶ,同时加入３个引物：一个是ＨＳＶ─１／ＨＳＶ─２型共同性上游引物,另两个分别是ＨＳＶ─１和ＨＳＶ─２型特异性下游引物。借此建立了能直接分型检测ＨＳＶ的抗原捕获聚合酶链式反应（ＡＣ─ＰＣＲ）。ＨＳＶ─１的扩增产物为４７７ｂｐ,ＨＳＶ─２的为３９９ｂｐ两型病毒经ＡＣ─ＰＣＲ扩增后产生分子量不同的ＤＮＡ片段,致使ＡＣ─ＰＣＲ能直接分型检测ＨＳＶ。ＨＳＶ─１和ＨＳＶ─２扩增产物的克隆和序列分析表明,本方法特异性好。用本法检测Ｂａｌｂ／ｃ幼鼠中枢神经系统ＨＳＶ感染的脑标本,进一步证实本方法不仅敏感、特异,而且分型准确。     

A comparison of RT-PCR-based assays for the detection of HAV from shellfish

The hepatitis A virus (HAV) is the most common cause of viral infection linked to shellfish consumption. The lack of correlation between the fecal coliform indicators and the presence of enteric viruses in shellfish and their harvesting waters points to the need for molecular methods to detect viruses. We compared two RT-PCR based techniques currently available for the detection of the hepatitis A virus (HAV) in shellfish. Both approaches involve extraction of viral particles by glycine buffer and concentration of virus particles by one or two PEG precipitation steps. One procedure involves as RNA extraction method the use of oligo (dT) cellulose to select poly (A) RNA, and the other uses a system in which total RNA is bound on silica membrane. Comparison of the two RT-PCR based methods highlighted the efficiency of the first approach which is less time-consuming and technically demanding than the second.     

Concentration and detection of hepatitis A virus and rotavirus from shellfish by hybridization tests.

A modified polyethylene glycol precipitation method for concentration of virus followed by a new method to recover nucleic acid was used to detect hepatitis A virus (HAV) and rotavirus (SA11) in shellfish (oysters and hard-shell clams) by hybridization tests. Infectious virus, seeded into relatively large quantities of shellfish, was recovered consistently, with greater than 90% efficiency as measured by either in situ hybridization (HAV) or plaque assay (rotavirus SA11). Viral nucleic acid for dot blot hybridization assays was extracted and purified from virus-containing polyethylene glycol concentrates. Separation of shellfish polysaccharides from nucleic acid was necessary before viral RNA could be detected by dot blot hybridization. Removal of shellfish polysaccharides was accomplished by using the cationic detergent cetyltrimethylammonium bromide (CTAB). Use of CTAB reduced background interference with hybridization signals, which resulted in increased hybridization test sensitivity. After polysaccharide removal, dot blot hybridization assays could detect approximately 10(6) physical particles (corresponding to approximately 10(3) infectious particles) of HAV and 10(4) PFU of SA11 rotavirus present in 20-g samples of oyster and clam meats. These studies show continuing promise for the development of uniform methods to directly detect human viral pathogens in different types of shellfish. However, practical applications of such methods to detect noncultivatable human viral pathogens of public health interest will require additional improvements in test sensitivity.     

Concentration and detection of hepatitis A virus and rotavirus from shellfish by hybridization tests.

A modified polyethylene glycol precipitation method for concentration of virus followed by a new method to recover nucleic acid was used to detect hepatitis A virus (HAV) and rotavirus (SA11) in shellfish (oysters and hard-shell clams) by hybridization tests. Infectious virus, seeded into relatively large quantities of shellfish, was recovered consistently, with greater than 90% efficiency as measured by either in situ hybridization (HAV) or plaque assay (rotavirus SA11). Viral nucleic acid for dot blot hybridization assays was extracted and purified from virus-containing polyethylene glycol concentrates. Separation of shellfish polysaccharides from nucleic acid was necessary before viral RNA could be detected by dot blot hybridization. Removal of shellfish polysaccharides was accomplished by using the cationic detergent cetyltrimethylammonium bromide (CTAB). Use of CTAB reduced background interference with hybridization signals, which resulted in increased hybridization test sensitivity. After polysaccharide removal, dot blot hybridization assays could detect approximately 10(6) physical particles (corresponding to approximately 10(3) infectious particles) of HAV and 10(4) PFU of SA11 rotavirus present in 20-g samples of oyster and clam meats. These studies show continuing promise for the development of uniform methods to directly detect human viral pathogens in different types of shellfish. However, practical applications of such methods to detect noncultivatable human viral pathogens of public health interest will require additional improvements in test sensitivity.     

Use of genomic probes to detect hepatitis A virus and enterovirus RNAs in wild shellfish and relationship of viral contamination to bacterial contamination.

Genomic probes were used to investigate hepatitis A virus (HAV) and enterovirus RNAs in two types of shellfish from natural beds (Atlantic coast, France). After elution concentration, nucleic acid extracted by proteinase K and purified by phenol-chloroform and ethanol precipitation was assayed by dot blot hybridization. The probes used were a specific HAV probe corresponding to the 3' end (3D polymerase coding region) and an enterovirus probe corresponding to the 5' noncoding region. The method was first tested under experimental conditions by using virus-spiked shellfish before being applied under field conditions. Our results show that shellfish were highly contaminated: enterovirus and HAV RNAs were found in 63 and 67%, respectively, of samples examined with the riboprobes. On the same site, viral (HAV and enterovirus) RNAs were found in a larger fraction of cockles than mussels. Statistical tests of dependence showed no relationship between viral contamination and bacterial contamination (evaluated by fecal coliform counts).     

Hepatitis A virus strains identified in jogaejeot associated with outbreaks in Seoul,South Korea

Jogaejeot, seasoned Venerupis philippinarum, is a traditional Korean fermented food, and hepatitis A virus (HAV) can be transmitted through contaminated food, especially bivalve shellfish, causing acute gastroenteritis worldwide. Here, we carried out a phylogenetic analysis to identify and characterize HAV strains in jogaejeot samples associated with hepatitis A (HA) outbreaks in Seoul, South Korea, in 2019. The HAV strains were identified using blast and molecular analysis of the amplified HAV VP1-P2B genome region. The HAV strains identified in the five jogaejeot samples shared at least 99% sequence identity, were all classified as genotype IA and were most closely related to strains that are widespread in East Asia. These results support a link between the consumption of jogaejeot and the HA outbreaks observed in 2019 in Seoul. In addition, they indicate a need for more stringent enforcement of food safety regulations for the shellfish industry, especially against HAV, and the value of widespread vaccination.     

High-pressure inactivation of hepatitis A virus within oysters

Previous results demonstrated that hepatitis A virus (HAV) could be inactivated by high hydrostatic pressure (HHP) (D. H. Kingsley, D. Hoover, E. Papafragkou, and G. P. Richards, J. Food Prot. 65:1605-1609, 2002); however, direct evaluation of HAV inactivation within contaminated oysters was not performed. In this study, we report confirmation that HAV within contaminated shellfish is inactivated by HHP. Shellfish were initially contaminated with HAV by using a flowthrough system. PFU reductions of >1, >2, and >3 log(10) were observed for 1-min treatments at 350, 375, and 400 megapascals, respectively, within a temperature range of 8.7 to 10.3 degrees C. Bioconcentration of nearly 6 log(10) PFU of HAV per oyster was achieved under simulated natural conditions. These results suggest that HHP treatment of raw shellfish will be a viable strategy for the reduction of infectious HAV.