苦参素治疗慢性乙型肝炎疗效分析

苦参素主要成分为氧化苦参碱 (占 98% ) ,是从植物中药苦豆子的苦参根中取出的生物碱。在临床上具有免疫调节、保护肝细胞及抗病毒等作用。本文通过应用苦参素治疗 2 8例慢性乙型肝炎 (ＣＨＢ)患者 ,观察其症状、体征、生化及乙型肝炎标志等指标的变化 ,以进一步评价其临床疗效     

甘利欣联合拉米夫定治疗慢性乙型肝炎41例

目的 观察甘利欣联合拉米夫定治疗慢性乙型肝炎的效果。方法 将80例慢性乙型肝炎患者随机分成甘利欣联合拉米夫定组(治疗)41例，甘利欣组(对照)39例，疗程均为3个月，观察临床症状、体征、生化、病毒复制指标的变化。结果 治疗3个月后，两组患者综合疗效，肝功能复常，HBeAg、HBV-DNA阴转差异均有显著性。结论 甘利欣联合拉米夫定治疗慢性乙型肝炎在改善病人症状、恢复肝功能和抗病毒等方面均有很好疗效。     

阿德福韦酯片联合安络化纤丸治疗慢性乙型肝炎疗效观察

目的评价阿德福韦酯片联合安络化纤丸治疗慢性乙型肝炎的疗效及安全性。方法将45例慢性乙型肝炎患者随机分成治疗组(30例)和对照组(15例),治疗组接受阿德福韦酯片联合安络化纤丸治疗,对照组单用阿德福韦酯片治疗,疗程均为24周。两组患者在治疗前后均行肝纤维化血清学指标、肝功能、血清病毒学指标检测。结果治疗结束时,治疗组患者的主要症状和体征、肝功能、肝纤维化血清指标改善优于对照组患者(P0.05),但两组HBV DNA低于检测下限的比率和血生化指标的改善差异无统计学意义(P0.05)。结论阿德福韦酯片联合安络化纤丸治疗慢性乙型肝炎能明显改善患者的症状、体征、肝纤维化血清学指标、肝功能、血清病毒学指标,且比单用阿德福韦酯片治疗慢性乙型肝炎的肝纤维化血清学指标疗效更好,能明显改善肝功能和改善患者生活质量,值得临床推广应用。     

病原未定型肝炎的临床研究

目的探讨病原未定型肝炎的临床特征。方法以43例慢性乙型肝炎和30例急性乙型肝炎为对照组,对62例病原未定型肝炎患者进行临床分析,比较病原未定型肝炎的流行病学、临床表现、实验室检查及肝组织学改变。结果62例病原未定型肝炎患者发病以冬末及春季多见;发病年龄以青、中年(18岁~50岁)占92.2%;临床表现有急性和慢性,多数症状轻、肝病体征少;血清转氨酶水平呈轻、中度升高;肝活检组织病理学显示炎症轻;绝大多数预后良好。结论病原未定型肝炎的致病因子仍不清楚。     

复方甘草酸苷(美能)治疗慢性乙型肝炎的疗效观察

目的了解复方甘草酸苷治疗慢性乙型肝炎的疗效。方法将邵阳市中心医院感染科2004年08月-2005年08月收治的66例慢性乙型肝炎患者随机分为治疗组(33例)和对照组(33例),治疗组用美能注射剂60ml加入10%葡萄糖注射液250ml中,静脉滴注,1/d,连续6周;对照组用甘利欣注射剂30ml加入10%葡萄糖注射液250ml中,静脉滴注,1/d,连续6周。2组均加用维生素C辅助治疗。观察2组的临床症状、体征、肝功能指标变化及不良反应。结果2组病例症状及体征大多消失或好转,尤以治疗组明显,治疗组在总胆红素、ALT、AST的改善方面较对照组差异有显著性(P<0.05),且治疗组不良反应小于对照组。结论复方甘草酸苷治疗慢性乙型肝炎具有较好的临床疗效且安全。     

水飞蓟宾胶囊治疗慢性乙型肝炎疗效观察

目的观察水飞蓟宾胶囊治疗慢性乙型肝炎(CHB)的疗效。方法 80例慢性乙型肝炎患者随机分为两组,治疗组56例口服水飞蓟宾胶囊,对照组24例口服护肝片,观察治疗前、后的临床疗效、患者症状、体征恢复情况、肝脏功能及病毒指标变化,并监测不良反应。结果治疗组治疗后总有效率及症状、体征的复常率显著高于对照组(P0.05)。两组治疗后ALT、AST及TBil水平降低,显著低于治疗前(P0.05)。治疗组治疗后TBil水平显著低于对照组(P0.05)。两组治疗后病毒指标转阴率差异无统计学意义(P0.05)。两组在治疗过程中无不良反应。结论水飞蓟宾能够促进肝细胞修复,防止肝细胞进一步坏死,减轻黄疸,改善肝脏功能,从而有效治疗慢性乙型肝炎。     

平肝饮辅助治疗慢性乙型肝炎急性发作疗效观察

目的观察平肝饮辅助治疗慢性乙型肝炎（CHB）急性发作的效果。方法 CHB急性发作患者106例,随机分为治疗组和对照组各53例,均予抗病毒、抗炎保肝、免疫调节和对症治疗,连续治疗6周。治疗组在常规治疗基础上加用平肝饮,2次/d,一次60ml口服。观察临床疗效。结果治疗组临床症状有效率明显高于对照组（P〈0.05）。两组均未发现明显不良反应。观察组5例发展成重型肝炎,对照组9例发展成重型肝炎。结论平肝饮可改善慢性乙型肝炎急性发作患者得临床症状,疗效显著。     

急性乙型肝炎和慢性乙型肝炎急性发作的血清学鉴别

本研究通过比较急性乙型肝炎(AHB)和慢性乙型肝炎(CHB)急性发作在生化、体液免疫、病毒指标方面的变化,以探讨两者的鉴别指标. 资料与方法 一、病例来源 泰州市人民医院感染科2006-2009年住院的AHB患者55例,其中男29例,女26例,年龄18～40岁,平均35.6岁,CHB急性发作者62例,其中男40例,女22例,年龄25～56岁,平均40.3岁.诊断符合2000年中华医学会传染病与寄生虫学分会和肝病学分会制定的《病毒性肝炎防治方案》[1]和2005年《慢性乙型肝炎防治指南》[2]的标准.所有患者均排除其他病毒性(甲、丙、丁、戊型)肝炎及非病毒性肝损伤.     

慢性淤胆型乙型病毒性肝炎的早期诊断指标探讨

目的探讨慢性乙型肝炎淤胆型的早期临床诊断指标及其特点。方法同顾性对照比较慢性乙型肝炎淤胆型与非淤胆患者临床指标差异，包括临床症状、体征、血清生化及B超所见。结果慢性乙型肝炎淤胆型与非淤胆比较，在临床症状和体征方面，无统计学意义（P〉0．05）；在血清生化方面，如血清直应胆红素／总胆红素（D/T）、总胆汁酸、谷胺酰转肽酶、碱性磷酸酶、总胆固醇有显著差异（P〈0．05）：淤胆型肝炎B超异常声像图．如胆囊壁增厚、胆囊壁欠光滑、胆汁透声差，有鉴别意义（P〈0．05）。结论慢性乙型淤胆型肝炎的临床症状和体征无特征性表现，D/T、总胆汁酸、谷胺酰转肽酶、碱性磷酸酶、总胆固醇及B超的检测对早期诊断慢性乙型淤胆型肝炎有一定临床价值。     

膈下逐瘀汤加味用于慢性乙型肝炎肝硬化患者的临床疗效观察

目的探讨膈下逐瘀汤加味治疗慢性乙型肝炎肝硬化的临床疗效。方法选取本院2013年6月至2014年5月收治的慢性乙型肝炎肝硬化患者126例,采用随机数表法将其分为观察组与对照组,每组各63例。观察组患者给予膈下逐瘀汤加味与拉米夫定治疗,对照组患者仅给予拉米夫定治疗,比较两组患者临床治疗效果。结果观察组患者治疗有效率为82.5%(52/63),显著高于对照组61.9%(39/63),差异具有显著性(P=0.0097);两组患者治疗前谷丙转氨酶(ALT)、谷草转氨酶(AST)、Child-Pugh评分、透明质酸(HA)、层粘连蛋白(LN)、Ⅳ型胶原蛋白(Ⅳ-C)、Ⅲ型前胶原蛋白(PⅢP)水平比较差异均无显著性(P>0.05),治疗后两组患者上述指标水平均显著降低(观察组:P=0.0000,0.0000,0.0000,0.0000,0.0000,0.0000,0.0000;对照组:P=0.0000,0.0000,0.0000,0.0000,0.0276,0.0003,0.0000),且观察组显著低于对照组(P=0.0000,0.0000,0.0000,0.0127,0.0287,0.0000,0.0164)。结论膈下逐瘀汤加味与拉米夫定联合治疗慢性乙型肝炎肝硬化,能够在有效抗病毒基础上良好改善患者症状体征,降低肝纤维化指标,促进肝细胞再生,延缓或逆转肝硬化进程,值得临床推广应用。     

Clinical, biochemical, immunological and virological profiles of, and differential diagnosis between, patients with acute hepatitis B and chronic hepatitis B with acute flare

Background and Aim: In areas with high or intermediate endemicity for chronic hepatitis B virus (HBV) infection, it is difficult to distinguish acute hepatitis B (AHB) from chronic hepatitis B with an acute flare (CHB‐AF) in patients whose prior history of HBV infection has been unknown. The present study aimed to screen laboratory parameters other than immunoglobulin M antibody to hepatitis B core antigen (IgM anti‐HBc) to discriminate between the two conditions. Methods: A retrospective and prospective study was conducted in patients first presenting clinically as HBV‐related acute hepatitis to sort out acute self‐limited hepatitis B (ASL‐HB). Then, clinical and laboratory profiles were compared between patients with ASL‐HB and CHB‐AF. Parameters closely associated with ASL‐HB were chosen to evaluate sensitivity, specificity, accuracy, positive predictive values and negative predictive values for diagnosing AHB. Results: There were significant differences between patients with ASL‐HB and CHB‐AF in relation to clinical and laboratory aspects, with many outstanding differences in levels of serum HBV‐DNA, hepatitis B e antigen (HBeAg) and alpha‐fetoprotein (AFP) as well as IgM anti‐HBc. In particular, there was a greater difference between the two groups in low levels of HBeAg (ratio of the optical density of the sample to the cut‐off value [S/CO] <20) than in negativity for HBeAg (42.7% and 13.5% vs 49.3% and 45.9%). 1:10 000 IgM anti‐HBc had a sensitivity and specificity of 96.2% and 93.1%, respectively, for predicting ASL‐HB. Combining it with AFP, HBeAg or HBV‐DNA could improve diagnostic power. A combination of IgM anti‐HBc, HBV‐DNA and HBeAg had a predictive value of 98.9% and a negative predictive value of 100.0%, similar to that of a combination of IgM anti‐HBc and HBV‐DNA. Adding AFP to the combinations of IgM anti‐HBc and HBV‐DNA or HBeAg could further heighten the positive predictive value. The positive predictive value and negative predictive value of the combination of IgM anti‐HBc, HBV‐DNA and AFP were both 100.0%. Conclusions: (i) There are significant differences with respect to clinical, biochemical, immunological and virological aspects between ASL‐HB and CHB‐AF. (ii) Of several diagnostic combinations, IgM anti‐HBc jointing HBV‐DNA is most effective and most practicable in distinguishing ASL‐HB from CHB‐AF. (iii) A low HBeAg level is more useful than negative HBeAg in differential diagnosis between ASL‐HB and CHB‐AF. (iv) In those patients with a high level of IgM anti‐HBc, serum AFP level >10× upper reference limit could rule out a probability of ASL‐HB.     

Hepatitis B virus genotypes in acute and fulminant hepatitis patients from north India using two different molecular genotyping approaches.

Data from India on hepatitis B virus (HBV) genotype related differences in clinical progression and outcome of acute and fulminant hepatitis B are limited. Sera from patients with acute hepatitis B (AHB) (n=80), fulminant hepatitis B (FHB) (n=40) and asymptomatic HBsAg carriers (ASC) (n=40) were tested for HBV genotype using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and type-specific primers-based PCR (TSP-PCR). The genotype distribution for 160 patients with HBV related hepatitis/carriers were as follows: A, 3/80 (3.7%) in AHB, 2/40 (5%) in FHB and 7/40 (17.5%) in ASC; D, 77/80 (96.2%) in AHB, 38/40 (95%) in FHB and 33/40 (82.5%) in ASC. C, 0; B, 0; E, 0; F, 0 (p<0.01, genotype D versus A). Compared with genotype D, genotype A patients had no significant clinical or biochemical differences (p>0.05). HBV genotypes A and D were found to be prevalent in patients with HBV related acute and fulminant hepatitis from New Delhi, India. Genotype D was the dominant genotype prevalent in all patient categories while genotype A was solely responsible for AHB leading to chronic hepatitis B in 3.7% of the cases from this region.     

上海急慢性乙型肝炎患者病毒基因型分布概况比较

目的 了解上海急慢性乙型肝炎患者的病毒基因型分布概况.方法 2003至2007年入住上海长海医院的62例急性乙型肝炎(AHB)患者和随机抽取的73例同期住院的慢性乙型肝炎(CHB)患者被纳入本研究.对所有患者血清HBV S区基因应用直接基凶测序方法进行基因分型,同时收集肝功能、病毒学指标和相关流行病学资料.对组间均数差异应用t检验,频率差异用x2检验.结果 上海地区AHB和CHB的主要病毒基因型为B型、C型,分别为48.4%(30/62)、51.6%(32/62)和26.0%(19/73)、74.0%(54/73),B型在AHB比例明显高于CHB(P<0.05).在流行病学特征和临床转归方面,这两种病毒基囚型在AHB之间差异无统计学意义.C型在CHB中比例明显高于AHB(x2=7.25,P<0.01).AHB组的主要传播途径为多伴侣性接触,为18例,占29.0%;CHB组的主要传播途径为母婴传播,为38例,占52.1%.结论 上海地区AHB和CHB主要病毒基因型均为B型和C型,AHB组B型所占比例相对较高,CHB组C型所占比例相对较高,病毒基因型与AHB临床预后无关.     

PCR检测HBV感染患者血清HBV DNA的临床意义

目的探讨急、慢性乙型肝炎及与ＨＢＶ感染相关的肝硬变和肝癌患者血清ＨＢＶＤＮＡ的临床意义．方法应用ＰＣＲ技术检测不同ＨＢＶ感染２０５例，患者血清ＨＢＶＤＮＡ，并与正常人２０例作比较．结果ＨＢＶ感染患者２０５例血清ＨＢＶＤＮＡ阳性率为６９３％，慢性乙肝、乙肝后肝硬变和肝癌患者的阳性率分别为７６４％，７１９％和７００％，显著高于急性乙肝患者２１７％的阳性率（Ｐ＜００１）；ＨＢｅＡｇ（＋）患者血清ＨＢＶＤＮＡ阳性率为９３６％，显著高于ＨＢｅＡｇ（－）抗ＨＢｅ（＋）／（－）和ＨＢｓＡｇ（－）患者的阳性率（４５６％，２５０％和１２５％，Ｐ＜００１）；血清ＨＢＶＤＮＡ阳性和阴性两组患者的血清ＡＬＴ水平无明显差异（Ｐ＞００５）．结论血清中ＨＢＶＤＮＡ持续存在可能与乙型肝炎的慢性化有关，而与ＨＢＶ感染患者的肝损伤无明显关系     

乙肝病毒感染者外周血CD4^＋CD25^＋调节性T细胞的表达及临床意义

目的 探讨乙肝病毒感染者外周血CD4 CD25 调节性T细胞(CD4 CD25 Tr)表达水平及其临床意义.方法 选择乙肝病毒携带者25例、急性乙肝患者26例、慢性乙肝患者38例,26例正常对照,用流式细胞仪检测外周血中CD4 CD25 Tr表达水平;用PCR法检测患者HBV DNA载量.结果 乙肝病毒携带者组与慢性乙肝患者组CD4 CD25 Tr水平(9.93±3.51,11.21±3.29)明显高于对照组(8.12±2.80)(P＜0.01或0.05),急性肝炎组与对照组相比,差异没有显著性.结论 持续性HBV感染者CD4 CD25 Tr表达增加,提示CD4 CD25 Tr在慢性乙型肝炎中担负着重要的免疫调节作用,可能抑制HBV感染者特异性细胞免疫反应,与乙肝病毒感染的慢性化及肝病的临床发生、发展有关.     

Difference of HBV Genotype Distribution Between Acute Hepatitis and Chronic Hepatitis in Japan

Abstract Background: Recently genotype A which is rare in the patients in chronic hepatitis B (CHB) was frequently noted in patients with acute hepatitis B (AHB). To investigate their clinical and virological features, we studied the AHB patients in the past 5 years. Patients and Methods: 98 patients with AHB and 80 patients with CHB admitted to our hospital between 1998 and 2003 were studied. Results: Genotype A was not found in CHB but was frequently noted in AHB (p < 0.001). Comparison of the clinical features of acute hepatitis between the two major genotypes, A and C, homosexual and heterosexual with multiple partners were frequently seen among genotype A patients (p < 0.001). On the other hand, infection from steady partner showed a tendency to be more frequent in genotype C (p = 0.065). In genotype A, the levels of HBVDNA on admission was higher (p = 0.007) and AHB has significantly more frequently progress to chronic infection than in genotype C (p = 0.028). Phylogenetic analysis of genotype A revealed that almost all strains from homosexual men belonged not to the African type A1 but to the Western type A2. Conclusion: Genotype A has increased recently among AHB in Japan. This fact may correlate to promiscuous intercourse in high risk group. Prophylactic efforts should be considered to prevent the prevailing of genotype A.     

Differentiating Acute Hepatitis B from the First Episode of Symptomatic Exacerbation of Chronic Hepatitis B

In countries with intermediate or high endemicity for chronic hepatitis B virus (HBV) infection, exacerbations of chronic hepatitis B (CHB) are common. We studied the clinical, biochemical, and virologic characteristics of patients first presenting clinically with features of acute icteric hepatitis B, to identify features that might differentiate between acute viral hepatitis B (AVHB) from first episode of exacerbation of chronic hepatitis (ECHB). We retrospectively analyzed 79 patients (mean age 35.4 ± 14 years; M:F = 60:19) who first presented clinically as AVHB, within 4 weeks of onset of symptoms. Patients who on follow-up cleared HBsAg and/or did not develop any clinical, radiologic, or histologic evidence of chronic liver disease (CLD) were categorized as AVHB (group 1). Patients who had persistence of HBsAg and developed clinical, biochemical, radiologic, or histologic evidence of chronic liver disease were categorized as ECHB (group 2). Forty-nine patients were in group 1 and 30 in group 2. The 2 groups were comparable with respect to prodrome, onset of jaundice, serum bilirubin, ALT, prothrombin time prolongation, serum albumin, and A/G ratio. Among group 1 patients, 78% had IgM anti-HBc positive in titers > 1:1000; in group 2, there were negative or positive in titers < 1:1000 in 70% patients (P < .001). Forty-seven of 49 (95.9%) patients in group 1 had HBV-DNA levels < 0.5 pg/mL, whereas 26 of 30 (86.73%) patients in group 2 had levels > 0.5 pg/mL (P ≤ .001). Quantitative HBV DNA and IgM anti-HBc titers at initial presentation can differentiate patients with a true episode of acute hepatitis B from patients with first episode of symptomatic exacerbation of chronic hepatitis B. Clinical and biochemical features do not help in differentiating the two.     

外周血DNT细胞和T细胞亚群检测在乙型肝炎病毒感染者诊断中的意义

目的：探讨乙型肝炎病毒感染者外周血CD3＋CD4-CD8-T细胞（DNT）和T细胞亚群的变化及意义。方法使用流式细胞仪检测136例乙型肝炎病毒感染者,包括33例无症状携带者、28例急性乙型肝炎患者、28例轻度慢性乙型肝炎患者、25例中度慢性乙型肝炎患者、22例重度慢性乙型肝炎患者和39例健康人外周血DNT细胞及T细胞亚群。结果健康人群和急性乙型肝炎患者外周血DNT细胞比例分别为（4.82±3.43）%和（4.75±2.71）%,显著低于无症状携带者[（5.43±3.31）%,P〈0.05]和慢性乙型肝炎患者（P〈0.05）;轻度慢性乙型肝炎患者DNT细胞比例为（7.97±4.12）%,显著低于重度慢性乙型肝炎患者[（11.36±5.01）%,P〈0.05];中度慢性乙型肝炎患者DNT细胞比例为（8.41±4.93）%,也显著低于重度慢性乙型肝炎患者（P〈0.05）;健康人、急性乙型肝炎患者和无症状携带者之间 T 淋巴细胞亚群分布无明显差异,但随着慢性乙型肝炎患者病情加重,外周血 CD3＋、CD3＋CD4＋CD8-细胞比例降低（P〈0.05）,CD3＋CD4-CD8＋细胞比例升高（P〈0.05）。结论外周血DNT细胞比例的升高与乙型肝炎病毒感染者慢性化及慢性乙型肝炎患者的疾病进程有关。     

慢性乙型肝炎的病理与临床

目的：提高慢性乙型肝炎临床诊断的正确性。方法：对202例慢性乙型肝炎患者的临床表现，血液生物化学指标[血清总胆红素（TBil)，白蛋白(ALB),凝血酶原活动度（PTA），ALT，白蛋白／球蛋白比值（A／G），r-球蛋白（GGT）]与病理分级分度进行对比分析。结果：临床表现如乏力，纳差，厌油，腹胀，鼻／牙龈出血及肝掌，蜘蛛痣，脾静脉增宽,胆囊炎与肝组织炎症活动密切相关；TBil,ALT,GGT上升及Alb,A/G比值，PTA下降均与肝组织炎症程度加重有关。6项指标中，轻度慢性肝炎临床与病理诊断符合率较高，为63.8%-79.0% ,其次为重度慢性肝炎，为40.0%-62.5%，符合率最低的是中度慢性肝炎，为10.0%-28.2%。结论：临床诊断时要高度重视临床症状，体征的变化，可适当放宽临床分度中有关中度异常值范围。     

Comparison of clinical, virologic and pathologic features in patients with acute hepatitis B and C

BACKGROUND AND AIMS: The clinical outcomes of adult-acquired acute infection of hepatitis C virus (HCV) and hepatitis B virus (HBV) are quite different. In order to compare the clinical, biochemical, virologic and pathologic pictures in these two groups of patients, we enrolled 22 adult patients with acute hepatitis C and 16 adult patients with acute hepatitis B, on whom liver biopsies were performed within 3 months of acute onset of the illness. RESULTS: The results showed that a significantly younger age, a higher ratio of the clinical symptoms of jaundice, nausea, vomiting, and poor appetite, a higher mean serum level of alanine transaminase, aspartate transaminase, and total bilirubin were present in patients with acute hepatitis B patients than in those with acute hepatitis C (P < 0.05). There was a significantly higher degree of periportal inflammation and total necro-inflammatory activity in the acute hepatitis B patients (P = 0.002 and 0.049, respectively). Fifteen (68.2%) of the 22 patients with acute hepatitis C had detectable serum HCV-RNA, but only two (14.3%) of the 14 tested patients with acute hepatitis B had detectable serum HBV-DNA, detected by using the branched DNA signal amplification assay. Eighteen (82%) of the 22 acute hepatitis C patients and none of the 16 acute hepatitis B patients progressed into a chronic hepatitis stage (P < 0.001). CONCLUSION: The manifestations of mild clinical symptoms, lower mean serum transaminases and bilirubin levels, a lesser degree of histological periportal necroinflammation, and more patients with a high circulatory viral load among the acute hepatitis C patients, may lead to more of that group developing chronicity than patients with acute hepatitis B.