散发性戊型肝炎病毒感染的诊断

用基因工程重组的戊型肝炎病毒基因结构区第二码框架和第二读码框架具有免疫表位的嵌合抗原，建立了间接酶联免疫法，检测散发性急性肝炎病人血清中抗－ＨＥＶＩｇＧ和ＩｇＭ抗体。在４６例急性肝炎病人中出抗－ＨＥＶＩｇＧ抗体阳性７例，阳性率为１５．２２％，７例ＩｇＧ抗体阳性中，有５例ＩｇＭ抗体也阳性，占７１．４％。     

A patient with hepatic granuloma formation and angiotensin-converting enzyme production by granuloma cells during clinical relapse of hepatitis A

Elevation of the serum angiotensin-converting enzyme (sACE) level and hepatic granulomas were found during a clinical relapse in a 22 year old patient with acute viral hepatitis type A (AVH-A). The serum transaminase level and sACE level remained high for more than 6 months. In the biopsied specimen of the liver, fibrous rings of granulomas composed of collagen types I, III, and V were observed. Furthermore, the localization of ACE was visible in the rough endoplasmic reticulum of epithelioid cells of granulomas in the liver under electron microscopy using the indirect immunoperoxidase method. These results suggest that granuloma cells in the liver caused by hepatitis A may be involved in ACE production. In addition, other diseases associated with the presence of granulomas in the liver, such as lymphoma, cytomegalovirus infection, visceral leishmaniasis, and lupoid hepatitis, were ruled out. However, the hepatic granulomas disappeared with the healing of AVH-A. In this regard, the present case is considered to be one of the very few cases of hepatic sarcoidosis.     

抗SARS病毒N蛋白单克隆抗体的制备和初步应用

目的 制备抗SARS病毒N蛋白的单克隆抗体并研究其初步应用。方法 用基因重组N蛋白免疫小鼠，取免疫后的鼠脾细胞与骨髓瘤细胞融合，筛选分泌抗SAPS病毒N蛋白单克隆抗体细胞株。将阳性细胞株接种小鼠腹腔制备单克隆抗体腹水并对抗体进行纯化，分析纯化抗体的相对亲和力。选择亲和力较高的抗体制备检测SARS病毒抗原的酶联免疫诊断试剂，并对其敏感性和特异性进行分析。结果 共获得11株单克隆抗体细胞株，其中3株单抗与N蛋白具有较高的亲和力，4株纯化单抗与N蛋白反应很弱，其余4株单抗介于两者之间。用亲和力较高的单抗制备检测SARS病毒抗原的诊断试剂，其敏感性可达31PFU／ml，而且与其他呼吸道病毒无交叉反应。结论 该试剂特异性较好，可用于SARS病毒抗原的检测，其敏感性仍需用临床急性期样品进行评价。     

一起戊型肝炎暴发的血清抗体比较研究

目的评价戊型肝炎(戊肝)抗体E2-IgM(抗-HEV E2-IgM)酶联免疫试剂(捕获法)在反映戊肝流行特征和对戊肝早期诊断中的作用.方法在首发病例26 d后对某单位戊肝暴发人群和相邻单位对照人群进行血清抗-HEV E2-IgM、IgG检测;部分人群进行美国Genelabs抗-HEV IgM、IgG的平行检测.结果抗-HEV E2-IgM试剂捕获法在对照人群中仅检出1例阳性(0.11%),且阳性和阴性之间可明显区分,其特异度为99.89%;在暴发流行人群中检出145例阳性(8.66%),显著高于对照人群(P＜0.001);暴发人群中戊肝患者的血清学动态变化为抗-HEV E2-IgM在暴露时间为30～60d时保持较高吸光度(A值),随着时间的延长A值呈明显下降趋势;抗-HEV E2-IgM阳性在该组人群中与性别和年龄无关;在暴发人群抗-HEV E2-IgM(+)的115例患者中,Genelabs抗-HEV IgG检测出88份阳性,检出率为76.52%,漏检27例,漏检率为23.48%.对照人群随机抽样179例患者中有20例Genelabs抗-HEVI IgG(+),阳性率为11.17%.在110份抗-HEV E2-IgM(+)的血样中,Genelabs抗-HEVIgM只检测出76份,检出率为69.09%;有16例患者Genelabs抗-HEV IgG、IgM均未能检出;Genelabs抗-HEV IgG和IgM的不一致率为25.45%.结论抗-HEV E2-IgM具有99%左右的特异度,与在正常人群中检出较高阳性率的Genelabs抗-HEV IgG试剂相比,减少了假阳性;抗-HEV E2-IgM与Genelabs抗-HEV IgM、IgG相比,对急性戊肝感染诊断的灵敏度提高了25%～30%,减少了漏诊;抗-HEV E2-IgM试剂盒操作简单、快速,本底较好,不存在酶结合物不足的问题.     

小儿巨细胞病毒性肝炎治疗的临床对照研究

目的　探讨小儿巨细胞病毒 (HCMV)肝炎的有效治疗方法。方法　将诊断为小儿HCMV肝炎的 2 5例分为治疗组和对照组 ,对照组给予泼尼松、肝太乐、消炎利胆片及苯巴比妥等 ,治疗组在此基础上给予更昔洛韦 (GCV) 静脉用免疫球蛋白 (IVIG) ,分别在治疗前、出院时检查血常规、肝功能和HCMVDNA拷贝数 ,并在出院后 3个月、6个月、9个月随访 ,检查患儿的症状、体征和HCMV定量。结果　治疗组在 5个时点 (治疗前、出院时、3个月、6个月、9个月 )HCMVDNA拷贝数明显下降 ,治疗组和对照组之间用药前后比较 ,在住院天数、黄疸开始消退时间及黄疸完全消退时间的差异有显著意义 ,治疗组输血率明显减少 (P <0 0 5 )。结论　GCV联合IVIG治疗小儿HCMV肝炎能明显降低病毒量 ,缩短病程 ,减轻症状 ,又可纠正贫血 ,减少输血机会 ,未见明显副作用。     

Prevalence of viral infection markers by polymerase chain reaction amplification and interferon-alpha measurements among patients undergoing lumbar puncture in an emergency department

Aseptic meningitis is a frequent diagnosis in emergency departments. Nevertheless, viral investigations are not carried out currently and the viral etiology in adult population has not been studied extensively. We conducted a prospective study including all consecutive patients undergoing lumbar puncture during a 15 months period in an adult emergency department. Bloody and purulent cerebrospinal fluid (CSF) were excluded. The main tests undertaken were: CSF genomic amplification by the polymerase chain reaction (PCR) for neurotropic viruses and serum and CSF interferon-alpha (IFN-alpha) measurements. Among 194 patients included, 45 had and 149 did not have aseptic meningitis. Of 45 patients with aseptic meningitis, 10 had alternative non-virological final diagnosis, and 35/45 were presumed to have neurological disorders of viral origin. Patients (27/35) completed virological analysis: 21/27 (78%) had either positive viral PCR (enterovirus: 8 patients, Varicella zoster virus (VZV): 5, Epstein-Barr virus (EBV): 2, herpes simplex virus (HSV): 1, human herpes virus 6: 1) or only raised serum or CSF IFN-alpha (4 patients). Overall, 59% of patients with a positive viral PCR had either CSF or serum raised IFN-alpha. Twentyone patients without meningitis had either positive viral PCR (enterovirus: 3 patients) or only high serum IFN-alpha level (18 patients). In the setting of aseptic meningitis diagnosed in an adult emergency department, viruses are the most common agents encountered, with enterovirus and VZV as the two main etiological agents. Current CSF viral genome amplification and IFN-alpha measurement are informative and could be useful to confirm the viral origin of various neurological disorders, although the sensitivity and specificity of IFN-alpha measurement for the diagnosis of viral infection need further confirmation.     

Murine acinar pancreatitis preceding necrotizing myocarditis after Coxsackievirus B3 inoculation.

Balb/C weanling mice were inoculated intraperitoneally with a myocarditic variant of coxsackie-virus B3, with the aim of characterizing more fully the cell damage induced in the heart as well as in other organs. During the first week postinfection (pi), all animals developed acinar pancreatitis, followed by focal myocarditis. In accordance with the increasing infectivity titers, such progressive histopathological changes correlated with local viral replication. From day 4 pi, acinar degeneration accompanied by diffuse inflammatory exudate was observed in the pancreas, followed by fatty tissue replacement by day 8. In the heart, focal necrosis rather than inflammatory reaction first appeared at 4 days pi and became widespread by 6-8 days pi. Necrotic foci usually presented calcium deposits, with absence of myofibrils in the affected fibers. The fact that both periodic acid Schiff (PAS) and Best carmine staining remained positive even after diastase treatment ruled out basophilic necrosis. In summary, the pancreas appeared to be the site of primary viral replication leading to viremia.     

Hepatitis B virus-DNA in the serum of patients followed-up longitudinally with acute and chronic hepatitis B

Sera from 79 patients with acute self-limiting hepatitis, 17 patients with acute hepatitis B evolving into chronic HBsAg carriership, and 43 chronic HBsAg carriers without a history of acute hepatitis were analyzed for presence of hepatitis B virus (HBV)-DNA by a molecular hybridization technique. In acute self-limiting hepatitis, HBV-DNA was cleared within a few weeks after the onset of clinical symptoms. The longest period of DNA positivity observed in this group was 42 days. In 29 of 52 patients HBV-DNA was cleared before HBeAg disappeared. Among 17 patients who became chronic HBsAg carriers, HBV-DNA was present for more than 6 months in all but one. Most of the HBsAg carriers eventually cleared HBV-DNA. The DNA clearance frequently preceeded the conversion of HBeAg to anti-HBe. Thus, in many patients there was a transitional period with HBeAg but without HBV-DNA. HBV-DNA was found to be a better index of impending chronicity than HBeAg since persistence of HBeAg for more than 42 days was noted in 10% of the patients who nevertheless cleared HBsAg within 6 months. By that time all those patients had turned negative for HBV-DNA. On the other hand, in 16 of the 17 patients who became chronic carriers of HBsAg, HBV-DNA as well as HBeAg persisted for more than 6 months. The present results also suggest that infectivity in acute hepatitis B is a feature mainly of the presymptomatic and early symptomatic period.     

用标记分析法检测我国海南省登革2型病毒抗原性变化

我们试用标记分析法,用3种单克隆抗体(黄病毒科特异性、登革病毒属特异性和登革病毒2型型特异性单克隆抗体)研究了我国海南省1985～1987年3年内流行的登革2型病毒8个流行株的抗原性变化,并与标准株新几内亚B株进行了比较。发现6株与标准株类似,2株显示出明显的差异。标记分析法为病毒抗原分析提供了一个简便、快速的方法,可用来监测一个地区病毒株群的变化及新株的传入。     

Chronic hepatitis C infection: influence of the viral load, genotypes, and GBV-C/HGV coinfection on the severity of the disease in a Brazilian population

The distributions of the different genotypes of the hepatitis C virus (HCV) and GBV-C virus (GBV-C/HGV) vary geographically and information worldwide is still incomplete. In particular, there are few data on the distribution of genotypes (and their relationship to the severity of liver disease) in South America. Findings are described in 114 consecutive patients from Northeast Brazil (median age 52 years, range 18-72 years) who had abnormal levels of serum aminotransferases and seropositivity for HCV RNA. The patients were recruited from an outpatient clinic between November 1997 and April 1998. Quantitative HCV RNA and GBV-C/HGV RNA estimations were carried out by double-nested polymerase chain reaction (PCR) using primers from the 5'-untranslated regions (UTRs) of the genomes. HCV genotypes were determined by restriction fragment length polymorphism (RFLP) analysis with 5'-UTR primers and by PCR with type-specific 5'-UTR primers. GBV-C/HGV-RNA genotypes were determined by RFLP with specific 5'-UTR primers and phylogenetic trees were constructed using the Neighbour-Joining and Drawtree programs. Histological features were graded and staged according to international criteria. Of the 114 patients, 35 (30.7%) patients had cirrhosis and 22 (27.8%) had mild, 51 (64.6%) had moderate, and 6 (7.6%) had severe chronic hepatitis. Median HCV viral load was 10(6) genome equivalents per millilitre (range 10(4)-10(9)/ml). Frequencies of genotypes were 5.3% type 1a, 44.7% type 1b, 3.5% type 2, 41.2% type 3, and 5.3% mixed types. GBV-C/HGV-RNA was detected in the sera of 12 (10.5%) patients and was distributed among three phylogenetic groups. There were no significant differences between patients with the predominant HCV genotypes (1b and 3) with respect to gender, age group, viral load, severity of liver disease, or coinfection with GBV-C/HGV.