脐带血乙肝标志物筛查乙肝病毒宫内感染的探讨

目的探讨脐带血乙肝标志物用于筛查乙肝病毒宫内感染的可能性。方法收集175例HBsAg阳性孕妇新生儿脐带血及24 h外周血,进行乙肝标志物和HBV DNA检测,6月龄时随访查外周血HBsAg。结果脐带血HBsAg阳性的新生儿外周血HBV DNA均为阳性,6月龄随访HBsAg阳性率均为100%。7例出生时注射了HBIG和乙肝疫苗的HBV DNA阳性的新生儿HBsAg随访阴转;8例脐带血HBsAg和HBV DNA均阴性的婴儿因直接母乳喂养HBsAg随访阳转。结论脐带血表面抗原可以作为筛查胎儿乙肝病毒宫内感染的指标。     

不同方案阻断乙肝病毒母婴垂直传播的临床研究

探讨阻断乙型肝炎病毒母婴垂直传播的方法。将122例HBsAg( )孕妇分成四组，HBVac治疗组29例，HBIG组29例。左旋咪唑涂布剂与以上两者联合应用30例。未治疗组34例。均在孕26周开始干预观察，孕妇和新生儿血清HBV标志物（HBVM）检测采用ELISA法，122例孕妇按分娩方式不同分别观察对乙肝病毒母婴垂直传播影响；随访产妇及新生儿HBVM变化。脐血中HBsAg阳性率；HBVac治疗组为17.24%。HBIG治疗组为10.35%。联合治疗组为3.33%。未治疗组为23.53%。在不同的分娩方式中，急症剖宫产新生儿脐血HBsAg阳性率为13.04%，行择期剖宫产者为0，经阴道分娩者为16.67%。携带HBV孕妇于孕晚期给予HBVac,HBIG和左旋咪唑涂布剂联合以上两者治疗后，可有效阻断母婴之间传播。以联合治疗组效果最佳。不同分娩方式也影响传播，剖宫产术有助于阻断HBV母婴传播。     

慢性乙型肝炎患者外周血单个核细胞内HBV RNA、HBV DNA的检测及其与血清HBV DNA的关系

目的:探讨慢性乙型肝炎(慢乙肝)患者外周血单个核细胞(PBMC)中HBV感染情况及复制状态,以及与血清HBV DNA的关系.方法:应用PCR技术特异性,选择地检测慢乙肝患者PBMC中HBV RNA、HBV DNA,并与血清HBV DNA进行比较.结果:在慢乙肝患者PBMC中能检测出HBV RNA及HBV DNA,阳性率分别为38.78%及77.55%,且两者的检出率有一致性.当PBMC中HBV RNA阳性时,HBV DNA均为阳性(100%),而当HBV DNA阳性时,部分病例可表现为HBV RNA阴性,两者阳性符合率为50%.血清中HBV DNA阳性率为71.42%.PBMC中HBV RNA的阳性率与血清中HBV DNA的阳性符合率为63.33%,血清中HBV DNA与PBMC中HBV DNA阳性符合率为76.32%.结果提示:HBV能感染PBMC,在部分患者存在着活动性复制,这种复制表现为不同于肝细胞内的低水平复制.此外,HBV感染PBMC后也存在着非复制状态,表现为PBMC中HBV DNA阳性,但HBV RNA阴性.另外,当血中HBV DNA阴性时,少数病例PBMC仍可表现为HBV RNA及HBV DNA阳性.结论:HBV能够感染PBMC并存在活动性复制,可能是造成患者免疫功能紊乱、肝脏损害慢性化的重要原因之一.     

Individualized management of pregnant women with high hepatitis B virus DNA levels

Hepatitis B is a major health concern in the Asia-Pacific region,and is endemic in China,Southeast Asia,and Africa.Chronic hepatitis B virus(HBV)infection may cause hepatic cirrhosis and liver cancer.It is estimated that there are more than 350 million chronic HBV carriers worldwide,of whom approximately one quarter will die of chronic hepatitis B-related liver diseases.HBV is transmitted horizontally through blood and blood products or by sexual transmission,and vertically from mother to infant.Perinatal infection is the predominant mode of transmission in countries with a high prevalence of hepatitis B surface antigen(HBsAg)carriage,and perinatal transmission leads to high rates of chronic infection.Therefore,it is important to prevent the mother-to-child transmission(MTCT)of HBV.Research has shown that pregnant women with high HBV DNA levels have an increased risk of MTCT.However,most of the obstetrics guidelines do not make a distinction between pregnant women with high HBV DNA levels and those who are HBsAg positive only.This review addresses the management of pregnant women with high levels of HBV viremia,in terms of antiviral therapy,use of hepatitis B immunoglobulin(HBIG),the combined application of hepatitis B vaccine and HBIG,choice of delivery mode and feeding practices.     

Hepatitis B Surface Antigen Seroprevalence among Children in Papua New Guinea, 2012–2013

Approximately 8% of the population in Papua New Guinea (PNG) has chronic hepatitis B virus (HBV) infection. To decrease the burden of chronic HBV infection, a national 3-dose infant hepatitis B vaccination program was implemented starting in 1989, with a birth dose (BD) added to the schedule in 1992. To assess the impact of the hepatitis B vaccination program, we conducted a serosurvey among children born after vaccine introduction. During 2012–2013, a cross-sectional stratified four-stage cluster survey was conducted to estimate hepatitis B surface antigen (HBsAg) prevalence among children 4–6 years of age. We collected demographic data, vaccination history, and tested children for HBsAg. Of 2,133 participants, 2,130 children had vaccination data by either card or recall: 28% received a BD; 81% received ≥ 3 vaccine doses. Of 2,109 children providing a blood sample, 60 (2.3%) tested positive for HBsAg. This is the largest, most geographically diverse survey of hepatitis B vaccination and HBsAg seroprevalence done in PNG. Progress has been made in PNG toward the Western Pacific Regional goal to reduce the prevalence of chronic HBV infection to < 1% by 2017 among 5-year-old children. Vaccination efforts should be strengthened, including increasing BD coverage and completing the 3-dose series.     

乙型肝炎病毒感染临床转归与宿主细胞免疫的相关性研究

目的 比较慢性乙型肝炎患者、HBV携带者、HBV既往无症状感染者之间T细胞亚群和HBV特异性CD4+ T细胞应答强度的差异,分析宿主的细胞免疫状态对HBV感染后临床转归的影响,探讨乙型肝炎的发病机制,为慢性乙型肝炎的治疗提供新的线索.方法 选取2004年2-10月在北京协和医院肝炎门诊就诊的慢性乙型肝炎患者30例、HBV携带者22例、HBV既往无症状感染者9例以及正常对照11例,使用流式细胞仪检测其T细胞亚群,使用酶联免疫斑点法检测病毒特异性CD4+T细胞应答强度,分析其差异及临床意义.结果 慢性乙型肝炎组CD4+T细胞计数显著低于HBV既往无症状感染组和正常对照组;慢性乙型肝炎组、HBV携带者组、HBV既往无症状感染组病毒特异性CD4+ T细胞应答强度分别为(156±105)、(56±68)、(229±114)SFC/106PBMC(每106个外周血单个核细胞中斑点形成细胞的个数);慢性乙型肝炎组明显高于HBV携带者组(P＜0.01),而低于HBV既往无症状感染组(P＜0.05).结论 慢性乙型肝炎患者、HBV携带者、HBV既往无症状感染者病毒特异性T细胞应答强度存在差异,这种差异可能是造成HBV感染后不同临床转归的主要因素之一.     

乙型肝炎患者血清粒细胞-巨噬细胞集落刺激因子检测的临床意义

目的：探讨血清粒细胞—巨噬细胞集落刺激因子(GM-CSF)对乙型肝炎患者的临床意义。方法：采用放射免疫法检测各型乙型肝炎和肝炎后肝硬化患者与健康受试者血清GM-CSF浓度，常规检测外用血白细胞(WBC)计数，聚合酶链反应(PCR)法检测外用血乙肝病毒基因组(HBV DNA)含量。结果：与正常人相比，慢性肝炎、肝炎后肝硬化患者血清GM-CSF水平、WBC水平下降(P＜0．05)；重型肝炎患者血清GM-CSF水平显著下降(P＜0．01)，WBC水平显著升高(P＜0．01)。HBV DNA含量在急性肝炎、肝炎后肝硬化、慢性重型肝炎、慢性肝炎中依次升高。血清GM-CSF浓度基本与WBC的计数量变化一致。结论：乙型肝炎患者血清GM-CSF水平对WBC水平的影响强于乙肝病毒，且有抗病毒作用。     

荧光定量检测HBV cccDNA在慢性乙型肝炎患者中的应用

目的:研究慢性乙型肝炎患者HBV共价闭合环状DNA(cccDNA)在外周血的分布、肝组织中含量及探讨抗病毒治疗对慢性乙型肝炎患者血清HBV cccDNA的影响。方法:随机选取HBV DNA阳性慢性乙型肝炎患者、肝硬化患者、重型肝炎患者共125例。使用实时荧光定量PCR法检测血清中cccDNA。选取36例慢性乙型肝炎患者肝组织和外周血样本,酶切后进行荧光定量PCR检测。60例慢性乙型肝炎患者,按1:1随机分配接受拉米夫定或干扰素治疗,所有患者均治疗24周以上;应用实时荧光定量聚合酶链反应技术检测慢性乙型肝炎患者0周、8周、12周、24周、HBV cccDNA及HBV DNA含量。结果:125例患者中cccDNA阳性率为71.2%,以肝硬化患者阳性率最低。肝硬化患者HBVcccDNA检出阳性率与慢性乙型肝炎患者及重型肝炎患者比较,差异有显著性意义(P0.05)。肝组织中HBV cccDNA与肝组织总HBV DNA及血清HBV DNA存在相关性(P0.05),HBeAg阳性组与阴性组患者比较差异有显著性意义(P0.05)。患者接受抗病毒治疗后血清HBV DNA及HBV cccDNA下降。结论:乙型肝炎肝硬化患者外周血HBV cccDNA阳性率低,慢性乙型肝炎患者中HBeAg(+)组病毒复制较HBeAg(-)组活跃。抗病毒治疗对血清HBV cccDNA有抑制作用;血清HBV cccDNA可作为抗病毒治疗的重要监测指标。     

Evidence of protection against clinical and chronic hepatitis B infection 20 years after infant vaccination in a high endemicity region

Summary. Vaccination against hepatitis B virus (HBV) immediately after birth prevents neonatal infection by vertical transmission from HBV carrier mothers. There is an ongoing debate whether infant vaccination is sufficient to protect against infection when exposed to HBV later in life. We studied 222 Thai infants born to HBsAg ?/+ and HBeAg ?/+ mothers who were vaccinated with recombinant hepatitis B vaccine at 0‐1‐2‐12 months of age. A subset of 100 subjects received a booster dose at age 5 years. Blood samples collected yearly for 20 years were examined for anti‐HBs antibodies and serological markers of hepatitis B infection (anti‐HBc, HBsAg, and in selected cases HBeAg, anti‐HBe, HBV DNA). During the 20‐year follow‐up, no subject acquired new chronic HBV infection or clinical hepatitis B disease. During the first decade, possible subclinical breakthrough HBV infection (anti‐HBc seroconversion) was only observed in subjects born to HBsAg +/HBeAg + mothers (6/49 [12.2%]). During the second decade, breakthrough HBV infections were detected in all groups (18/140 [12.8%]). Increases in anti‐HBs concentrations that were unrelated to additional HBV vaccination or infection were detected in approximately 10% of subjects in each decade. Primary infant vaccination with a recombinant hepatitis B vaccine confers long‐term protection against clinical disease and new chronic hepatitis B infection despite confirmed hepatitis B exposure. ( http://www.clinicaltrials.gov NCT00240500 and NCT00456625)     

Prevalence of hepatitis B virus infection and related risk factors in a rural community of Mexico.

A cross-sectional survey of the seroprevalence of hepatitis B virus (HBV) markers among healthy people was conducted in San Juanito, a rural community in the northern state of Chihuahua, Mexico. The overall prevalence in 970 people was 6.6% for antibody to hepatitis B core antigen. There was an age effect on the prevalence of HBV infection, and a gradual increase in prevalence was observed in patients up to the age of 40 years. Those subjects with a history of dental procedures had a 2-fold higher risk for HBV infection (odds ratio [OR], 2.4; 95% confidence intervals [CI], 1.01-5.86), and there was a 74% increased risk for each blood product transfusion (OR, 1.74; 95% CI, 1.09-2.77). Horizontal transmission seems to be the major source of endemicity in San Juanito because no woman was a chronic carrier. To lower HBV transmission rate, an adequate active screening program for blood donors should be implemented, together with a universal infant immunization program.     

Progress toward Elimination of Hepatitis B Virus Transmission in Oman: Impact of Hepatitis B Vaccination

Approximately 2–7% of the Omani population has chronic hepatitis B virus (HBV) infection. To decrease this burden, universal childhood hepatitis B vaccination was introduced in Oman in 1990. The hepatitis B vaccination strategy and reported coverage were reviewed. To assess the impact of the program on chronic HBV seroprevalence, a nationally representative seroprevalence study was conducted in Oman in 2005. Since 1991, hepatitis B vaccination in Oman has reached almost every eligible child, with reported coverage of ≥ 97% for the birth dose and ≥ 94% for three doses. Of 175 children born pre-vaccine introduction, 16 (9.1%) had evidence of HBV exposure, and 4 (2.3%) had evidence of chronic infection. Of 1,890 children born after vaccine introduction, 43 (2.3%) had evidence of HBV exposure, and 10 (0.5%) had evidence of chronic infection. Oman has a strong infant hepatitis B vaccination program, resulting in a dramatic decrease in chronic HBV seroprevalence.     

重型肝炎患者乙型肝炎病毒特异性细胞毒性T淋巴细胞应答功能研究

目的 用主要组织相容性复合物（MHC）抗原肽四聚体（Tetramer）流式细胞技术，分析乙型重型肝炎患者外周血中特异性细胞毒性T淋巴细胞（CTL）应答状况，并探讨其临床意义。方法 采用Tetramer流式细胞技术检测乙型重型肝炎患者外周血中受人类白细胞抗原Ⅰ类分子限制的三类特异性CD8^＋CTL细胞数量；采用酶联免疫吸附斑点试验技术，测定经特异性乙型肝炎病毒（HBV）肽段诱导培养的特异性CTL表达膜内细胞因子IFNγ、TNFα、IL-4和IL—10等的水平；采用Promega CytoTox96非放射性细胞毒试验技术，测定经特异性HBV肽段诱导培养的特异性CTL杀伤靶细胞能力。结果 急性乙型重型肝炎组外周血中针对HBVcore18-27表位的特异性CTL数量高于慢性乙型重型肝炎组（P〈0．05），而低于急性乙型肝炎组（P〈0．05）；急性乙型重型肝炎组表达干扰素γ和肿瘤坏死因子α较慢性乙型重型肝炎组高（P值均〈0．05）；急性乙型重型肝炎组HBVcore18—27特异性CTL裂解靶细胞能力高于慢性乙型重型肝炎组（P〈0．05）。结论 急性乙型重型肝炎患者特异性CTL应答作用增强，而慢性乙型重型肝炎患者特异性CTI。应答缺乏。急性乙型重型肝炎患者外周血特异性CTL持续存在，可能与促进病毒清除等相关。     

Elimination of new chronic hepatitis B virus infections: results of the Alaska immunization program

An immunization assessment and a serologic survey were conducted to evaluate the effectiveness of a hepatitis B immunization program in eliminating hepatitis B virus (HBV) transmission among Alaska Natives in a region in which HBV infection is endemic. Hepatitis B vaccine coverage was 93% among 567 children 相似文献   

Establishment of a new quantitative detection approach to adefovir-resistant HBV and its clinical application

AIM:To establish the more feasible and sensitive assessment approach to the detection of adefovir (ADV) resistance-associated hepatitis B virus (HBV) quasispecies.METHODS: Based on the characteristics of rtA181V/T and rtN236T mutations, a new approach based on real-time fluorescent quantitative polymerase chain reaction (RT-PCR) was established for the detection of ADV-resistant HBV quasispecies, total HBV DNA, rtA181 and rtN236 mutations in blood samples from 32 chronic hepatitis B (CHB) patients with unsa...     

唐山地区献血人群隐匿性乙型肝炎病毒感染分析

目的了解唐山地区无偿献血人群隐匿性乙型肝炎感染情况。方法用ELISA法检测无偿献血者的乙型肝炎血清标志物,对于HBsAg阴性样本,进行HBV核酸检测（NAT）,NAT阳性样本,用罗氏试剂确证HBV DNA载量。结果共检测116 741例血样,证实隐匿性乙型肝炎感染者35例,占总献血人数的0.29‰。其中97.1%隐匿性乙型肝炎感染者样本的HBV DNA滴度低于102IU/ml。在HBV DNA阳性人群中,抗-HBc阳性率较高,占81.5%,抗-HBs阳性或乙型肝炎病毒血清标志物全阴性也可检出HBV DNA分别占55.6%和22.9%。结论唐山地区献血人群中血清HBsAg阴性者存在一定比例的隐匿性HBV感染,其HBV病毒载量均较低,核酸检测能够提高HBV感染的检出率。     

The prevalence of hepatitis B and C in blood donors in a 3rd-level hospital of Mexico City

OBJECTIVE: To investigate the prevalence of the hepatitis C virus (HCV) and B virus (HBV) in blood donors attending Médica Sur Hospital. MATERIAL AND METHODS: A total of 9,099 blood donors were tested for hepatitis B and C viruses from 1994 to 1998. A questionnaire was used to collect data and HCV and HBV were detected in serum. We obtained percentages and assessed statistical significance using the chi 2 test. RESULTS: The prevalence of HCV and HBV carriers was 0.47 and 0.11 per cent. The main risk factors were dental procedures (11.6% for HCV and 20%, for HBV), and unsafe sexual practices (20%) for HBV. CONCLUSIONS: These results indicate a low prevalence of HCV and HBV infection in this population.     

High seroprevalence of asymptomatic viral haemoparasites among prospective blood donors in Nigeria

Objective:To determine the prevalence of viral haemoparasites in prospective Nigerian blood donors.Methods:Ethical clearance was obtained and informed consent questionnaires were distributed to blood donors to obtain their demographical data.A total of 186 blood donors from LAUTECH Teaching Hospital,Osogbo were tested for hepatitis A virus(HAV),hepatitis B virus(HBV) and hepatitis C virus(HCV) using rapid test kit and Enzyme Linked Immunosorbent Assay.Results:The highest prevalence of blood transmitted infections was 182(97.85%) while the prevalence of HIV,HAV,HBV and HCV were 6.45%,97.85%,14.52% and 3.23% respectively.Highest seroprevalence for hepatitis A,B and C occurred among low risk occupation.There was no significant association between all the hepatitis viruses and demographic factors except occupation with P value of 0.002 7.Hepatitis A,B and C seropositive blood donors on average tend to have PCV within the normal reference range.Out of the 27 hepatitis B positive blood donors,22 were donating blood for the first time while 5 were repeat donors.None of the hepatitis C seropositive donors have been exposed to blood or any form of its products and were all donating blood for the first time.However,the distribution of donor type for HAV is random.Conclusions:The presence of HAV,HBV,HCV and HIV among prospective donors in Nigeria particularly the alarming prevalence of HAV.These infections can be transmitted to recipients if proper screening is not carried out,hence they should be included as a routine test for blood donors.     

乙型肝炎患者外周血单个核细胞对HBV不同区抗原的增殖反应

目的进一步明确外周血细胞免疫在ＨＢＶ感染过程中的作用。方法对２０例急性乙型肝炎（乙肝）患者、２３例慢性乙肝患者、２０例正常献血员进行了研究,用氮蓝四唑实验（ＭＴＴ）测定乙肝患者外周血单个核细胞（ＰＢＭＣ）对ＨＢＶ不同区抗原的增殖反应。结果在急性乙肝患者ＰＢＭＣ对抗原的增殖反应大于慢性乙肝患者及正常对照,ＰＢＭＣ对ＨＢｃＡｇ的增殖反应最高,ＨＢｅＡｇ次之,而对ＨＢｓＡｇ的反应均较弱。另外,无论在急性、慢性患者,其ＰＢＭＣ对抗原的增殖反应水平与血清丙氨酸转氨酶（ＡＬＴ）的变化无明显相关性。血清ＨＢＶＤＮＡ阴性、ＨＢｅＡｇ阴性的慢性肝炎或慢性肝炎急性发作患者,其ＰＢＭＣ对ＨＢＶ抗原的增殖反应较弱,在血清ＨＢＶＤＮＡ或ＨＢｅＡｇ阳性患者,增殖反应较强,而当血清ＨＢＶＤＮＡ、ＨＢｅＡｇ均阳性时,增殖反应最强,表明外周细胞免疫与ＨＢＶ的复制及清除相关。结论ＨＢＶ感染后,外周血中存在对ＨＢＶ抗原的细胞免疫,这种细胞免疫可能与乙肝的发病及ＨＢＶ的清除有关。