多重引物聚合酶链反应扩增丙型肝炎病毒基因及基 …

利用聚合酶链反应（ＰＣＲ）技术对丙型肝炎病毒（ＨＣＶ）的５’－非编码区（５’－ＮＣＲ）、Ｃ及ＮＳ４基因区的３对引物分别及同时扩增，检测８０例抗－ＨＣＶ阳性患者的血清ＨＣＶ ＲＮＡ，并进行了ＨＣＶ基因分型研究。各不同引物所介导的ＰＣＲ检出ＨＣＶ ＲＮＡ的结果为：５’－ＮＣＲ基因区６０％（４８／８０），Ｃ基因区３７％（３０／８０），ＮＳ４基因区３０％（２４／８０）。以上３对引物同时扩增仅４２％（３４／     

输血后丙型肝炎与抗丙型肝炎病毒（HCV）阳性献血？…

采用丙型肝炎病毒（ＨＣＶ）５’－非编码区（５’－ＮＣＲ）和Ｃ区具有型特异性的引物建立的逆转录－聚合酶链反应方法检测了２５例丙型肝炎（ＨＣ）和２６例抗－ＨＣＶ阳性献血员的ＨＣＶ ＲＮＡ及基因型。结果２５例ＨＣ患者ＨＣＶ ＲＮＡ阳性率为１００．０％，２６例抗－ＨＣＶ阳性献血员ＨＣＶ ＲＮＡ阳性率为８４．５％，（２２／２６）。２５例ＨＣ中Ｉ、Ⅱ和混合型（Ｉ＋Ⅱ、Ⅱ＋Ⅲ、Ｉ＋Ⅲ、Ｉ＋Ⅱ＋Ⅲ）分别占８．０％     

合肥地区输血后慢性肝炎HCV基因分型研究

目的：探讨合肥地区输血后慢性肝炎ＨＣＶ感染的基因型。方法：用逆转录聚合酶链反应（ＲＴＰＣＲ）检测ＨＣＶＲＮＡ,对ＨＣＶＲＮＡ阳性标本用型特异引物ＰＣＲ进行ＨＣＶ分型。结果：６３ 例患者中检出ＨＣＶ　ＲＮＡ５４ 例,阳性率为８５．７％ ;其中Ⅱ型４６ 例（８５．２％）,Ⅲ型６ 例（１１．１％）,Ⅱ／Ⅲ型２ 例（３．７％）。结论：提示合肥地区ＨＣＶ感染大多数属Ⅱ型。     

乙/丙型肝炎病毒双重感染患者前C区终止变异低频率

目的了解乙型肝炎病毒（ＨＢＶ）与丙型肝炎病毒（ＨＣＶ）双重感染患者前Ｃ区基因变异，及其可能的临床意义。方法用聚合酶链反应（ＰＣＲ）与限制片段长度多态性（ＲＦＬＰ）来分析２５例ＨＢＶＤＮＡ和ＨＣＶＲＮＡ均阳性（Ａ组）和３１例ＨＢｓＡｇ和ＨＢＶＤＮＡ阳性但抗－ＨＣＶ和ＨＣＶＲＮＡ均阴性（Ｂ组）的慢性肝病患者前Ｃ区密码２８终止变异（终２８）。结果ＨＢＶ和ＨＣＶ双重感染患者（Ａ组）血清ＨＢＶＤＮＡ第１次ＰＣＲ阳性率（１６％）明显低于单独ＨＢＶ感染组（６５％）（Ｐ＜０．００１）；前Ｃ终２８检出率（２８％）亦明显低于单独ＨＢＶ感染（６８％）（Ｐ＜０．００１）。结论提示双重感染患者ＨＢＶ前Ｃ终止变异低频率可能与ＨＢＶ低水平复制有关     

利用双扩增聚合酶链反应检测非甲非乙型肝炎患者血清中丙型肝炎病毒RNA

利用丙型肝炎病毒（ＨＣＶ）５’－端序列合成两对引物，建立了灵敏、特异的ＨＣＶＲＮＡ双扩增聚合酶链反应检测方法。用此方法及第二代Ａｂｂｏｔｔ酶联抗－ＨＣＶ检测试剂盒，检测了４４例非甲非乙型肝炎患者血清及１０名抗－ＨＣＶ阴性健康人。在４４例患者中，４１例（９３％）ＨＣＶＲＮＡ阳性，３６例（８２％）抗－ＨＣＶ阳性，３３例（７５％）ＨＣＶＲＮＡ、抗－ＨＣＶ全部阳性。３例ＨＣＶＲＮＡ阴性，但抗－ＨＣＶ阳性，另外，有８例抗－ＨＣＶ阴性，ＨＣＶＲＮＡ阳性。１０名健康人ＨＣＶＲＮＡ均为阴性。结果表明，大部分（９２％）抗－ＨＣＶ阳性患者带有ＨＣＶ，但为了检测所有病毒血症患者，抗－ＨＣＶ检测是不够的，利用双扩增ＰＣＲ方法检测ＨＣＶＲＮＡ对于抗－ＨＣＶ阴性患者的诊断是非常有用的。     

中国湖南株丁型肝炎病毒cDNA（443－870）片段的克隆和序列分析

取１例湖南丁型肝炎病毒（ＨＤＶ）ＲＮＡ阳性血清，经强变性剂法抽提ＨＤＶＲＮＡ，逆转录－聚合酶链反应（ＲＴ－ＰＣＲ）扩增，扩增的ＨＤＶＣＤＮＡ片段重组到ｐＵＣ１８质粒中，获得了中国湖南株ＨＤＶＣＤＮＡ（４３３－８７０）片段克隆，ＤＮＡ测序结果显示，该片段（４３８ｈｐ长，包括一端ＰＣＲ引物２５ｈｐ）与已知的美国、意大利、法国、诺鲁和中国台湾５株ＨＤＶｃＤＮＡ相同片段比较，同源性分别为９１．３％，９４．５％，９１．３％，８４．５％和８９．３％，其中与ＨＤＶＲＮＡ复制密切相关的第一个高度保守区与美国株、意大利株和法国株完全同源。     

用聚合酶链反应检测人肝细胞癌乙型肝炎病毒DNA和丙型肝炎病毒RNA

为研究乙型肝炎病毒ＤＮＡ（ＨＢＶＤＮＡ）和丙型肝炎病毒ＲＮＡ（ＨＣＶＤＮＡ）与肝细胞癌的关系，用聚合酶链反应（ＰＣＲ）和巢式ＰＣＲ（ｎｅｓｔｅｄ－ＰＣＲ）分别检测４２例肝肿瘤组织中ＨＢＶＤＮＡ和ＨＣＶＲＮＡ。结果：１例胆管细胞癌组织ＨＢＶＤＮＡ和ＨＣＶＲＮＡ均阳性，１例胆管囊腺瘤ＨＢＶＤＮＡ阳性。４０例肝细胞癌组织中，单纯ＨＢＶＤＮＡ阳性１９例，单纯ＨＣＶＲＮＡ阳性３例，二者均阳性１０例。ＨＢＶＤＮＡ阳性率７２．５％，ＨＣＶＲＮＡ阳性率３２．５％。ＨＢＶＤＮＡ和ＨＣＶＲＮＡ感染与肝癌组织学分型无关；且肝细胞癌中ＨＣＶ感染与ＨＢＶ未见相关。结果提示，我国ＨＢＶ感染仍是引起肝细胞癌的主要原因。但由于肝细胞癌患者中ＨＣＶ的感染率也较高，且有上升趋势，因此ＨＣＶ可能也是肝细胞癌发生的重要原因之一。     

深圳地区不同人群庚型肝炎病毒感染的分子流行病学调查

在庚型肝炎病毒（ＨＧＶ）基因５’端非编码区（５’－ＵＴＲ）设计两对套式引物，建立检测ＨＧＶＲＮＡ的逆转录－巢式聚合酶链反应（ＲＴ－ｎｅｓｔｅｄＰＣＲ）。对深圳地区１０６例职业献血员、１６８例肝炎病人及８０例静脉毒瘾者进行ＨＧＶＲＮＡ的检测，阳性率分别为８．５％、７．７％与４６．３％，前两者与后者相比较差异均有显著性意义（Ｐ＜０．０１）。６１例慢性乙型肝炎与３３例慢性丙型肝炎病人ＨＧＶＲＮＡ阳性率分别为８．２％与２１．２％。３３例慢性丙型肝炎病人中，１５例接触过血液或血制品的病人ＨＧＶＲＮＡ阳性率为４０．０％，明显高于１８例无血液或血制品接触史者（Ｐ＜０．０５）。本研究结果提示深圳地区职业献血员中ＨＧＶ携带者较常见；静脉毒瘾者是ＨＧＶ感染的高危人群；慢性丙型肝炎常重叠ＨＧＶ感染，主要与接触血液或血制品有关。故对献血员进行ＨＧＶ筛查将减少输血后ＨＧＶ感染的发生     

丙型肝炎病毒基因型与血清HCV RNA含量关系及与干扰素应答的研究

目的探讨丙型肝炎病毒（ＨＣＶ）基因型与血清ＨＣＶＲＮＡ含量的关系及其对干扰素应答的影响。方法应用定量荧光ＰＣＲ（Ａｍｐｌｉｓｅｎｓｏｒ－ＰＣＲ）技术检测了１３５例不同基因型ＨＣＶ感染的慢性丙型肝炎患者血清ＨＣＶＲＮＡ含量，另对其中７７例进行干扰素治疗并随访１２个月以上。结果ＨＣＶ－Ⅱ型感染血清ＨＣＶＲＮＡ水平（１０７．８±３．４拷贝／ｍｌ）显著高于ＨＣＶ－Ⅲ型感染（１０６．３±２．５拷贝／ｍｌ）（Ｐ＜０．０１），Ⅲ型感染的应答率（７／１３，５３．８％）显著高于Ⅱ型感染（２０／６４，３１．３％）（Ｐ＜０．０５）。应答组治疗前血清ＨＣＶＲＮＡ含量（１０６．８±２．７拷贝／ｍｌ）显著低于无应答组（１０８．３±３．２拷贝／ｍｌ）（Ｐ＜０．０１）。ＨＣＶＲＮＡ含量低于１０６．５拷贝／ｍｌ者，无论何种型别ＨＣＶ感染均应答较好，而ＨＣＶＲＮＡ高于１０８．０拷贝／ｍｌ者则应答极差。结论ＨＣＶ基因型及病毒血症水平是预测干扰素疗效的重要因素，且后者比前者意义更大。Ⅱ型感染病毒血症水平较高可能是影响其疗效的原因之一。     

再生障碍性贫血与丙型和戊型肝炎病毒相关性的研究

目的和方法：采用ＲＴ／ＰＣＲ和定量酶标标准化的测定方法,检测了先患（丙型或戊型）肝炎后患再生障碍性贫血和先患再生障碍性贫血后患丙型（或戊型）肝炎的阳性率,并与对照组比较。结果：血清组中ＨＣＶ－ＲＮＡ的阳性率分别是５７９％和２８９％,二者差异显著（Ｐ＜００５）;ＨＥＶ－ＲＮＡ阳性率分别是２４％和２５９％,二者差异不显著（Ｐ＞００５）。在单个核细胞组中ＨＣＶ－ＲＮＡ阳性率分别为１１８％和１０５％;ＨＥＶ－ＲＮＡ的阳性率分别为０％和３７％;ＨＥＶ－ＲＮＡ在粪便中的阳性率３２％和３７％,均无显著差异。结论：丙型和戊型肝炎病毒不直接影响造血细胞的基因表达,仅使造血微环境有一定改变,引起患者自身免疫反应,对造血有一定的影响     

肝病产妇丙型肝炎病毒母婴传播的可能性调查

对１９９１～１９９３年在南京市钟阜医院肝病产科住院的１０４７例肝病产妇中１２例丙型肝炎病毒抗体和／或丙型肝炎病毒核糖核酸阳性者，追踪观察了所生１２名婴儿的丙型肝炎病毒感染情况，发现１例抗－ＨＣＶ和ＨＣＶＲＮＡ均阳性的孕妇所生的婴儿，０、１、６和１２个月时抗－ＨＣＶ和ＨＣＶＲＮＡ均阳性，且该婴儿ＨＣＶ的血清型与母亲一致。结果提示，肝病产妇丙型肝炎病毒母婴传播是可能的，但不是主要的传播途径。     

Heterogeneity analysis of the hepatitis B virus genome in intrauterine infection

There are many factors leading to intrauterine infection with hepatitis B virus (HBV). These factors include viral structure, HBV mutations, HBV DNA level, placenta barrier, immune status of the mother, and susceptibility of the fetus. The purpose of this study was to investigate the possible relationship between intrauterine infection with and HBV mutations of the genome of the virus. In this study, HBsAg-positive mothers were divided into two groups: intrauterine infection group and non-infection group according to whether the newborn infants were infected or not. The intrauterine infection group included four pairs of mother and their newborn infants infected in utero, and non-infection group included five HBsAg-positive mothers. HBV sequences from the two groups were analyzed and compared. The predominant strains in the mothers and infants from the intrauterine infection group were not completely consistent. This suggested that both HBV predominant strains and minority strains in the mothers could infect their infants through intrauterine transmission. Some HBV mutations probably related to intrauterine infection were examined and it was found that the frequencies of mutations were low in isolates of the virus of infants from the intrauterine infection group and high in the non-infection group. These results suggest that some strains of HBV from the mother may be transmitted selectively to the fetus in utero because of viral heterogeneity. The strains without screened mutations such as P21L in the pre-S1 region may infect the fetus more readily.     

基因芯片法特异性检测丙型肝炎病毒的基因分型

目的：采用基因芯片特异性检测血清中丙型肝炎病毒（HCV）并进行基因分型。方法：设计HCV基因型特异探针，将其固定在玻璃片上制成微阵列芯片。阳性组血清60份，阴性组血清15份，乙型肝炎血清5份（抗HCV阴性）。经核酸提取，多聚酶链式反应（PCR）扩增，与芯片上的探针杂交，最后分析结果并与测序分型结果比较。结果：阳性组血清全部检测到HCV-RNA，均有基因芯片分型结果。基因芯片分型结果与测序分型结果一致者56例。阴性组血清HCV-RNA全部阴性。乙型肝炎血清全部阴性。结论：基因芯片可准确对HCV感染血清做定性检测并同时检测HCV基因型，简便快捷，特异性好，并且不需荧光标记和昂贵的荧光扫描仪器，与乙型肝炎血清无交叉反应。可替代基因测序分型，适于临床大量样品的检测。     

临床诊断为非甲～戊型肝炎患者的病原学研究

目的探讨临床诊断为非甲-戊型肝炎患者的病原学。方法 采用巢式PCR（nPCR)检测HBV、TTV、B19、和SENV DNA；用逆转录巢式PCR（RT-nPCR)检测HGV和HCV RNA。结果 60例临床诊断为非甲-戊型肝炎患者中，单独HBVDNA阳性30例（阳性率为50.0%)，HBV和TTVDNA阳性10例（16.7%)，HBV和B19DNA阳性6例（10.0%)，HCVRNA、HBV和SENVDNA阳性1例（1.7%)，单独HCVRNA阳性1例（1.7%)，HCVRNA和B19DNA阳性1例（1.7%),HGVRNA无一例阳性，单独B19DNA阳性2例（3.3%)。单独TTVDNA阳性1例（1.7%)，另8例（13.3%)上述病毒核酸均为阴性。HBV合并感染TTV或B19对其血清学生化指标无影响。结论HBV是临床诊断为非甲-戊型肝炎的主要病原，HGV、TTV、B19和SENV与非甲-戊型肝炎无关。     

影响HBV宫内感染的相关临床因素的探讨

目的探讨乙型肝炎病毒（HBV）宫内感染的高危因素或保护因素。方法对2006年6月至2008年2月在中山大学附属第三医院产科分娩的417例血清HBsAg阳性孕妇的新生儿进行回顾性分析。结果HBV宫内感染组33例,非感染组384例,感染组的母亲HBeAg阳性率、HBV DNA阳性率和非感染组的具有显著性差异（P〈0.05）,母亲孕晚期注射HBIG在2组中均无显著性差异（P〉0.05）;在母亲各HBV DNA水平级上分析,新生儿HBV宫内感染和母亲使用HBIG均无明显相关（P〉0.05）;结论1.HBV DNA阳性是HBV宫内感染的高危因素。2.HBsAg阳性孕妇晚孕期间肌注HBIG对HBV宫内感染未见明显的保护作用。     

Prospective cohort study of mother‐to‐infant infection and clearance of hepatitis C in rural Egyptian villages

Although persistent transmission of hepatitis C virus (HCV) from infected mothers to their infants is reported in 4–8%, transient HCV perinatal infection also occurs. This prospective cohort study determined perinatal HCV infection‐ and early and late clearance‐rates in 1,863 mother‐infant pairs in rural Egyptian villages. This study found 15.7% and 10.9% of pregnant women had HCV antibodies (anti‐HCV) and HCV‐RNA, respectively. Among 329 infants born of these mothers, 33 (10.0%) tested positive for both anti‐HCV and HCV‐RNA 2 months following birth—29 (12.5%) having HCV‐RNA positive mothers and 4 (with transient infections) having mothers with only anti‐HCV. Fifteen remained HCV‐RNA positive at one and/or 2 years (persistent infections), while 18 cleared both virus and antibody by 1 year (transient infections). Among the 15 persistent cases, 7 cleared their infections by 2 or 3 years. At 2‐ to 6‐ and at 10‐ to 12‐month maternally acquired anti‐HCV was observed in 80% and 5% of infants, respectively. Four perinatally infected and one transiently infected infant were confirmed to be infected by their mothers by the sequence similarity of their viruses. Viremia was 155‐fold greater in mothers of infants with persistent than mothers of infants with transient infections. Maternal‐infant transmission of HCV is more frequent than generally reported. However, both early and late clearance of infection frequently occurs and only 15 (4.6%) and 8 (2.4%) infants born of HCV‐RNA positive mothers had detectable HCV‐RNA at one and 2–3 years of age. Investigating how infants clear infection may provide important information about protective immunity to HCV. J. Med. Virol. 81:1024–1031, 2009. © 2009 Wiley‐Liss, Inc.     

Molecular and clinical aspects of hepatitis D virus infections

Hepatitis D virus (HDV) is a defective virus with circular, single-stranded genomic RNA which needs hepatitis B virus (HBV) as a helper virus for virion assembly and infectivity. HDV virions are composed of a circular shape HDV RNA and two types of viral proteins, small and large HDAgs, surrounded by HBV surface antigen (HBsAg). The RNA polymerase II from infected hepatocytes is responsible for synthesizing RNAs with positive and negative polarities for HDV, as the virus does not code any enzyme to replicate its genome. HDV occurs as co-infection or super-infection in up to 5% of HBsAg carriers. A recent multi-center study highlighted that pegylated interferon α-2a (PEG-IFN) is currently the only treatment option for delta hepatitis. Nucleotide/nucleoside analogues, which are effective against HBV, have no relevant effects on HDV. However, additional clinical trials combining PEG-IFN and tenofovir are currently ongoing. The molecular interactions between HDV and HBV are incompletely understood. Despite fluctuating patterns of HBV viral load in the presence of HDV in patients, several observations indicate that HDV has suppressive effects on HBV replication, and even in triple infections with HDV, HBV and HCV, replication of both concomitant viruses can be reduced. Additional molecular virology studies are warranted to clarify how HDV interacts with the helper virus and which key cellular pathways are used by both viruses. Further clinical trials are underway to optimize treatment strategies for delta hepatitis.     

Association between genomic heterogeneity of hepatitis B virus and intrauterine infection

Hepatitis B virus (HBV) intrauterine infection remains to be an important cause for a large number of persistent hepatitis B surface antigen (HBsAg) positive carriers in areas with a high HBV prevalence, particularly in China and Southeast Asia. In this study, the possible association between the HBV genomic heterogeneity and intrauterine infection was investigated by comparing the quasi species isolated from eight pairs of HBsAg-positive mothers and their neonates, who were infected intrauterinely with HBV, with clones from eight HBsAg-positive mothers whose neonates were not infected with HBV. The proportion of clones with specific mutations was compared among different subject groups, and phylogenetic analysis was performed to evaluate the significance of specific mutations. It was observed that the core promoter with conserved major functional regions and conserved hepatitis B e antigen (HBeAg) might be beneficial to HBV maternal-fetal transmission. Particularly, A1762T/G1764A mutations seemed to be disadvantageous for fetal infection. It was also shown that amino acid substitutions located in the immune epitopes of HBsAg were strongly associated with intrauterine HBV transmission. The clones with mutations such as amino acid P110S in preS1 region, P36L in preS2 region and C107R in S region might infect fetuses more readily. In addition, positively selected site analysis confirmed the above results.     

Clinical significance of occult hepatitis B virus infection in chronic hepatitis C patients

Background/Aims

We investigated the frequency of occult hepatitis B virus (HBV) infection in anti-hepatitis C virus (HCV)-positive individuals and the effects of occult HBV infection on the severity of liver disease.

Methods

Seventy-one hepatitis B virus surface-antigen (HBsAg)-negative patients were divided according to their HBV serological status into groups A (anti-HBc positive, anti-HBs negative; n=18), B (anti-HBc positive, anti-HBs positive; n=34), and C (anti-HBc negative, anti-HBs positive/negative; n=19), and by anti-HCV positivity (anti-HCV positive; n=32 vs. anti-HCV negative; n=39). Liver biopsy samples were taken, and HBV DNA was quantified by real-time PCR.

Results

Intrahepatic HBV DNA was detected in 32.4% (23/71) of the entire cohort, and HBV DNA levels were invariably low in the different groups. Occult HBV infection was detected more frequently in the anti-HBc-positive patients. Intrahepatic HBV DNA was detected in 28.1% (9/32) of the anti-HCV-positive and 35.9% (14/39) of the anti-HCV-negative subjects. The HCV genotype did not affect the detection rate of intrahepatic HBV DNA. In anti-HCV-positive cases, occult HBV infection did not affect liver disease severity.

Conclusions

Low levels of intrahepatic HBV DNA were detected frequently in both HBsAg-negative and anti-HCV-positive cases. However, the frequency of occult HBV infection was not affected by the presence of hepatitis C, and occult HBV infection did not have a significant effect on the disease severity of hepatitis C.     

广东地区肝炎患者血清中庚型肝炎病毒RNA的检测

目的了解庚型肝炎病毒（ＨＧＶ）感染在不同临床类型肝炎患者中的存在状况。方法用逆转录－聚合酶链反应（ＲＴ－ＰＣＲ）技术对７２１例肝炎患者血清进行了ＨＧＶＲＮＡ检测。结果发现８０例ＨＧＶＲＮＡ阳性，以非甲、乙、丙、丁或戊型肝炎中阳性率为高；慢性丙型肝炎（ＨＣＶ）和慢性乙型混合丙型肝炎（ＨＢＶ＋ＨＣＶ）次之；在慢性重型肝炎和肝硬化时较低。结论庚型肝炎病毒在广东地区现症肝炎患者中有一定程度的流行