{"id":10297,"date":"2020-04-23T04:02:16","date_gmt":"2020-04-23T02:02:16","guid":{"rendered":"https:\/\/www.synevo.ro\/product\/arn-viral-hepatita-d-cantitativ\/"},"modified":"2025-07-11T14:37:18","modified_gmt":"2025-07-11T11:37:18","slug":"arn-viral-hepatita-d-cantitativ","status":"publish","type":"product","link":"https:\/\/old.synevo.md\/ru\/shop\/arn-viral-hepatita-d-cantitativ\/","title":{"rendered":"\u0420\u041d\u041a \u0432\u0438\u0440\u0443\u0441\u0430 \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u0430 D (\u043a\u043e\u043b\u0438\u0447\u0435\u0441\u0442\u0432\u0435\u043d\u043d\u044b\u0439 \u0442\u0435\u0441\u0442)"},"content":{"rendered":"

Informa\u0163ii generale \u015fi recomand\u0103ri privind efectuarea ARN viral hepatit\u0103 D (cantitativ)<\/em><\/strong><\/p>\n

Hepatita D (delta) este considerat\u0103 ca fiind cea mai sever\u0103 form\u0103 de hepatit\u0103 viral\u0103 la om. Virusul hepatitei D (HDV) este un virus defectiv care necesit\u0103 antigenul de suprafa\u0163\u0103 al virusului hepatitei B (AgHBs) pentru replicare complet\u0103 \u015fi transmitere. Astfel, hepatita D se dezvolt\u0103 numai la persoanele AgHBs pozitive, fie ca o co-infec\u0163ie acut\u0103, fie ca o suprainfec\u0163ie la persoanele care prezint\u0103 deja hepatita cronic\u0103 B.<\/p>\n

Mai multe studii au ar\u0103tat c\u0103 infec\u0163ia HDV cronic\u0103 conduce la o afectare hepatic\u0103 mai sever\u0103 dec\u00e2t monoinfec\u0163ia cronic\u0103 HBV, cu o progresie accelerat\u0103 c\u0103tre fibroz\u0103, o decompensare precoce a cirozei \u015fi un risc mai mare de carcinom hepatocelular. Tratamentul cu interferon pegylat induce un r\u0103spuns virusologic sus\u0163inut \u00een aproximativ un sfert din cazuri.<\/p>\n

HDV a fost descris pentru prima dat\u0103 \u00een 1977 \u00een Italia \u015fi este un virus ARN circular monocatenar de dimensiuni mici. Genomul este c\u0103ptu\u015fit cu proteina de \u00eenveli\u015f derivat\u0103 din antigenele pre-S \u015fi S ale HBV1;2<\/sup>. ARN HDV are 6 cadre deschise citirii, ORF-uri (engl. open reading frames)<\/em>, 3 fiind situate pe catena genomic\u0103 \u015fi celelalte 3 pe catena antigenomic\u0103. Un ORF codific\u0103 antigenul hepatitei D (AgHD), \u00een timp ce celelalte ORF-uri nu par s\u0103 fie transcrise activ.<\/p>\n

Replicarea ARN HDV cuprinde urm\u0103toarele etape: replicarea catenei genomice de c\u0103tre ARN polimeraza gazdei; rezult\u0103 o structur\u0103 multimeric\u0103 linear\u0103 care este clivat\u0103 autocatalitic \u00een monomeri lineari; ace\u015ftia sunt liga\u0163i \u00een ARN HDV viral circular (\u201cdouble-rolling circular model\u201d)<\/em>2<\/sup>.<\/p>\n

HDV a fost clasificat ini\u0163ial \u00een 3 genotipuri, \u00eens\u0103 analize filogenetice recente sugereaz\u0103 existen\u0163a a cel pu\u0163in 7 genotipuri majore. Genotipul I este cel mai frecvent \u015fi are o distribu\u0163ie ubicuitar\u0103. Genotipul II este \u00eent\u00e2lnit \u00een estul Asiei, \u00een timp ce genotipul III prevaleaz\u0103 \u00een America de Sud. Genotipul I se asociaz\u0103 atat cu afectare hepatica sever\u0103 c\u00e2t \u015fi cu forme u\u015foare, \u00een timp ce genotipul II determin\u0103 o boal\u0103 mai u\u015foar\u0103 \u00een cursul unei evolu\u0163ii \u00eendelungate1;2<\/sup>.<\/p>\n

Datorit\u0103 leg\u0103turii str\u00e2nse cu HBV, HDV are c\u0103i de transmitere similare, \u00een principal parenteral\u0103. Infec\u0163ia cu HDV este endemica \u00een \u0163\u0103rile mediteraneene, Orientul Mijlociu, Africa Central\u0103 \u015fi regiunile nordice din America de Sud. In Occident se constat\u0103 o prevalen\u0163\u0103 crescut\u0103 \u00een r\u00e2ndul consumatorilor de droguri intravenoase.<\/p>\n

Ca urmare a implement\u0103rii programelor de vaccinare \u00eempotriva hepatitei B inciden\u0163a infec\u0163iei HDV a sc\u0103zut semnificativ, \u00eens\u0103 continu\u0103 s\u0103 reprezinte o problem\u0103 grav\u0103 de s\u0103n\u0103tate.<\/p>\n

Datele privind patogenia infec\u0163iei HDV sunt limitate. Observa\u0163iile clinice au sugerat existen\u0163a unui proces mediat imunologic \u00een majoritatea cazurilor. Ocazional a fost suspectat \u015fi un mecanism citopatic.<\/p>\n

\u00cen cazul hepatitei D examenul histologic al ficatului nu este diferit fa\u0163\u0103 de cel asociat cu hepatita B sau C, cu leziuni necroinflamatorii de \u00eenso\u0163ire a infec\u0163iei. Este important de men\u0163ionat c\u0103 viremia HDV nu este direct asociat\u0103 cu gradul afect\u0103rii hepatice (Zachou, 2006). Exist\u0103 date care sus\u0163in c\u0103 at\u00e2t cantitatea c\u00e2t \u015fi calitatea r\u0103spunsului celular indus de limfocitele T sunt asociate cu un anumit control al infec\u0163iei. Acest r\u0103spuns celular-specific poate avea valoare predictiv\u0103 asupra r\u0103spunsului la tratamentul cu interferon pegylat.<\/p>\n

Co-infec\u0163ia cu virusuri hepatitice multiple este asociat\u0103 cu diferite modele de inhibi\u0163ie reciproc\u0103 a replic\u0103rii virale. S-a constatat frecvent c\u0103 HDV suprim\u0103 replicarea HBV. Aproximativ 70-90% dintre pacien\u0163ii cu hepatit\u0103 D sunt AgHBe negativi \u015fi cu niveluri sc\u0103zute ale viremiei B. Evolu\u0163ia pacien\u0163ilor cu hepatita D AgHBe pozitivi nu este\u00a0suficient studiat\u0103, \u00eens\u0103 se pare c\u0103 ace\u015fti pacien\u0163i au viremie B nedetectabil\u0103 \u00een contextul coinfec\u0163iei HDV. Pe de alt\u0103 parte, pacien\u0163ii cu hepatit\u0103 D pot dezvolta muta\u0163ii pre-core de tip stop codon, astfel c\u0103 pacien\u0163ii AgHBe negativi pot prezenta niveluri semnificativ crescute ale viremiei B care necesit\u0103 tratament antiviral pentru hepatita B.<\/p>\n

Exist\u0103 dovezi c\u0103 HDV suprim\u0103 nu numai replicarea HBV, ci \u015fi replicarea HCV la pacien\u0163ii cu infec\u0163ie viral\u0103 tripl\u0103. Cu toate acestea, dominanta viral\u0103 se poate schimba \u00een timp, astfel c\u0103 pacien\u0163ii cu infec\u0163ie tripl\u0103 trebuie atent monitoriza\u0163i \u015fi, dac\u0103 este cazul, trata\u0163i pentru virusul dominant2<\/sup>.<\/p>\n

Co-infec\u0163ia<\/em> determin\u0103 apari\u0163ia unei hepatite acute, dup\u0103 o perioad\u0103 de incuba\u0163ie ce variaz\u0103 \u00eentre 3 \u015fi 7 s\u0103pt\u0103m\u00e2ni. Manifest\u0103rile clinice includ oboseal\u0103, letargie \u015fi grea\u0163\u0103 \u015fi preced cu o s\u0103pt\u0103m\u00e2n\u0103 apari\u0163ia icterului. Replicarea ARN-HDV este limitat\u0103, fiind eviden\u0163iat\u0103 doar \u00een perioada de incuba\u0163ie \u015fi dispare dup\u0103 cre\u015fterea transaminazelor serice. In cele mai multe cazuri, vindecarea este complet\u0103, rareori ap\u0103r\u00e2nd cronicizarea.<\/p>\n

Suprainfec\u0163ia<\/em> se caracterizeaz\u0103 prin forme severe de hepatit\u0103 acut\u0103, care pot progresa spre infec\u0163ie cronic\u0103. Replicarea ARN-HDV este marcat\u0103 \u015fi prelungit\u0103, acidul nucleic fiind detectabil at\u00e2t \u00een s\u00e2nge, c\u00e2t \u015fi \u00een \u0163esutul hepatic. Infec\u0163iile fulminante sunt relativ rare, dar pot determina encefalopatie hepatic\u0103 cu modific\u0103ri de personalitate, tulbur\u0103ri de somn, confuzie, somnolen\u0163\u0103 \u015fi com\u0103, iar ARN-ul viral seric se g\u0103se\u015fte \u00een cantit\u0103\u0163i crescute. Rata de mortalitate \u00een aceste forme acute poate ajunge la 80%.<\/p>\n

60-70% din persoanele infectate cu ambele virusuri \u00a0progreseaz\u0103 spre ciroz\u0103 dup\u0103 un anumit num\u0103r de ani. \u00cen aceast\u0103 etap\u0103, singurul tratament este transplantul hepatic. Carcinomul hepatocelular poate fi \u00eent\u00e2lnit la persoanele cu infec\u0163ie cronic\u0103 cu virus D \u015fi este asociat cu ciroza4<\/sup>.<\/p>\n

Fiecare pacient AgHBs pozitiv trebuie testat cel pu\u0163in o dat\u0103 pentru anticorpi anti-HDV. Testarea direct\u0103 pentru ARN HDV nu prezint\u0103 utilitate \u00een absen\u0163a anti-HD. Pe de alt\u0103 parte, un rezultat pozitiv pentru anti-HD nu indic\u0103 \u00een mod necesar hepatita D activ\u0103, astfel c\u0103 este necesar\u0103 efectuarea viremiei D pentru confirmarea unei infec\u0163ii active. Dac\u0103 se ob\u0163ine un ARN HDV pozitiv, este necesar s\u0103 se stabileasc\u0103 gradul afect\u0103rii hepatice, s\u0103 se monitorizeze atent pacien\u0163ii pentru carcinomul hepatocelular \u015fi s\u0103 se ia \u00een considerare tratamentul antiviral.<\/p>\n

Deoarece p\u00e2n\u0103 \u00een prezent nu sunt date suficiente care s\u0103 demonstreze corelarea viremiei D cu markeri clinici ai afect\u0103rii hepatice, cuantificarea ARN HDV este util\u0103 numai dac\u0103 se ini\u0163iaz\u0103 tratamentul antiviral.\u00a0 Sunt \u00een curs de evaluare reguli de oprire a tratmentului antiviral \u00een func\u0163ie gradul de reducere a viremiei. Astfel, dup\u0103 unii autori (Erhardt, 2006), pacien\u0163ii cu o reducere <3 log a nivelului ARN HDV dup\u0103 24 s\u0103pt\u0103m\u00e2ni de tratment nu vor mai beneficia de terapia antiviral\u0103 cu PEG-INF \u03b1-2b.<\/p>\n

\u00cen 2004 a fost ini\u0163iat studiul HIDIT-1 (Hep-Net International Delta Hepatitis Intervention Trial<\/em>) care a inclus 90 pacien\u0163i cu hepatit\u0103 cronic\u0103 D \u015fi boala hepatic\u0103 compensat\u0103. Ace\u015ftia au fost randomiza\u0163i pentru 3 tipuri de terapie: PEG-INF \u03b1-2a \u00eempreun\u0103 cu adefovir dipivoxil, PEG-INF \u03b1-2a + placebo \u015fi adefovir izolat pe o perioad\u0103 de 48 s\u0103pt\u0103m\u00e2ni. Concluziile acestui studiu au fost urm\u0103toarele:<\/p>\n

a)\u00a0PEG-INF \u03b1-2a prezint\u0103 o eficacitate semnificativ\u0103 fa\u0163\u0103 de HDV la >40% dintre pacien\u0163i, 25% dintre ace\u015ftia av\u00e2nd o viremie D nedetectabil\u0103 dup\u0103 48 s\u0103pt\u0103m\u00e2ni;<\/div>\n
b)\u00a0Adefovir dipivoxil prezint\u0103 o eficacitate redus\u0103 \u00een ceea ce prive\u015fte reducerea viremiei D, dar poate fi luat\u00a0\u00een considerare la pacien\u0163ii cu replicare HBV semnificativ\u0103;<\/div>\n
c)\u00a0terapia combinat\u0103 PEG-INF \u03b1-2a \u015fi adefovir nu prezint\u0103 avantaje \u00een ceea ce prive\u015fte reducerea ADN HBV sau ARN HDV.<\/div>\n

\u00cen prezent este studiat\u0103 eficacitatea PEG-INF \u03b1-2a \u00een combina\u0163ie cu tenofovir pentru tratmentul hepatitei D; de asemenea sunt explorate \u015fi alte op\u0163iuni terapeutice2<\/sup>.<\/p>\n

Preg\u0103tire pacient<\/em><\/strong> \u2013 nu este necesar\u0103 o preg\u0103tire special\u01033<\/sup>.<\/p>\n

Specimen recoltat<\/em><\/strong> \u2013 s\u00e2nge venos3<\/sup>.<\/p>\n

Recipient de recoltare<\/em><\/strong>\u00a0\u2013 vacutainer ce con\u0163ine EDTA ca anticoagulant3<\/sup>.<\/p>\n

Prelucrare necesar\u0103 dup\u0103 recoltare <\/em><\/strong>\u2013 se separ\u0103 plasma prin centrifugare3<\/sup>.<\/p>\n

Volum prob\u0103 <\/em><\/strong>\u2013 minim 5 mL plasm\u01033<\/sup>.<\/p>\n

Stabilitate prob\u0103 <\/em><\/strong>\u2013 probele de plasm\u0103 sunt stabile 1 lun\u0103 la \u2013<\/em>20\u00b0C3<\/sup>.<\/p>\n

Metod\u0103 <\/em><\/strong>- Real-time PCR (TaqMan)<\/span>: reac\u0163ie de polimerizare \u00een lan\u0163 cu detec\u0163ie \u00een timp real a produsului PCR acumulat, prin m\u0103surarea fluorescen\u0163ei emise; limita de detec\u0163ie a metodei de lucru: 200 copii\/mL.<\/p>\n

Valori de referin\u0163\u0103 <\/em><\/strong>\u2013 ARN-HDV nedetectabil; un rezultat \u00abnedetectabil\u00bb semnific\u0103 faptul c\u0103 este vorba fie de o viremie foarte sc\u0103zut\u0103 (sub limita de cuantificare), fie de o viremie absent\u01031<\/sup>.<\/p>\n

Limite \u015fi interferen\u0163e<\/em><\/strong><\/div>\n
Heparina inhib\u0103 PCR-ul, de aceea aceasta nu trebuie folosit\u0103 ca anticoagulant3<\/sup>.<\/div>\n

\u00a0<\/span><\/p>\n

\u0411\u0438\u0431\u043b\u0438\u043e\u0433\u0440\u0430\u0444\u0438\u044f<\/span><\/strong><\/p>\n

1. Bader Faiyaz Zuberi. Hepatitis D: A Review. In JDUHS 2007, Vol.1(1):36-40.<\/span><\/span><\/div>\n
2. Heiner Wedemeyer. Hepatitis D \u2013 Diagnostic Procedures and Therapy. www.hepatology.com. Reference Type: Internet Communication.<\/span><\/div>\n
3. Laborator Synevo. Referin\u0163ele specifice tehnologiei de lucru utilizate.\u00a02015 Ref Type: Catalog.<\/span><\/div>\n
4. Lothar Thomas. Viral Hepatitis<\/span>. In Clinical Laboratory Diagnostics-Use and Assessment of Clinical Laboratory Results. TH-Books Verlagsgesellschaft mbH, Frankfurt \/Main, Germany, 1 Ed., 1998, 1278-11281.<\/span><\/span><\/div>","protected":false},"excerpt":{"rendered":"

\u0412\u0438\u0440\u0443\u0441 \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u0430 D \u2013 “\u0434\u0435\u0444\u0435\u043a\u0442\u043d\u044b\u0439” \u0432\u0438\u0440\u0443\u0441, \u0441\u043e\u0434\u0435\u0440\u0436\u0430\u0449\u0438\u0439 \u043a\u043e\u043b\u044c\u0446\u0435\u0432\u0438\u0434\u043d\u0443\u044e \u043e\u0434\u043d\u043e\u0446\u0435\u043f\u043e\u0447\u0435\u0447\u043d\u0443\u044e \u043d\u0438\u0442\u044c \u0420\u041d\u041a \u0438 \u0441\u043f\u043e\u0441\u043e\u0431\u043d\u044b\u0439 \u043a \u0440\u0435\u043f\u043b\u0438\u043a\u0430\u0446\u0438\u0438 \u0442\u043e\u043b\u044c\u043a\u043e \u0432 \u043f\u0440\u0438\u0441\u0443\u0442\u0441\u0442\u0432\u0438\u0438 \u0432\u0438\u0440\u0443\u0441\u0430 \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u0430 \u0412. HDV \u0441\u0442\u0440\u043e\u0438\u0442 \u0441\u0432\u043e\u044e \u043e\u0431\u043e\u043b\u043e\u0447\u043a\u0443 \u0438\u0437 HBs-\u0430\u043d\u0442\u0438\u0433\u0435\u043d\u0430 \u0438 \u0431\u0435\u0437 H\u0412V \u043d\u0435 \u043c\u043e\u0436\u0435\u0442 \u043f\u043e\u043b\u043d\u043e\u0446\u0435\u043d\u043d\u043e \u0440\u0430\u0437\u043c\u043d\u043e\u0436\u0430\u0442\u044c\u0441\u044f. \u041f\u043e \u043f\u0440\u0438\u0431\u043b\u0438\u0437\u0438\u0442\u0435\u043b\u044c\u043d\u044b\u043c \u043f\u043e\u0434\u0441\u0447\u0435\u0442\u0430\u043c, \u043e\u043a\u043e\u043b\u043e 5 % \u0431\u043e\u043b\u044c\u043d\u044b\u0445 \u0432\u0438\u0440\u0443\u0441\u043d\u044b\u043c \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u043e\u043c \u0412 \u0442\u0430\u043a\u0436\u0435 \u0438\u043d\u0444\u0438\u0446\u0438\u0440\u043e\u0432\u0430\u043d\u043e \u0432\u0438\u0440\u0443\u0441\u043e\u043c \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u0430 D.<\/p>\n

\u0421\u0443\u0449\u0435\u0441\u0442\u0432\u0443\u0435\u0442 3 \u043e\u0441\u043d\u043e\u0432\u043d\u044b\u0445 \u0433\u0435\u043d\u043e\u0442\u0438\u043f\u0430 \u0432\u0438\u0440\u0443\u0441\u0430, \u043a\u043e\u0442\u043e\u0440\u044b\u0435 \u043e\u0442\u043b\u0438\u0447\u0430\u044e\u0442\u0441\u044f \u0442\u044f\u0436\u0435\u0441\u0442\u044c\u044e \u0442\u0435\u0447\u0435\u043d\u0438\u044f \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u044f \u0438 \u0445\u0430\u0440\u0430\u043a\u0442\u0435\u0440\u043d\u044b \u0434\u043b\u044f \u043e\u043f\u0440\u0435\u0434\u0435\u043b\u0435\u043d\u043d\u044b\u0445 \u0433\u0435\u043e\u0433\u0440\u0430\u0444\u0438\u0447\u0435\u0441\u043a\u0438\u0445 \u0440\u0435\u0433\u0438\u043e\u043d\u043e\u0432. \u041f\u0435\u0440\u0432\u044b\u0439 \u0433\u0435\u043d\u043e\u0442\u0438\u043f \u043d\u0430\u0438\u0431\u043e\u043b\u0435\u0435 \u0440\u0430\u0441\u043f\u0440\u043e\u0441\u0442\u0440\u0430\u043d\u0435\u043d \u0432\u043e \u0432\u0441\u0435\u043c \u043c\u0438\u0440\u0435, \u0432\u0442\u043e\u0440\u043e\u0439 \u0432\u044b\u044f\u0432\u043b\u044f\u0435\u0442\u0441\u044f \u0432 \u0412\u043e\u0441\u0442\u043e\u0447\u043d\u043e\u0439 \u0410\u0437\u0438\u0438, \u0430 \u0442\u0440\u0435\u0442\u0438\u0439 \u2013 \u0432 \u042e\u0436\u043d\u043e\u0439 \u0410\u043c\u0435\u0440\u0438\u043a\u0435.<\/p>\n

\u0412\u0438\u0440\u0443\u0441 \u0443\u0441\u0442\u043e\u0439\u0447\u0438\u0432 \u043a \u043a\u0438\u0441\u043b\u043e\u0439 \u0441\u0440\u0435\u0434\u0435 \u0438 \u043a \u0432\u044b\u0441\u043e\u043a\u0438\u043c \u0442\u0435\u043c\u043f\u0435\u0440\u0430\u0442\u0443\u0440\u0430\u043c, \u043d\u043e \u0440\u0430\u0437\u0440\u0443\u0448\u0430\u0435\u0442\u0441\u044f \u043f\u043e\u0434 \u0434\u0435\u0439\u0441\u0442\u0432\u0438\u0435\u043c \u0449\u0435\u043b\u043e\u0447\u0438.<\/p>\n

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\u041f\u0440\u0438 \u0438\u043d\u0444\u0438\u0446\u0438\u0440\u043e\u0432\u0430\u043d\u0438\u0438 \u0432\u0438\u0440\u0443\u0441\u043e\u043c \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u0430 D \u043f\u0440\u0438 \u043d\u0430\u043b\u0438\u0447\u0438\u0438 \u0432\u0438\u0440\u0443\u0441\u043d\u043e\u0433\u043e \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u0430 \u0412 \u0432\u043e\u0437\u043d\u0438\u043a\u0430\u0435\u0442 \u0442\u0430\u043a \u043d\u0430\u0437\u044b\u0432\u0430\u0435\u043c\u0430\u044f \u0441\u0443\u043f\u0435\u0440\u0438\u043d\u0444\u0435\u043a\u0446\u0438\u044f. \u041f\u043e\u043b\u043d\u043e\u0435 \u0432\u044b\u0437\u0434\u043e\u0440\u043e\u0432\u043b\u0435\u043d\u0438\u0435 \u043f\u0440\u0438 \u044d\u0442\u043e\u043c \u0440\u0435\u0433\u0438\u0441\u0442\u0440\u0438\u0440\u0443\u0435\u0442\u0441\u044f \u0442\u043e\u043b\u044c\u043a\u043e \u0443 5-10 %.<\/p>\n

\u041e\u0442\u043b\u0438\u0447\u0438\u0442\u044c \u043a\u043e\u0438\u043d\u0444\u0435\u043a\u0446\u0438\u044e \u043e\u0442 \u0441\u0443\u043f\u0435\u0440\u0438\u043d\u0444\u0435\u043a\u0446\u0438\u0438 \u043d\u0435 \u0432\u0441\u0435\u0433\u0434\u0430 \u043b\u0435\u0433\u043a\u043e. \u041e\u0431\u044b\u0447\u043d\u043e \u043e\u0440\u0438\u0435\u043d\u0442\u0438\u0440\u0443\u044e\u0442\u0441\u044f \u043d\u0430 \u043e\u0441\u043e\u0431\u0435\u043d\u043d\u043e\u0441\u0442\u0438 \u0442\u0435\u0447\u0435\u043d\u0438\u044f \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u044f \u0438 \u043f\u0440\u0438\u0441\u0443\u0442\u0441\u0442\u0432\u0438\u0435 anti-HBc \u043a\u043b\u0430\u0441\u0441\u0430 IgM \u043f\u0440\u0438 \u043a\u043e\u0438\u043d\u0444\u0435\u043a\u0446\u0438\u0438 \u0438 \u0430\u043d\u0442\u0438\u0442\u0435\u043b \u043a\u043b\u0430\u0441\u0441\u0430 IgG \u043f\u0440\u0438 \u0441\u0443\u043f\u0435\u0440\u0438\u043d\u0444\u0435\u043a\u0446\u0438\u0438.<\/p>\n

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\u0423 \u0440\u0435\u0446\u0438\u043f\u0438\u0435\u043d\u0442\u043e\u0432 \u0434\u043e\u043d\u043e\u0440\u0441\u043a\u043e\u0439 \u043f\u0435\u0447\u0435\u043d\u0438, \u0438\u043d\u0444\u0438\u0446\u0438\u0440\u043e\u0432\u0430\u043d\u043d\u043e\u0439 \u0432\u0438\u0440\u0443\u0441\u043e\u043c \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u0430 D, \u0431\u044b\u0432\u0430\u0435\u0442 \u043b\u0430\u0442\u0435\u043d\u0442\u043d\u0430\u044f \u0444\u043e\u0440\u043c\u0430 \u0438\u043d\u0444\u0435\u043a\u0446\u0438\u0438. \u041f\u0440\u0438 \u043e\u0442\u0441\u0443\u0442\u0441\u0442\u0432\u0438\u0438 \u0432\u0438\u0440\u0443\u0441\u043d\u043e\u0433\u043e \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u0430 \u0412 \u0438\u043b\u0438 \u0435\u0433\u043e \u043f\u043e\u0434\u0430\u0432\u043b\u0435\u043d\u0438\u0438 \u0438\u043c\u043c\u0443\u043d\u043e\u043f\u0440\u043e\u0444\u0438\u043b\u0430\u043a\u0442\u0438\u0447\u0435\u0441\u043a\u0438\u043c\u0438 \u043c\u0435\u0442\u043e\u0434\u0430\u043c\u0438 \u0440\u0430\u0437\u043c\u043d\u043e\u0436\u0435\u043d\u0438\u0435 \u0432\u0438\u0440\u0443\u0441\u043d\u044b\u0445 \u0447\u0430\u0441\u0442\u0438\u0446 \u043f\u0440\u043e\u0438\u0441\u0445\u043e\u0434\u0438\u0442 \u0442\u043e\u043b\u044c\u043a\u043e \u0432 \u043f\u0440\u0435\u0434\u0435\u043b\u0430\u0445 \u043f\u043e\u0440\u0430\u0436\u0435\u043d\u043d\u044b\u0445 \u0433\u0435\u043f\u0430\u0442\u043e\u0446\u0438\u0442\u043e\u0432 \u0431\u0435\u0437 \u0440\u0430\u0441\u043f\u0440\u043e\u0441\u0442\u0440\u0430\u043d\u0435\u043d\u0438\u044f \u0438\u043d\u0444\u0435\u043a\u0446\u0438\u0438 \u0432 \u0434\u0440\u0443\u0433\u0438\u0435 \u0443\u0447\u0430\u0441\u0442\u043a\u0438 \u043f\u0435\u0447\u0435\u043d\u0438. \u0420\u041d\u041a \u0432\u0438\u0440\u0443\u0441\u0430 \u0432 \u043a\u0440\u043e\u0432\u0438 \u043f\u0440\u0438 \u044d\u0442\u043e\u043c \u043d\u0435 \u0432\u044b\u044f\u0432\u043b\u044f\u0435\u0442\u0441\u044f.<\/p>\n

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\u0414\u043b\u044f \u0447\u0435\u0433\u043e \u0438\u0441\u043f\u043e\u043b\u044c\u0437\u0443\u0435\u0442\u0441\u044f \u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0435?<\/strong><\/em><\/p>\n

    \n
  • \u0414\u043b\u044f \u0434\u0438\u0444\u0444\u0435\u0440\u0435\u043d\u0446\u0438\u0430\u043b\u044c\u043d\u043e\u0439 \u0434\u0438\u0430\u0433\u043d\u043e\u0441\u0442\u0438\u043a\u0438 \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u043e\u0432.<\/li>\n
  • \u0414\u043b\u044f \u0432\u044b\u044f\u0432\u043b\u0435\u043d\u0438\u044f \u0432\u0438\u0440\u0443\u0441\u043d\u043e\u0433\u043e \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u0430 D \u0438 \u043c\u0438\u043a\u0441\u0442-\u0433\u0435\u043f\u0430\u0442\u0438\u0442\u043e\u0432.<\/li>\n
  • \u0414\u043b\u044f \u043a\u043e\u043d\u0442\u0440\u043e\u043b\u044f \u0437\u0430 \u044d\u0444\u0444\u0435\u043a\u0442\u0438\u0432\u043d\u043e\u0441\u0442\u044c\u044e \u043b\u0435\u0447\u0435\u043d\u0438\u044f.<\/li>\n
  • \u0414\u043b\u044f \u0441\u043e\u0441\u0442\u0430\u0432\u043b\u0435\u043d\u0438\u044f \u043f\u0440\u043e\u0433\u043d\u043e\u0437\u0430 \u0442\u0435\u0447\u0435\u043d\u0438\u044f \u0438 \u0438\u0441\u0445\u043e\u0434\u0430 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u044f.<\/li>\n<\/ul>\n

    \u041a\u043e\u0433\u0434\u0430 \u043d\u0430\u0437\u043d\u0430\u0447\u0430\u0435\u0442\u0441\u044f \u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0435?<\/strong><\/em><\/p>\n

      \n
    • \u041f\u0440\u0438 \u0432\u043e\u043b\u043d\u043e\u043e\u0431\u0440\u0430\u0437\u043d\u043e\u043c \u0442\u0435\u0447\u0435\u043d\u0438\u0438 \u0432\u0438\u0440\u0443\u0441\u043d\u043e\u0433\u043e \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u0430 \u0412.<\/li>\n
    • \u041f\u0440\u0438 \u0431\u044b\u0441\u0442\u0440\u043e \u043f\u0440\u043e\u0433\u0440\u0435\u0441\u0441\u0438\u0440\u0443\u044e\u0449\u0435\u043c \u043f\u043e\u0440\u0430\u0436\u0435\u043d\u0438\u0438 \u043f\u0435\u0447\u0435\u043d\u0438 (\u0444\u0443\u043b\u044c\u043c\u0438\u043d\u0430\u043d\u0442\u043d\u043e\u043c \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u0435) \u0438 \u043e\u0431\u043e\u0441\u0442\u0440\u0435\u043d\u0438\u0438 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u044f \u0443 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u0430 \u0441 \u0432\u0438\u0440\u0443\u0441\u043d\u044b\u043c \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u043e\u043c \u0412.<\/li>\n
    • \u041f\u0440\u0438 \u0445\u0440\u043e\u043d\u0438\u0447\u0435\u0441\u043a\u0438\u0445 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u044f\u0445 \u043f\u0435\u0447\u0435\u043d\u0438 (\u0445\u0440\u043e\u043d\u0438\u0447\u0435\u0441\u043a\u0438\u0439 \u0432\u0438\u0440\u0443\u0441\u043d\u044b\u0439 \u0433\u0435\u043f\u0430\u0442\u0438\u0442 \u0412, \u0446\u0438\u0440\u0440\u043e\u0437).<\/li>\n
    • \u041f\u0440\u0438 \u043e\u0431\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0438 \u043b\u0438\u0446, \u043a\u043e\u043d\u0442\u0430\u043a\u0442\u0438\u0440\u043e\u0432\u0430\u0432\u0448\u0438\u0445 \u0441 \u0438\u043d\u0444\u0438\u0446\u0438\u0440\u043e\u0432\u0430\u043d\u043d\u044b\u043c\u0438 \u0434\u0435\u043b\u044c\u0442\u0430-\u0433\u0435\u043f\u0430\u0442\u0438\u0442\u043e\u043c.<\/li>\n
    • \u041f\u0440\u0438 \u043c\u043e\u043d\u0438\u0442\u043e\u0440\u0438\u043d\u0433\u0435 \u043b\u0435\u0447\u0435\u043d\u0438\u044f.<\/li>\n
    • \u041f\u0440\u0438 \u043a\u043e\u043d\u0442\u0440\u043e\u043b\u0435 \u0437\u0430 \u0442\u0435\u0447\u0435\u043d\u0438\u0435\u043c \u043c\u0438\u043a\u0441\u0442-\u0433\u0435\u043f\u0430\u0442\u0438\u0442\u043e\u0432 (\u0432\u0435\u0440\u043e\u044f\u0442\u043d\u043e \u043e\u0434\u043d\u043e\u0432\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0435 \u0438\u043d\u0444\u0438\u0446\u0438\u0440\u043e\u0432\u0430\u043d\u0438\u0435 \u0432\u0438\u0440\u0443\u0441\u0430\u043c\u0438 B, D \u0438 C).<\/li>\n<\/ul>\n

      \u0427\u0442\u043e \u043e\u0437\u043d\u0430\u0447\u0430\u044e\u0442 \u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442\u044b?<\/strong><\/p>\n

      \u0420\u0435\u0444\u0435\u0440\u0435\u043d\u0441\u043d\u044b\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u044f: \u043e\u0442\u0440\u0438\u0446\u0430\u0442\u0435\u043b\u044c\u043d\u043e.<\/p>\n

      \u041f\u0440\u0438\u0447\u0438\u043d\u044b \u043f\u043e\u043b\u043e\u0436\u0438\u0442\u0435\u043b\u044c\u043d\u043e\u0433\u043e \u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442\u0430 – \u0412\u0438\u0440\u0443\u0441\u043d\u044b\u0439 \u0433\u0435\u043f\u0430\u0442\u0438\u0442 D.<\/p>\n

      \u041f\u0440\u0438\u0447\u0438\u043d\u044b \u043e\u0442\u0440\u0438\u0446\u0430\u0442\u0435\u043b\u044c\u043d\u043e\u0433\u043e \u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442\u0430 – \u041e\u0442\u0441\u0443\u0442\u0441\u0442\u0432\u0438\u0435 \u0432\u0438\u0440\u0443\u0441\u0430 \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u0430 D.<\/p>\n

      \u0420\u0430\u043d\u043d\u0438\u0439 \u043f\u0435\u0440\u0438\u043e\u0434 \u0438\u043d\u0444\u0438\u0446\u0438\u0440\u043e\u0432\u0430\u043d\u0438\u044f.
      \n\u041d\u043e\u0441\u0438\u0442\u0435\u043b\u044c\u0441\u0442\u0432\u043e (\u0431\u0435\u0437 \u0440\u0430\u0437\u043c\u043d\u043e\u0436\u0435\u043d\u0438\u044f \u0432\u0438\u0440\u0443\u0441\u0430) \u0438\u043b\u0438 \u0432\u044b\u0437\u0434\u043e\u0440\u043e\u0432\u043b\u0435\u043d\u0438\u0435.<\/p>\n

      \u0412\u0430\u0436\u043d\u044b\u0435 \u0437\u0430\u043c\u0435\u0447\u0430\u043d\u0438\u044f<\/strong><\/p>\n

      \u0422\u0435\u0441\u0442 \u043d\u0430 \u0432\u0438\u0440\u0443\u0441 \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u0430 D \u043d\u0430\u0437\u043d\u0430\u0447\u0430\u0435\u0442\u0441\u044f \u043f\u043e\u0441\u043b\u0435 \u0432\u044b\u044f\u0432\u043b\u0435\u043d\u0438\u044f \u0432\u0438\u0440\u0443\u0441\u043d\u043e\u0433\u043e \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u0430 \u0412 (HBs-\u0430\u043d\u0442\u0438\u0433\u0435\u043d\u0430).
      \n\u0420\u0430\u0437\u043c\u043d\u043e\u0436\u0435\u043d\u0438\u0435 \u0432\u0438\u0440\u0443\u0441\u0430 \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u0430 D \u043f\u043e\u0434\u0430\u0432\u043b\u044f\u0435\u0442 \u0440\u0430\u0437\u043c\u043d\u043e\u0436\u0435\u043d\u0438\u0435 \u0432\u0438\u0440\u0443\u0441\u0430 \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u0430 \u0412 \u0432 \u043a\u043b\u0435\u0442\u043a\u0430\u0445 \u043f\u0435\u0447\u0435\u043d\u0438 (\u0444\u0435\u043d\u043e\u043c\u0435\u043d \u0432\u0438\u0440\u0443\u0441\u043d\u043e\u0439 \u0438\u043d\u0442\u0435\u0440\u0444\u0435\u0440\u0435\u043d\u0446\u0438\u0438). \u0412\u0441\u043b\u0435\u0434\u0441\u0442\u0432\u0438\u0435 \u044d\u0442\u043e\u0433\u043e \u043c\u043d\u043e\u0433\u0438\u0435 \u0441\u0435\u0440\u043e\u043b\u043e\u0433\u0438\u0447\u0435\u0441\u043a\u0438\u0435 \u043c\u0430\u0440\u043a\u0435\u0440\u044b \u043c\u043e\u0433\u0443\u0442 \u0431\u044b\u0442\u044c \u043d\u0435 \u043e\u0431\u043d\u0430\u0440\u0443\u0436\u0435\u043d\u044b \u0432 \u043a\u0440\u043e\u0432\u0438 \u043e\u0431\u0441\u043b\u0435\u0434\u0443\u0435\u043c\u043e\u0433\u043e \u0438\u043b\u0438 \u0438\u0445 \u043a\u043e\u043d\u0446\u0435\u043d\u0442\u0440\u0430\u0446\u0438\u044f \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u0441\u043d\u0438\u0436\u0435\u043d\u0430.<\/p>","protected":false},"featured_media":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"product_brand":[],"product_cat":[971],"product_tag":[],"class_list":{"0":"post-10297","1":"product","2":"type-product","3":"status-publish","5":"product_cat-teste-moleculare-pentru-diagnosticul-infectiilor","7":"first","8":"instock","9":"sold-individually","10":"shipping-taxable","11":"purchasable","12":"product-type-simple"},"_links":{"self":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product\/10297","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product"}],"about":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/types\/product"}],"replies":[{"embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/comments?post=10297"}],"wp:attachment":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/media?parent=10297"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_brand?post=10297"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_cat?post=10297"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_tag?post=10297"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}