非疫苗源性因素与新生儿乙肝疫苗免疫预防效果的关系

本文对新生儿出生体重,性别、母亲 HBsAg 携带状态等非疫源性因素与乙肝疫苗免疫效果的关系作了分析。结果表明,新生儿出生体重与乙肝疫苗免疫应答反应有关,低体重儿免疫应答率高,而超重儿应答率低。在不同的体重组、加强或未加强组以及 HBsAg( )或(-)母亲组,女性抗-HBs 阳性率高于男性。HBsAg( )母亲及(-)母亲所生婴儿的 HBsAg( )率差异非常显著(p<0.01),但接受疫苗注射后的抗-HBs 阳性率及高滴度所占的比例差异不显著。     

低分子肝素治疗急性缺血性脑卒中的临床研究

肝素用于治疗短暂性脑缺血发作 (ＴＩＡ)、进展型脑卒中及急性部分缺血性脑卒中已有 5 0多年的历史 ,并取得一定的疗效。但另一些研究却认为肝素有增加出血的危险性 ,因而不宜用于治疗脑梗死。 80年代由于新一代生物利用度高、引起出血等并发症少的抗凝药———低分子肝素 (ＬＭＷＨ)的出现 ,选用低分子肝素作为抗凝药又引起大家的广泛兴趣[1,2 ] 。现将我科 1997年 1月至 2 0 0 0年 12月用低分子肝素治疗脑梗死的临床研究报告如下。1　一般资料1.1　病例入选标准　①急性脑梗死 (颈动脉系统 )发病 4 8ｈ以内 ;②没有昏迷 ;③头颅ＣＴ或ＭＲ…     

巨噬细胞移动抑制因子对2型糖尿病患者血管病变的影响

目的探讨2型糖尿病(T2DM)患者血清巨噬细胞移动抑制因子(MIF)水平变化及其对糖尿病血管病变的影响。方法用ELISA法检测T2DM合并血管病变患者(A组,19例)、T2DM无血管病变患者(B组,19例)和健康体检者(C组,16例)血清MIF和超敏C反应蛋白(hs-CRP)。同时检测血糖(BG)和糖化血红蛋白(HbA1c)。结果 A组和B组MIF、hs-CRP水平均高于C组(P<0.01)。A组hs-CRP与血糖呈正相关。B组MIF与hs-CRP、BG水平呈正相关,hs-CRP与BG、HbA1c水平呈正相关。结论糖尿病血管病变患者MIF与hs-CRP高表达是促进血管病变发生的重要因素。     

乙肝疫苗母-婴阻断失败者病毒全基因变异分析

Objective To determine the factors responsible for failed postnatal immunoprophylaxis for hepatitis B virus(HBV) in Qidong, China. Methods Eleven children who developed into chronic HBV infection after receiving HBIG and HBV recombinant vaccines were recruited into the study. Eleven paired mothers with chronic hepatitis and other 6 mothers whose children successfully generated anti-HBs after im-munoprophylaxis were included as the control in the study. Full-length HBV DNA was amplified through ser-um sample by PCR method and underwent cloning and sequencing. HBV DNA level was quantified by real-time PCR. Results The mean levels of HBV DNA in mothers who had HBV DNA positive children and healthy children were ( 1.2 ×107± 3.1 × 106 ) copies/ml and ( 1.6× 107±8.8×106 ) copies/ml, respec-tively. There was no significant difference between the groups (P >0.05). Meanwhile, viral load in chil-dren was unrelated to that in their mothers (r2 =0.2429). In 11 HBV DNA positive children, 4(36.4% ) demonstrated amino acid substitutions in HBsAg "a" determinant region with 6 different types, I.e. T125A, I126T, Q129H, M133V, D144V and G145A. All of the mothers showed the wild-type sequence in "a" epitope, indicating surface escape mutants were not acquired from the initial infection, but developed under the immune pressure. The mutation rates after immunoprophylaxis for preS1, preS2, S, X, preC/C and P genes were 0.38%, 0. 22%, 0.27%, 0.17%, 0.11%, and 0.11%, respectively, nt2999-3157 in preS1, nt529-677 in S, nt1955-2016 in C, nt923-1001 and nt2489-2602 in P genes were among the hottest muta-tional spots throughout the HBV genome. Conclusion HBV mutation may occur in all the open readingframes after passive and active immunoprophylaxis. In addition to S gene, HBV preS and P genes could alsoassociate with the escape mutants.     

肝癌高发区肝癌患者乙、丙、丁型肝炎病毒重叠感染情况

乙肝病毒(HBV)对肝癌病因学的作用经广泛研究后得到充分肯定。但乙型肝炎病毒与丙、丁型肝炎病毒(HCV、HDV)在启东肝癌高发区肝癌患中的感染情况尚未有报道。本采用ELISA法对50例HBsAg阳性肝癌患进行了HCV和HDV血清学检测，现报道如下。     

肝癌患者乙、丙、丁、庚型肝炎病毒感染状况分析

原发性肝癌是常见的 10种恶性肿瘤之一 ,已占我国居民恶性肿瘤死亡的第 2位 [1 ] 。病毒性肝炎则是危害人类健康最严重的一种传染病 ,我国年罹患率高达 10 0 / 10万～ 2 0 0 / 10万 ,在国际上被划为高度流行区 [2 ]。乙型肝炎病毒(HBV)在肝癌病因学的作用已得到肯定。但丙型肝炎病毒 (HCV)、丁型肝炎病毒 (HDV )与庚型肝炎病毒 (HGV )是否具有促进 HBV的致癌作用则报道甚少。为了解肝癌高发区启东地区 HBV、HCV、HDV与 HGV感染对肝癌发生的意义 ,我们采用血清流行病学调查的方法对 10 0例肝癌患者 HBV、HCV、HDV与 HGV血清…     

乙肝疫苗母-婴阻断失败者病毒全基因变异分析

Objective To determine the factors responsible for failed postnatal immunoprophylaxis for hepatitis B virus(HBV) in Qidong, China. Methods Eleven children who developed into chronic HBV infection after receiving HBIG and HBV recombinant vaccines were recruited into the study. Eleven paired mothers with chronic hepatitis and other 6 mothers whose children successfully generated anti-HBs after im-munoprophylaxis were included as the control in the study. Full-length HBV DNA was amplified through ser-um sample by PCR method and underwent cloning and sequencing. HBV DNA level was quantified by real-time PCR. Results The mean levels of HBV DNA in mothers who had HBV DNA positive children and healthy children were ( 1.2 ×107± 3.1 × 106 ) copies/ml and ( 1.6× 107±8.8×106 ) copies/ml, respec-tively. There was no significant difference between the groups (P >0.05). Meanwhile, viral load in chil-dren was unrelated to that in their mothers (r2 =0.2429). In 11 HBV DNA positive children, 4(36.4% ) demonstrated amino acid substitutions in HBsAg "a" determinant region with 6 different types, I.e. T125A, I126T, Q129H, M133V, D144V and G145A. All of the mothers showed the wild-type sequence in "a" epitope, indicating surface escape mutants were not acquired from the initial infection, but developed under the immune pressure. The mutation rates after immunoprophylaxis for preS1, preS2, S, X, preC/C and P genes were 0.38%, 0. 22%, 0.27%, 0.17%, 0.11%, and 0.11%, respectively, nt2999-3157 in preS1, nt529-677 in S, nt1955-2016 in C, nt923-1001 and nt2489-2602 in P genes were among the hottest muta-tional spots throughout the HBV genome. Conclusion HBV mutation may occur in all the open readingframes after passive and active immunoprophylaxis. In addition to S gene, HBV preS and P genes could alsoassociate with the escape mutants.     

慢性乙肝患者补硒后HBV血清标志物动态变化10年追踪

目的:观察慢性乙肝患者服用亚硒酸钠片剂后血清HBV 5项标志物动态变化。方法:持续检测补硒组和对照组慢性乙肝患者在服硒前、服硒期间(3年)和服硒后(7年)各阶段的血清HBV 5项标志物。结果:服硒1年、2年、3年时,补硒组HBsAg转阴率分别为15.6%、19.4%和19.2%;对照组为9.8%、12.0%和13.9%;停服后1年时,两组分别为21.5%和13.1%,相比均有极显著差异(P值在0.012~0.001范围)。停服后7年时,血清HBV 5项标志物完全正常者在补硒组中有6.5%(16/246),对照组中1.2%(3/254),差异有显著性(P双侧=0.002)。但此时两组HBsAg转阴率亦无显著差异(P=0.656);抗-HBs阳转动态亦有差异。结论:补硒在一定时期内能使乙肝患者HBsAg转阴率提高,并在一定程度上增强机体清除HBV的能力,但必须长期服用才能显示其良好的疗效。     

启东乙肝干预研究30年随访人群烟酒嗜好、转氨酶及治疗史的横断面分析

目的 了解启东乙型肝炎干预研究队列人群在达到婚配年龄后的社会学人口特征、烟酒嗜好及疾病史信息。 方法 2013年1-10月采用横断面调查方法,分别对启东乙型肝炎干预研究的疫苗组与对照组研究对象分层随机抽样,采用自行设计的问卷收集研究对象的基本信息、个人生活习惯、疾病史等资料。 结果 共随访调查8 423人,疫苗组及对照组中男性分别占47.61%和46.62%,两组间男女性别差异无统计学意义(χ²=0.833,P=0.362)。两组男性目前吸烟率分别为48.36%和48.12%,差异无统计学意义(χ²=0.022,P=0.883)。疫苗组男性饮酒率22.84%低于对照组的28.87%,差异有统计学意义(χ²=18.844,P<0.001)。疾病史调查结果两组中2.86%和5.50%的研究对象有过转氨酶升高,差异有统计学意义(χ²=37.274,P<0.001),1.18%和2.13%的研究对象进行过抗乙肝病毒治疗,差异有统计学意义(χ²=7.124,P=0.008)。 结论 本次研究获得了研究对象的吸烟、饮酒、转氨酶及乙肝治疗史等重要信息,为肝癌及其他慢性病的病因研究提供了可靠资源;还需进一步优化问卷设计和实施,以获得更准确的流行病学信息。     

血清肝纤维化指标与B超部分肝实质图象的比较

目的 :为了解早期肝纤维化的B型超声波检查 (B超 )结果与血清肝纤维化指标之间的相关性。方法 :除去B超示占位性病变和 (或 )腹腔积液者 ,对B超肝实质回声显示“光点较粗较密 ,分布尚均”的 136例 (第一组 )和肝实质回声示“光点粗 ,分布不均匀 ,呈条索状或蜂窝状或斑片状改变”90例 (第二组 ) ,进行了血清透明质酸 (HA)、Ⅲ型前胶原 (PCⅢ )、Ⅳ型胶原(ⅣC)和层粘连蛋白 (LN)测定。结果 :两组患者的血清肝纤维化指标检测阳性率以HA最高 ,ⅣC次之 ,PCⅢ和LN较低。第一组HA和 -ⅣC阳性率低于第二组 ;其中HA阳性率在两组间有显著差异 (P <0 .0 1)。另外二项检测指标在两组间无可比性。第一组中 10 8例无脾肿大者可以视作基本正常图象 ,但HA、PCⅢ、Ⅳ -C和LN的阳性率分别为 6 8.5 %、4 2 .6 %、6 4 .8%和 4 4 .4 %。第二组B超图象呈明显病变 ,但有 8.9%患者肝纤维化指标阴性 ,与B超图象未达一致性。结论 :四项血清纤维化指标与B超的相关性HA >Ⅳ -C >PCⅢ和LN ,HA是比较理想的早期诊断指标。血清纤维化指标与B超的不一致性可能为患者肝脏处于炎症和纤维化静止期。