很久没有到这里来了，记得08年的时候，大家都在纠结于H试剂，我就是其中一个，当时我跑遍了南京，江门，上海，广州番禺，网络上看了medhelp的相关帖子，查阅了SCI上华盛顿大学Morrow教授关于H试剂的研究报告，还发过电子邮件联系VCR（华盛顿大学的病毒研究实验室，就是美国唯一做WB试验的实验室），还看了南京皮研所的一位做H试剂准确性的博士研究论文。
客观的说，我于09年脱恐，事实证明我没有感染，只是常见的包皮龟头炎。对于PZ的恐惧我切身体会，之所以09年后不来坛子，是因为不想回首恐惧PZ的日子，但觉得还是应该把自己的了解的真实情况告诉各位。
这是我在paozhen8上发的一篇《H试剂的那些事儿》的帖子，由于在paozhen8上和坛主争执，我的老账号iiuu被封，就注册了carline的账号，这是我对H试剂的一些认识。
一、《H试剂的那些事儿》
谢版主给的这个论坛让我发表我一下的言论，首先我申明，我不是郭的托儿，我不喜欢郭开始的时候H的信息作为收费项目（这里鄙视一下，不管郭搞不高兴），我想谈谈我和H的那些事儿。
1.H的准确性
首先我谈谈我的经历，我做过H试剂的检验有2次，其中，H两次为阴（当然指2型的），先说说我对H的认识，首先H在美国应用非常广泛，用VRC实验室（美国华盛顿大学病毒学研究室及诊所）人员的话说，如果你6个月后的H检验为阴，那么你患2型
GH的机会是very unlikily（基本为零）。如果有战友感兴趣我可以把我和VRC的邮件公布一下，不过全是英文的，我就不翻译了，怕有人说我误导。
2.IgM vs IgG
首先肯定bio-caring和郭的基本观点，IgM没有意义，但是我不同意上述两位关于为什么IgM没有意义的理由，很简单，如果将IgM不能分型就认为IgM不能诊断HSVII，是不充分的，如果IgM仅仅是不能分型，那么我认为恰恰IgM对于诊断HSV2具有意义，理由是：我们知道单纯性疱疹病毒只有两种：1型和2型，其中1型在中国大部分人在很久以前就有了，那么说大部分人在成年以后不会出现1型的IgM，即便1型复发，如果成年人血液中出现IgM，绝大部分只有一种可能，那就是感染了HSV2，因此单纯性疱疹的特性决定的对IgM分型意义不大了，中国的成年人，只要血液中出现单泡的IgM，基本上就是HSV2，因此单纯因为IgM不能分型就认为IgM对诊断没有意义在逻辑上是不成立的。
IgM没有诊断意义的真正原因是什么呢？medhelp上的HHH博士，VCR的医生，美国疱疹专家（那个什么steven.H我还不知道是何许人也，至少我在SCI上没有发现他的影子，郭医生不要拿板砖拍我！）在medhelp上有一篇帖子，论述为什么IgM没有意义，他的理由归结为：一是，从免疫学上来说，感染后首先出现IgM，然后当个体再次被免疫，在HSV即是复发后产生IgG，所以从原理上来说，应该是首先出现IgM，然后出现IgG，因此出现了bio-caring的那张图，但是，注意我说的是理论上，理论上这些现象在very young children上的现象是非常符合这种理论的，但是在adult（成年人）上，却不符合，大量的数据表明在成年人中有初发的人根本不出现IgM，直接产生IgG，至于为什么，HHH没有说；二IgM不能反映感染的时间，很多人（或者医生）认为，IgM只是在初发时出现，复发时不会出现IgM，这种观点同样只适合very young children，很多adult在复发时仍然出现IgM，所以检验出IgM不能表示你是初发；三关于IgM的准确性，HHH认为，很多人认为IgM不准确的原因是IgM不能分型，事实上并非如此，IgM不准确的原因更多的来源于试剂的物理化学反应的影响；四为什么很多医院喜欢做IgM，这一点bio-caring说对了，原因主要有：一是习惯性，大家做单疱1，单疱2习惯IgM和IgG一起做，那怕美国的Quest实验室也是有这种习惯，很多情况当医院要求做IgG时，Quest都会补充问要不要做IgM；二是，利益关系，IgM的试剂成本低于IgG,但在美国，实验室通过IgG和IgM向保险公司获得的美元是一样多的。
3 H的局限性，
准确的说是所有重组gG糖蛋白试剂的局限性，这也许是大家最为关心的，如果大家感兴趣，可以上VRC实验室的网站可以下载资料（补充一下VRC是美国唯一做单泡1和单泡2 WB的实验室），里面叙述的关于H的局限性，归结来说就是，通过重组gG糖蛋白抗原的实际在抗体结合点上比真正病毒的结合点要少的多，也就是说elisa这种方法利用抗体与抗原反应的方法不能真正符合实际病毒与抗体的反应，这就是为什么H 的elisa不可能查出所有的抗体，这就是H目前的最大的局限性。但是VRC最后补充了一点：即便如此，事实表明H的敏感性和特异性仍然是非常高的。
4 H试剂人种的影响
VRC没有做过H在中国人的适应性，但在越南、韩国、泰国，尼日利亚等国家做过H的人种适应性，结果表明敏感性和特异性除尼日利亚外基本都在90%以上，尼日利亚特异性较差，大约为70%。所以H对黄种人应该有比较好的适应性。研究结果表明H对华人敏感是大于86%，特异是大于96%，下面引述一下Morrow（再次声明我只听说过Morrow，没听说过Steven.H）教授关于尼日利亚专一性差的问题，Morrow认为，差异可能来自两个方面：一是H的敏感性，试验结果表明H相对WB的敏感性更好，但特异性WB更加出色，H能更早的发现2性抗体，尼日利亚的在选择实验对象上除了偏差，也就是说选择的实验对象更多的早期的感染者，WB没有检出，但H检出了，由于使用WB作为金标准，所以使得H的特异性降低（不明白的建议研究一下敏感性和特异性的概念），事实上也许这些人确实感染了2型病毒；二是病毒的变异，Morrow没有说在尼日利亚存在新的类型的病毒，但他说造成H试剂特异性下降的另一个原因就是可能在尼日利亚的病毒发生变异，由于WB的特异性更好，不能检出这些变异病毒引起的抗体，而H却检出了，造成H特异性的下降。我个人认为第二个理由十分重要，那么有没有可能在中国HSV也存在变异或新的亚型的病毒，H也无法检出造成H敏感性下降呢？这个还是很有启发意义的。
5 H可能出现的问题
我认为如果H真的有问题的话可能出现在以下几个方面：
一是，H不准，这个什么原因我还不知道，就当是一种假设吧；
二是，H很准，但是H只是检测单泡2抗体很准，不是所有的患者都会产生特异性抗体，部分产生1型抗体的病患，在再次感染2型后不会产生2型特异性抗体；
三是，H很准，但是要知道H严格检测1或2型疱疹的抗体，但是事实上导致战友们有症状的疱疹病毒不一定只有1型或2型，可能存在一种疱疹病毒，不是1或2型，同样产生疱疹或类似于疱疹病毒感染的症状，但H由于高度的专一性不能检测到这些病毒的抗体，造成漏诊。
以上是我的一点浅见，供大家参考！
下面是我与VRC试验室的邮件原文，我就不翻译了，防止别人说我误导，另外补充一句，电子邮件的地址是我在morrow发表的SCI论文的联系方式上找到的，会给我的应该是他们实验室的学生，用的学校的邮件。
Hi ####,（这是我的称谓，略去）：
If there is a visible symptom present, the standard procedure is to
perform a viral culture or PCR. If there are no visible symptoms then, a
blood test will be the best approach. Blood tests are an important tool
in diagnosing herpes since 80-90% of people with herpes never have any
noticeable symptoms. One of the most commonly used herpes blood test in
the United States is the IgG herpes select ELISA (type specific) which
is about 98% accurate when taken 12 to 16 weeks after exposure. The
BioKit is about 97% accurate, also at 12 to 16 weeks after exposure. The
HSV Western Blot is considered the gold standard for testing (99%
accurate), but is not widely used since it is only available through the
University of Washington.
The blood tests for herpes are looking for the antibodies your body has
created in response to herpes. Creating antibodies takes some time which
is why the test is designed for 12 to 16 weeks after exposure. Once your
body has created antibodies, you will always have the antibodies. If a
person starts taking Acyclovir or Valacyclovir daily, this can delay the
creation of antibodies for a few weeks.
A half of a years is usually enough time for your body to create
antibodies. If you have contracted herpes, you will most likely test
positive on the herpes select ELISA blood test if it has been 6 months.
If your test is negative at 6 months, you most likely do not have herpes.
Hope that answers your questions!
Kaile Ross
### wrote:
> Dear Doctor.
> Excuse me for my disturbing to you,thanks you for you e-mail sent
> to me, which was really helpful.
> There are some forum about the GH, some member of the
> forum introdeced the antibody test,these member hold the point that the
> Herpeselect elisa kit was an
> accurate test,which can provided some valuable information for
> diagnose,but almost all Doctor in our country think the blood test is
> only suit to the investigate of epdimic, and useless in
> clinic diagnosis,they would more believed the symptom they have watched
> or the PCR test reslut.
> I have read some other papers about the HSV IgG test, one author
> think the IgG test was useless, his result showed the OD of the IgG(not
> IgM) might rise at first episode, but the recurrent patinent's
> OD will descent and similar to the normal people, this paper was written
> by Doerr HW in 1987. The application of Herpeselect kit test
> in China might agreed with this point, too many recurrent patient
> Herpeselect test result was Negative, and almost all people with the
> atypical symptom got a negative result in our country, all of them take
> the test after 4 months. especially, one patient had taken the test 5
> times, All the results showed Negative, but the PCR test was
> Positive.Another question is some of these patients have
> taked some anti-herpe drug(Acyclovir,Valaciclovir),some Doctors think
> these drugs would delay the antibody's produce.
> My questions were:
> 1. Does the antibody test suit to the clinic diagnose ?
> 2. How long does the IgG last in patient's blood ?
> 3. if patients get the Acyclovir or the Valaciclovir, what effect
> on the Herpeselect elisa test reslut would be?
> 4. Does the antibody-test(herpeselect elisa,BiokitUSA, WB) used in
> US clinic diagnose ?
> 5. if one person got the Herpeselect elisa Negative result after
> half year, is it ture that he/she was not infected by herpe?
>
> Sincerely!
>
>
> ##
Hi, The only way I can answer your question is that most people will develop IgG by 12 to 16 months. So it is very unlikely that you have herpes and another test is not needed. I do need to add, and that is if any symptoms develop get to your health care provided.
Also it is not necessary to do a western blot the Herpes Select is very good at this time period.
Sincerely,
Mike Remington PA
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*******************************
University of Washington
Virology Research and Remington Clinics
Phone: 206.720.4340
Fax: 206.720.4371
vrc@u.washington.edu600 Broadway, Suite 400
Seattle, WA 98122
UW BOX 359928
On Sun, 7 Dec 2008, [GBK] ### wrote:
> hi, Ross
> how about the Herpeselect Elisa test?
> I had taken this test 3 months after sex, it was negative result, the OD of HSV2 was 0.063, Does it confirm I hadnt been infected by the HSV?
###,
Sorry I put months instead of weeks. The proper form is, by 12 to 16 months 97 to 99% will develop IgG for herpes simplex 2.
Sorry about that,
Mike Remington PA
CONFIDENTIALITY NOTICE: This e-mail message contains information that may be
confidential or privileged. The information is intended for the use of the
individual or entity named above. If you are not the intended recipient, be
aware that any disclosure, copying, distribution or use of the contents of
this information is prohibited. If you believe you have received this
e-mail message in error, please contact the sender by reply e-mail and
destroy all copies of the original message.
*******************************
University of Washington
Virology Research and Remington Clinics
Phone: 206.720.4340
Fax: 206.720.4371
vrc@u.washington.edu600 Broadway, Suite 400
Seattle, WA 98122
UW BOX 359928
On Fri, 12 Dec 2008, [GBK] ### wrote:
> Thank for your help! but I was infored from some website that about 98% people will develop IgG that enought to test in 12 to 16 weeks. why dose Doctor think it is 12 to 16 months?
> Sincerely,
> ###
>
Hi ###,
The Western Blot test kit for HSV can only be ordered through the University of Washington Virology Laboratory. This is the website
http://depts.washington.edu/rspvirus/. On the left side of the webpage there is a request form which you can use to order the Western Blot test kit. Requesting the Western Blot test kit, drawing the blood, and returning the kit should be done through a doctor's office. Speak with your doctor about ordering the test through the website, or have your doctor contact the Virology Laboratory directly at 206.987.2088.
Good Luck,
Kaile Ross
Virology Research Clinic Study Coordinator
CONFIDENTIALITY NOTICE: This e-mail message contains information that may be
confidential or privileged. The information is intended for the use of the
individual or entity named above. If you are not the intended recipient, be
aware that any disclosure, copying, distribution or use of the contents of
this information is prohibited. If you believe you have received this
e-mail message in error, please contact the sender by reply e-mail and
destroy all copies of the original message.
*******************************
University of Washington
Virology Research and Remington Clinics
Phone: 206.720.4340
Fax: 206.720.4371
vrc@u.washington.edu600 Broadway, Suite 400
Seattle, WA 98122
UW BOX 359928
On Sun, 30 Nov 2008, [GBK] ### wrote:
> Dear Doctor ,
>
> if I want take a westernblot test for HSV and I am Chinese,
> how can I do?
>
> ###>
