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目的对血清学标志阴性的非甲～戊型肝炎进行病原学研究。方法用ＨＢＶＰＣＲ、ＨＣＶＲＴ－ＰＣＲ和ＨＥＶＲＴ－ＰＣＲ分别检测血清学标志阴性的非甲～戊型肝炎患者血清，并对其部分阳性产物进行克隆测序。结果８７例非甲～戊型肝炎血清ＨＢＶＤＮＡ均为阴性，９例（１０．３％）为ＨＣＶＲＮＡ阳性，部分经测序证实为ＨＣＶ１ｂ亚型；余７８例为ＨＢＶＤＮＡ和ＨＣＶＲＮＡ均阴性。该７８例中，１４例因无血清未作ＨＥＶＲＮＡ检测，余６４例中４９例（７６．６％）为ＨＥＶＲＮＡ阴性，１５例（２３．４％）为ＨＥＶＲＮＡ阳性。经序列分析显示，其中９例为典型的中国ＨＥＶ株基因序列，６例变异较大，与典型的中国株基因序列的同源性仅为８０％左右。４９例ＨＢＶＤＮＡ、ＨＣＶＲＮＡ和ＨＥＶＲＮＡ均阴性的血清中１６例（３２．６％）ＨＧＶＲＮＡ阳性。由此可见，该８７例中至少有９例为ＨＣＶ感染，１５例为ＨＥＶ感染，１６例为ＨＧＶ感染。结论对血清学标志阴性的非甲～戊型肝炎的病人应该用ＰＣＲ法进行病原学分型，以明确其诊断
Objective To study the etiology of seronegative non-hepatitis A-E hepatitis. Methods The serological markers of non-hepatitis E and hepatitis E were detected by HBV PCR, HCVRT-PCR and HEVRT-PCR respectively, and some of the positive products were cloned and sequenced. Results Serum HBVDNA was negative in 87 cases of non-hepatitis E, 9 cases (10.3%) were positive for HCVRNA, and some were confirmed as HCV1b subtype by sequencing. The remaining 78 cases were negative for both HBV DNA and HCV RNA. Of the 78 patients, HEV RNA was negative in 14 of 64 (76.6%) and HEVRNA in 15 (23.4%) of the 64 patients without HEV RNA. Sequence analysis showed that 9 of them were typical HEV strains in China, 6 were highly variant, and their homologies with typical Chinese strains were only about 80%. Of the 49 cases of HBVDNA, HCVRNA and HEVRNA negative serum, 16 cases (32.6%) were positive for HGVRNA. Thus, at least 9 of the 87 patients were HCV-infected, 15 were HEV-infected and 16 were HGV-infected. Conclusion Patients with non-Hepatitis A-E seronegative markers should be genotyped by PCR to confirm their diagnosis