慢性丙肝患者干扰素治疗前后血清细胞因子的变化

目的 :探讨细胞因子在慢性丙型肝炎发病机制中的作用。方法:2 0例慢性丙型肝炎患者应用干扰素联合利巴韦林抗病毒治疗 2 4周。于治疗前后用 EL ISA法检测血清 IL- 2、IFN- γ、IL- 4、IL- 10水平 ,同时检测生化和病毒指标并观察不良反应。结果:抗病毒治疗后 IL- 2、IFN- γ、IL- 4、IL- 10水平发生了明显变化。与治疗前比较 ,IL- 2、IFN- γ水平逐渐升高 ,IL- 4、IL- 10水平逐渐降低 ,其中 IL- 2、IL- 10水平变化具有统计学意义 (P<0 .0 1)。对干扰素完全应答者 15例 ,IL- 2、IL- 10水平变化具有统计学意义 (P<0 .0 5 ) ;无应答者 5例 ,IL- 2、IFN- γ、IL- 4、IL- 10水平变化无统计学意义 (P >0 .0 5 )。抗病毒治疗过程中无严重不良反应。 结论:IL - 2、IL - 4、IL - 10、IFN-γ共同参与了丙型肝炎的发病。干扰素联合利巴韦林通过调整机体的免疫状态而发挥抗病毒效应 ,IL - 2、IL - 10可以作为预测抗病毒疗效的指标之一。     

慢性乙型病毒性肝炎患者外周血T淋巴细胞亚群CD27和CD28的表达

目的分析慢性乙型病毒性肝炎患者外周血T淋巴细胞亚群CD27和CD28的表达,初步探讨其分化表型。方法采集分离健康人和慢性乙型病毒性肝炎患者外周血单个核细胞(PBMC),利用多种荧光标记抗体标记细胞表面分子,再用流式细胞仪检测CD8 和CD4 T淋巴细胞表面CD27和CD28分子的表达。结果31例慢性乙型病毒性肝炎患者CD8 CD27 CD28 T细胞占CD8 T细胞(41.13±24.89)%,低于28例健康对照组的(71.93±14.47)%(P<0.05)。而CD8 CD27-CD28-T细胞占CD8 T细胞(42.16±10.98)%,显著高于健康对照组的(9.16±5.24)%(P<0.01)。慢性乙型病毒性肝炎患者CD4 CD27 CD28 T细胞(80.89±7.93)%和健康对照组(83.17±8.31)%比较,差异无统计学意义。结论健康人外周血T淋巴细胞以CD27 CD28 早期分化表型为主。而慢性乙型病毒性肝炎患者外周血中不同的亚群分化特征又有所不同,CD4 T淋巴细胞的分化表型仍然以CD27 CD28 早期分化表型为主,而CD8 T淋巴细胞中早期分化表型明显减少,晚期分化表型(CD27-CD28-)显著增加。     

合并乙肝的涂阳肺结核病人DOTS中肝损害观察

目的 观察免费板式组合药在DOTS中对合并乙肝的涂阳肺结核病人肝损害情况。方法 比较HBsAg、HBeAg、HBcAb阳性的涂阳肺结核病人与无乙肝的涂阳肺结核病人DOTS前后肝功能损害情况。结果 合并乙肝病人肝损害发生率66．3％，无乙肝者肝损害发生率8．6％，两者相比差异有显著性（P〈0．01）。22．5％病人因肝损害需更改治疗方案。结论 DOTS中合并乙肝的病人采用板式组合药用2H3R3Z3E3／4H3R3方案易发生肝损害，对这类病人应慎用常规方案，并要密切全程观察肝功能，尽可能应用肝损害较小的抗结核药。     

拉米夫定对慢性乙型肝炎的疗效及肝脏组织病理学改变

目的:从血清生化,病毒学,肝纤维化指标以及肝脏组织病理学改变的角度分析拉米夫定(LMD)治疗慢性乙型肝炎的疗效.方法:慢性乙型肝炎患者21例,给予口服LMD100 mg/d,连用1 a,动态观察服药0,24和48 wk肝功能、乙肝五项、HBV-DNA定量、血清肝纤维化指标透明质酸(HA)、层黏蛋白(LN)、Ⅲ型前胶原(PⅢP)和Ⅳ型胶原(ⅣC)的变化,通过肝组织穿刺活检,观察用药前后肝脏组织病理学的改变.结果:LMD治疗48 wk,可显著抑制HBV-DNA(copy/L)复制(6.13×109±4.03×105 vs 9.01×105±4.89×103,P＜0.01),使大多数患者肝功能(nkat/L,ALT:1697±907 vs550±503;AST:1787±717 vs 498±430)恢复正常(P＜0.01),显著降低血清肝纤维化指标水平(P＜0.01).减轻肝细胞坏死,汇管区炎细胞浸润及纤维化.结论:LMD是治疗慢性乙型肝炎的一种较为切实有效的措施.     

Acute urticaria and hepatitis complicating high-dose methotrexate therapy

We report an unusual case of anaphylaxis and hepatitic dysfunction in a child with the administration of the twenty-third course of high-dose methotrexate. The latter had been used as an adjuvant to prevent pulmonary metastases and the prior 22 courses had been well tolerated. An attempt to reinstate methotrexate after the twenty-third course was again followed by a similar reaction. © 1995 Wiley-Liss, Inc.     

广西急性散发性病毒性肝炎的血清流行病学研究

对广西１６６例住院急性散发性病毒性肝炎病毒性肝炎病例进行血清流行病学调查研究，结果表明，甲型，乙型，丙型，戊型，庚型肝炎生期感染指标检出率分别为４．８２％，５１．２０％，１３．８６％和１１．６４％，未分病例占１７．４２％，危险性因素分析表明，乙肝、丙肝和庚肝病人中有较高的肝病史、输血史和手术史。认为乙肝在急性散病毒性肝炎中占重要地位，医源性传播是主要传播途径 。     

Effect of hepatitis C antibody screening in blood donors on post-transfusion hepatitis in Taiwan

A national screening programme for antibody to hepatitis C virus (HCV) in blood donors in Taiwan began in July 1992 using a second-generation immunoassay. To study the impact of this screening on post-transfusion hepatitis in Taiwan, a prospective study on post-transfusion hepatitis, that was started in 1987, was continued. As of June 1994, 245 patients who received a blood transfusion after July 1992 had completed a follow-up period for more than 6 months post-transfusion. Of them, seven (2.8%) recipients developed acute post-transfusion hepatitis. The hepatitis in six cases could not be attributed to infection by hepatitis A, B, C, D, E viruses or cytomegalovirus (CMV) or Epstein-Barr virus (EBV). The remaining patient seroconverted to both IgG and IgM anti-CMV. All seven patients recovered in 6 months without development of chronicity, and the mean peak alanine aminotransferase level was lower compared with that of the cases before anti-HCV screening (i.e. pre-July 1992). These results indicate that the current anti-HCV screening has effectively interrupted HCV transmission through blood transfusion in Taiwan.     

Detection of IgA class antibody to hepatitis E virus in serum samples from patients with hepatitis E virus infection

A newly developed assay for IgA class antibody to hepatitis E virus (IgA anti-HEV) was used to study 145 serum samples collected during an outbreak of an enterically transmitted hepatitis that occurred in 3 villages in the lower Shebeli region of Southern Somalia between January, 1988 and November, 1989. A total of 52.4% of the afflicted patients were found positive for IgA anti-HEV, and 73.1% of these were also positive for IgM. Both antibodies disappeared during the convalescence period. Similar results were also seen in serum obtained from sporadic cases of acute waterborne hepatitis in Pakistan. © 1993 Wiley-Liss, Inc.     

HCV的检测方法

从发现丙型肝炎病毒以来 ,丙肝的检测技术发展迅速 ,灵敏度和特异性都有明显的提高 ,方法学在不断改进完善。笔者就近年来丙型肝炎的实验室检测方法作简要的综述     

HBV-M定量检测与HBV-DNA含量水平关系的初步探讨

目的 研究乙型肝炎病毒标志物定量检测结果与其HBV-DNA含量的临床关系。方法 采用时间分辨免疫定量和荧光定量-PCR技术，对HBV-DNA和HBV-DNA含量进行检测。结果 在HBsAg/HBeAg/HBcAb,HBsAg/HBcAb/HBcAb,HBeAg/IC及单纯HBcAb阳性的四个组别中，HBV-DNA阳性率分别是97.17%、30.56%、100%和25%；在HBsAg,HBeAg,HBeAb,HBcAb定量检测高，低值两组HBV-DNA含量对比中，HBV-DNA阳性率分别为76.92%、58.14%；100%、97.26%；20.00%、11.42%；64.62%、27.63%。结论 HBV-DNV比HBV-M更能及时准确反映乙型肝炎病毒感染者的病程情况。