HIV/AIDS病人合并HBV和HCV感染状况分析

目的分析艾滋病病毒(HIV)感染者和艾滋病(AIDS)病人(简称HIV/AIDS病人)合并感染乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)的流行现状及其特点,为AIDS的防控和治疗提供科学依据。方法选取2011-2015年期间准备开始高效抗反转录病毒治疗(HAART)的HIV/AIDS病人986例,采用酶联免疫吸附试验检测HIV/AIDS病人血液中的乙型肝炎表面抗原(HBsAg)和/或丙型肝炎病毒抗体(HCV-Ab)。计数资料样本率的比较采用χ2检验,计量资料的比较采用t检验。结果 HIV/AIDS病人合并HBV感染率为6.06%(59/974),合并HCV感染率为4.12%(40/972),合并HBV/HCV双重感染率为0.42%(4/960),HIV/AIDS病人合并HBV和HCV感染率的差异无统计学意义。血液途径感染HIV者的合并HBV感染率为15.79%,合并HCV感染率为41.03%,均显著高于性途径合并HBV和HCV的感染率(5.01%和1.68%)。合并乙型肝炎病人的CD4+T淋巴细胞200个/μL的比例,明显高于合并丙型肝炎病人CD4+T淋巴细胞200个/μL的比例。合并HBV和HCV感染的病人的天冬氨酸转氨酶、丙氨酸转氨酶、总胆红素均没有显著性差异。结论郑州市HIV/AIDS病人合并HBV和HCV总体感染率低于普通人群,HIV合并HBV/HCV感染的趋势有所控制。但血液途径感染HIV者合并HBV和HCV感染率仍高于普通人群,要加大防控力度。     

北京地区HIV/HBV合并感染者与HBV单独感染者中HBV基因型分布

目的比较北京地区艾滋病病毒(HIV)/乙型肝炎病毒(HBV)合并感染者和HBV单独感染者中HBV基因型分布是否存在差异,分析两组人群中基因型相关的基本临床特征差异。方法收集2016年7月至2017年12月在北京地坛医院门诊和住院处就诊的慢性乙型肝炎患者共1 453例,分为HIV/HBV合并感染组和HBV单独感染组,通过测序来鉴定HBV基因型。结果共343例分型成功。其中,HIV/HBV合并感染者75例,HBV-B型占40.0%(30例),HBV-C型占60.0%(45例);HBV单独感染者268例,HBV-B型占27.6%(74例),HBV-C型占72.4%(194例)。在HBV单独感染者中,HBV-C型患者的丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)处于异常水平比率及乙型肝炎病毒e抗原(HBeAg)阳性率明显高于HBV-B型患者;而在HIV/HBV合并感染者中,HBV-B、C型患者的ALT、AST水平及HBeAg阳性率无显著差异。在两组人群中,HBV-B型患者在年龄、ALT、AST水平上无显著差异;HBV-C型患者在性别、年龄、ALT水平上存在显著差异。结论北京地区HIV/HBV合并感染者和HBV单独感染者中HBV基因型分布存在差异。HBV-C型患者的肝功能损害程度重于HBV-B型,HIV/HBV合并感染可能对肝功能造成一定的影响。     

运城市农村地区HIV感染者/AIDS病人健康状况分析

目的 为了摸清运城市农村地区艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人的健康状况,为今后的关怀、治疗、管理工作提供科学依据.方法 对477例HIV感染者/AIDS病人进行全面健康检查及相关化验检查,观察合并感染情况和治疗效果.结果 477例HIV感染者/AIDS病人中,有1/5的人发生常见机会性感染症状,AIDS病人治疗后白细胞计数、血红蛋白、血小板均高于治疗前(P＜0.05);男女性治疗后CD4 细胞明显高于治疗前(P＜0.01),平均增长37.08%;病人均有不同程度的肝功能损害.HIV合并乙型肝炎病毒(HBV)感染的占2.9%,合并丙型肝炎病毒(HCV)53.5%,同时合并HBV和HCV感染的占1.9%;有心电图改变者占20.3%;HIV/结核菌(TB)双重感染率为2.3%.结论 运城市农村地区HIV感染者/AIDS病人健康状况较好,抗病毒治疗效果良好,今后要积极开展机会性感染或合并感染的预防和治疗.     

HIV／HCV协同感染者的存活率较低归咎于药物的肝脏毒性

法国学者Chne博士等人发现 ,造成艾滋病病毒 (HIV) /丙型肝炎病毒 (HCV)协同感染者死亡率较高的原因是药物导致的肝脏毒性 ,而非HCV感染本身。他们是根据一项在法国1 8所医院开展的Aquitaine队列研究得出该结论的。他们分别调查了 576名HCV阳性和 41 9HCV阴性的HIV感染者 ,这些患者都接受了双核苷逆转录酶抑制剂 (NRTI) (76 % )或双NRTI和 1或 2种蛋白酶抑制剂 (PI) (2 4 % )的治疗。两组患者的平均随访期分别为 40和 2 0个月。结果显示 ,HCV阳性组患者天门冬氨酸转氨酶 (AST)高度升高 (>2 0 0IU/L) ,和丙氨酸转氨酶 (ALT)…     

广西桂中地区艾滋病患者乙型和丙型肝炎病毒感染调查研究

目的了解广西桂中地区人类免疫缺陷病毒(HIV)/艾滋病(AIDS)患者合并乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)感染的情况。方法调查分析我院2007-01～2009-12确诊的2 342例AIDS患者临床资料。结果 HIV/HBV、HIV/HCV、HIV/HBV/HCV共感染率分别为16.8%、22.5%、2.5%,其中吸毒和性传播者HIV/HCV感染率分别为74.7%和8.0%、HIV/HBV感染率分别为15.6%和17.2%、HIV/HBV/HCV感染率分别为7.8%和1.0%。结论广西桂中地区HIV/HBV共感染在性传播和吸毒传播者中差异无统计学意义,HIV/HCV、HIV/HBV/HCV共感染差异有统计学意义,应采取措施控制其传播。     

HIV/HCV重叠感染者疾病进展及病毒间相互作用机制的研究进展

自1981年美国首次从男同性恋患者中报道艾滋病(AIDS)以来,相同症状的患者不断被发现,该疾病也以其惊人的速度在世界范围内传播开来。由于丙型肝炎病毒(HCV)与艾滋病病毒(HIV)有相同的传播途径,使HCV在HIV感染者中得到广泛的传播。据报道,全球HCV感染者中大约6%～10%合并HIV感染,HIV感染者中大约有30%合并HCV感染。因此HIV/HCV重叠感染成为AIDS最关注的领域之一。现对HIV/HCV重叠感染者疾病进展及病毒间在人体内相互作用机制的最新研究进展综述如下。     

人类免疫缺陷病毒感染者混合感染丙型和乙型肝炎病毒后对高效抗逆转录病毒治疗疗效的影响

目的 观察HIV感染者合并HCV和HBV感染后对高效抗逆转录病毒治疗(HAART)疗效的影响.方法 对某地区HIV、HCV共感染患者166例(HIV+HCV组),HIV、HCV和HBV混合感染患者23例(H1V+HCV+HBV组)及单纯HIV感染者178例,给予1年的HAART治疗,观察3组患者病毒学反应、免疫学反应和肝功能动态变化.以流式细胞仪检测外周血CD4+T淋巴细胞;实时PCR定量检测HCV、HIV和HBV病毒载量.结果 单纯HIV感染组、HIV+HCV+HBV组和HIV+HCV组经HAART 1年后,HIV病毒载量分别由治疗前(6.78±1.08)、(6.23±1.34)、(6.54±1.23)lg拷贝/ml下降至(0.53±0.15)、(0.67±0.16)、(0.43±0.11)lg拷贝/ml(P值均＜0.001).CD4+T淋巴细胞计数分别由治疗前的(197±127)、(184±113)、(213±143)个/μl上升至(382±74)、(383±70)、(378±76)个/μl(P值均＜0.001).3组之间各时间点CD4+T淋巴细胞、HIV病毒载量差异无统计学意义.3组患者ALT、AST、总胆红素治疗前后无显著变化,相同时间点组间比较差异无统计学意义.HAART前后,HCV病毒载量差异无统计学意义.结论 HIV感染者混合感染HBV和(或)HCV,不影响HAART的疗效;HAART对HCV复制无抑制作用.     

13例HIV/HBV重叠感染患者的实验指标分析

目的了解艾滋病病毒与乙型肝炎病毒（HIV/HBV）重叠感染患者的临床特征,分析HIV与HBV在疾病进展中的相互作用。方法回顾性分析、比较13例HIV/HBV重叠感染组、28例单纯HIV感染组、28例单纯HBV感染组患者,在免疫功能、肝脏功能及血常规方面的差异。结果免疫功能检测：CD4^＋T细胞计数和CD4^＋/CD8^＋T细胞比值表现为HIV/HBV重叠感染组〈单纯HIV组〈单纯HBV组（P〈0.01）;肝脏功能检测：HIV/HBV重叠感染组与单纯HIV感染组各项指标无显著性差异,而单纯HBV组的丙氨酸氨基转移酶（ALT）、天冬氨酸转氨酶（AST）、总胆红素显著高于（P〈0.01）或高于（P〈0.05）另外两组;血常规检测：HIV/HBV重叠感染组和单纯HIV组各指标无显著性差异,但与单纯HBV组比较,则红细胞和血红蛋白显著降低（P〈0.01）,血小板明显升高（P〈0.01）。结论研究结果初步提示,HIV与HBV重叠感染后,可能减轻患者的肝细胞损伤,进一步降低患者的免疫功能。     

HCV RNA病毒载量和肝功能及白蛋白的相关性研究

目的:研究血液中丙型肝炎病毒核糖核酸(HCV RNA)载量与肝功能及白蛋白(ALB)等指标间的相关性,探讨病毒含量和肝组织损伤之间的关系。方法:选取193例大连地区汉族人群HCV感染患者为研究对象,检测血液中HCV RNA病毒载量,同时测定谷丙转氨酶(ALT)、谷草转氨酶(AST)、AST/ALT及ALB等指标。用豆形图展示HCV RNA病毒载量数据,分析HCV RNA载量与各指标间的相关性。结果:不同性别组HCV RNA载量分布差异无统计学意义(P0.05);HCV RNA载量与年龄不存在显著的相关性(P0.05)。HCV RNA载量与ALT、AST、AST/ALT及ALB均不相关(P0.05)。根据受试者HCV RNA载量数量级将其分为4组,ALT、AST、AST/ALT及ALB在各组间差异无统计学意义(P0.05)。结论:大连地区汉族人群HCV患者血液中HCV RNA载量与ALT、AST、AST/ALT及ALB等指标不相关,HCV RNA病毒载量不能反映肝脏损伤程度。     

HCV与HBV重叠感染者与乙型或丙型肝炎的临床研究

目的探讨丙型/乙型肝炎病毒(HCV/HBV)重叠感染者与乙型或丙型肝炎患者血生化、病毒学和肝纤维化指标的差异。方法在32例HCV/HBV重叠感染患者、40例丙型肝炎和100例乙型肝炎患者,分别常规检测生化、肝纤维化和病毒学指标。结果 HBV/HCV重叠感染患者与乙型或丙型肝炎比,TBIL明显升高,ALB和CHE明显下降,PT明显延长,HA、PCⅢ、CIV、LN明显升高,HBV DNA水平较乙型肝炎高,HCV RNA水平与丙型肝炎无明显差异。结论 HBV/HCV重叠感染比单纯感染者肝损害严重,有重症化倾向。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.