血清乙型肝炎病毒载量与抗病毒药物疗效

为了提高α-干扰素(IFN)及拉米夫定(LAM)两种抗病毒药物的抗病毒治疗应答率,我们对乙型肝炎病毒(HBV)不同血清含量的病人分组治疗,发现各组疗效有明显差异。     

乙型肝炎病毒载量及ALT水平与干扰素应答关系的研究

探讨慢性乙型肝炎患者血清病毒载量及ALT水平在预测IFN疗效中作用.50例慢乙肝患者接受重组IFN治疗24周并随访一年以上.IFN治疗后20例患者(40%)持续应答,应答组治疗前HBV DNA水平显著低于无应答组(P＜0.05).50例IFN治疗患者中26例(52%)为高病毒血症水平(HBV DNA＞107Copies/ml),24例(48%)为低病毒血症水平(HBV DNA＜107 Copies/ml),低病毒血症水平组血清HBV DNA及HBeAg阴转率显著高于高病毒血症水平组(54%vs 25%和46.1%vs16.7%,P均＜0.05).多变量分析显示,治疗前高水平ALT、低HBVDNA含量及治疗过程中ALT明显升高(＞4倍以上)是判断干扰素治疗的患者HBV DNA阴转的独立预测因素(P＜0.05).乙型肝炎病毒载量及治疗前和治疗过程中ALT升高与IFN应答密切相关.     

乙型肝炎孕妇HBV血清标志物与HBVDNA载量及ALT的相关性分析

目的 分析乙型肝炎(乙肝)孕妇HBV血清标志物、HBVDNA载量及ALT检测结果,为HBV感染孕妇的诊治提供参考。方法 回顾性分析2016年11月—2017年11月在我区孕检的120例乙肝孕妇的临床资料,应用酶联免疫吸附法检测血清五项HBV标志物,同时采用荧光实时定量PCR技术检测HBVDNA水平,酶速率法检测ALT,并对检测结果进行统计分析。结果 120例孕妇血清中,感染模式Ⅰ(大三阳)HBsAg(+)、HBeAg(+)、HBcAb(+)58例,占48.33%;HBVDNA(+)49例,占84.48%,其中HBVDNA>106IU/ml42例,占72.41%;ALT增高39例,异常率为67.24%。感染模式Ⅱ(小三阳)HBsAg(+)、HBeAb(+)、HBcAb(+)45例,占37.50%;HBVDNA(+)27例,占60.00%,其中HBVDNA>106IU/ml15例,占33.33%;ALT增高20例,异常率为44.44%。感染模式Ⅰ孕妇HBVDNA阳性率、HBVDNA>106IU/ml率和ALT异常率最高,感染模式Ⅱ孕妇次之。结论 HBV血清标志物与HBVDNA高载量和ALT水平密切相关,三者相结合能为孕妇的临床诊断、围产期干预措施以及疗效观察提供参考依据。     

乙型肝炎病毒载量与干扰素治疗效果的相关性研究

乙型肝炎病毒 (HBV)感染时 ,外周血中HBVDNA是病毒复制活动最直接和可靠的标志 ,因此在临床实践中监测患者外周血中病毒核酸的动态变化 ,对感染转归、病情和预后的判断 ,以及药物疗效评价均具有重要价值。实时荧光定量聚合酶链反应 (FQ PCR)是近年出现的核酸定量新方法 ,具有敏感性高、重复性好、特异性强和定量范围宽等突出优点[1,2 ] 。本文应用该方法检测了 71例慢性乙型肝炎患者干扰素治疗前后血清中的HBVDNA含量 ,并与相关因素和免疫学指标相比较 ,以探讨病毒载量与干扰素治疗之间的关系。材料与方法一 .病例所有慢性乙型肝炎…     

血清乙型肝炎病毒载量与肝细胞癌发生的关系

根据WHO提供的数据,全球每年约有55万人死于肝细胞癌(HCC)。有资料表明,HCC的发病率与HBV的流行状态相关。在东南亚及非洲撒哈拉地区HBV感染率为5%~20%或更高,被称为高流行区,这些地区60%~90%HCC患者可检出HBV血清标志,也就是说有HBV感染背景。我国在HBV高流行地区,HBV感染者占     

乙型肝炎病毒血清标志物的再认识

临床上,抗原抗体的检测一直是病毒性肝炎病原学诊断的常用方法,但也存在着许多难以解释的临床现象.随着分子生物学的飞速发展,特别是PCR技术的广泛应用,对这种临床现象的认识逐步清晰起来.     

HBV血清学标志物与前C区终止突变及HBV DNA载量的关系

目的探讨HBV1896位终止突变株在不同HBsAg阳性乙型肝炎病人体内的检出率及与血清HBVDNA载量的关系.方法对100份乙型肝炎病人血清,分别以EIA法、特异性引物PCR法和PCR荧光法检测HBV血清学标志物、HBV1896位终止突变株及HBVDNA载量.结果非突变株、突变株/非突变株和突变株的检出率,在HBeAg阳性血清中分别是46.6%(27/58)、53.4%(31/58)及0%(0/58);在抗HBe阳性血清中分别是4.8%(1/21)、33%(7/21)和61.9%(13/21).在HBeAg阳性和抗HBe阳性血清中,突变株/非突变株的HBVDNA载量无显著差异.单检出突变株的血清HBVDNA载量较非突变株和突变株/非突变株为低.结论HBeAg阳性血清中以非突变株和突变株/非突变株为主,抗HBe阳性血清中以突变株为主,此种突变株的复制水平较之非突变株或突变株/非突变株有所下降.     

HDV感染后乙型肝炎患者血清肝炎病毒标志物的变化

目的　分析HDV感染患者血清病毒性肝炎标志物的变化和意义 ,探讨HDV致病机理。方法　对 469例HDV阳性乙型肝炎患者常见各类型病毒性肝炎血清标志物的变化等作统计分析 ,以 2 13例HDV( -)乙型肝炎患者作对照。结果　HDV感染后血清HBeAg检出率降低 (P <0 .0 1)。在HDV ( +)HBVDNA( -)组 ,HBeAg( -)的机会大 (P <0 .0 1)。在急性肝炎、重型肝炎和肝硬化患者HDAg( +)HBeAg( -)为主要血清病毒表现形式 (P <0 .0 1或 0 .0 5 )。HDV感染后合并其它肝炎病毒感染率高于乙型肝炎组。结论　HDV感染可抑制HBV复制或HBeAg表达 ,混合感染HDV的乙型肝炎中HDV的直接细胞毒性作用可能起主要致病作用。重叠感染HDV的乙型肝炎患者其病情重、病死率高和容易慢性化。     

探讨乙型肝炎血清标志物与乙型肝炎DNA含量的关系

目的:研究不同感染乙型肝炎病毒血清标志物与乙型肝炎DNA含量的关系及临床意义.方法:采用信号引物能量转移定量聚合酶反应测定血清HBV DNA载量.采用全自动快速微粒子酶免分析检测系统检测.结果:不同HBV DNA载量的血清其病毒含量,HBV DNA载量越高,免疫清除HBV DNA载量相对较低,病毒残留HBV DNA载量较低或无HBV DNA复制.结论:研究显示HBsAg和HbeAg与乙肝病毒含量有一定的关系,在一定程度上反映了病毒的复制状态.另外还表明肝功酶学的2个指标AST ALT与乙型肝炎病毒含量关,可以将其比值作为评估感染乙型肝炎病毒程度高低的依据.     

血清乙型肝炎病毒载量与抗病毒药物疗效关系的研究

乙型肝炎的治疗是十分棘手的问题,目前公认对HBV有效的药物α-干扰素(IFN)及拉米夫定(LAM)总体应答率仍然不高,为了提高上述2种抗病毒药物的抗病毒治疗应答率,我们对HBV不同血清含量的患者分组治疗,发现各组的疗效有明显差异,现将结果报告如下。     

A comparative study on serologic profiles of virus hepatitis B

INTRODUCTIONHepatitis B viral infection, one of the most-prevalent liver disorders in China and Korea, is aserious infectious disease as it has the potential ofprogressing into liver cirrhosis and primary hepaticcarcinoma. China and Korea both belong to high-risk endemic regions of viral hepatitis[1]. TheHBsAg positive rates in China ranged from 6.9% -17.9% by age, race and test methods[2-5].     

Changes in levels of hepatitis B virus markers in patients positive for low-titer hepatitis B surface antigen

Aim: Recently, patients positive for the low-titer hepatitis B surface antigen (HBsAg) have been found occasionally owing to the increase in the accuracy of detection methods. The aim of this study is to clarify the clinical status of acute hepatitis B virus (HBV) infection in patients positive for low-titer HBsAg. Method: Eight patients, who were positive for HBsAg at low titers and diagnosed as having acute HBV infection, were enrolled in this study. Assays of HBsAg, hepatitis B core antibody (anti-HBc), hepatitis B e-antigen (HBeAg), hepatitis B e-antibody (anti-HBe), hepatitis B surface antibody (anti-HBs) and HBV DNA, and biochemical tests were basically conducted every 4 weeks for at least 24 weeks. Result: The average cut-off index of HBsAg was 8.7 ± 9.6 (range, 1.0–25.7). All the patients were negative for anti-HBc, HBeAg, anti-HBe and HBV DNA on their initial visit. The genotype of HBV could be determined in four patients: two were infected with genotype B/HBV, one was infected with genotype A/HBV, and the remaining patient was infected with genotype C/HBV. Although HBsAg clearance was observed within 4 months in all the patients, none of the other HBV markers seroconverted during the observation period. Conclusion: HBV infection terminating with seronegativity for HBV markers may occur in transient HBV infection.     

Hepatitis B virus markers and antibodies to hepatitis C virus in Japanese patients with hepatocellular carcinoma

Sera from Japanese patients with chronic liver disease were tested for hepatitis B virus (HBV) markers and antibodies to hepatitis C virus (anti-HCV), and the results were correlated to the presence of hepatocellular carcinoma. In chronic non-A, non-B liver disease, anti-HCV prevalence was high both in patients with hepatocellular carcinoma (78/89, 88%) and without it (66/84, 79%), while previous HBV infection was more common in patients with hepatocellular carcinoma (65/89, 73%) than in those without it (46/84, 55%) (P<0.05). Coexistence of anti-HCV and antibodies to HBV was observed frequently in patients with hepatocellular carcinoma (56/89, 63%) compared with patients without it (39/84, 46%) (P<0.05). In chronic HBV carriers, anti-HCV was more common in patients with hepatocellular carcinoma (12/38, 32%) than in those without it (3/62, 5%) (P<0.01). These results suggest that infection with the two viruses may be a risk factor for more serious liver disease.This work was supported by a Grant-in-Aid from the Ministry of Education, Science and Culture, Japan.     

Novel hepatitis B virus surface antigen mutations associated with occult genotype B hepatitis B virus infection affect HBsAg detection

The causative factors of occult hepatitis B infection are complicated and not yet been fully elucidated. Mutations in hepatitis B virus (HBV) S gene are one of the factors may contributing to occult infection. In this study, 89 blood donors with genotype B occult HBV infection were investigated. Fifty‐seven hepatitis B surface antigen (HBsAg)‐positive/HBV DNA‐positive blood donors served as control group for comparison. Occult HBV‐related mutations with a high incidence (P < .05) in the S gene were identified. To further verify these occult infection‐related mutations, a conservative full‐gene expression vector of HBV B genotype (pHBV1.3B) was constructed. Then, the mutant plasmids on the basis of pHBV1.3B were constructed and transfected into HepG2 cells. Extracellular as well as intracellular HBsAg was analysed by electrochemical luminescence and cellular immunohistochemistry. Ten occult infection‐related mutations (E2G, Q101R, K122R, M133T, D144E, G145R, V168A, S174N, L175S and I226S) were significantly more frequent in the occult infection group (P < .05). Five of the ten mutations (E2G, D144E, G145R, V168A and S174N) strongly decreased extracellular HBsAg level (P < .05) in the transfection system. Notably, the E2G mutation had the most significant impact on the ratio of extracellular HBsAg (3.8% vs pHBV1.3B) and intracellular HBsAg (239.3% vs pHBV1.3B) (P < .05), and the fluorescence density of E2G mutant HBsAg was significantly higher than that of pHBV1.3B (P < .0001). Hence, ten mutations were associated with genotype B occult HBV infection; E2G and V168A were novel mutations which we confirmed significantly affect HBsAg detection. E2G might cause HBsAg secretion impairment that results in intracellular accumulation and a decrease in HBsAg secretion.     

50例乙型肝炎病毒携带者肝组织病理与血清学指标关系的探讨

目的探讨乙型肝炎病毒（HBV）携带者肝组织病理与血清学指标的关系。方法对50例HBV携带者进行肝穿刺取肝组织送病理,研究病理结果与血清学指标的关系。结果 26例HBeAg阳性患者中,全部为HB-VDNA阳性,其中肝组织病理显示6例为G3S1,全为40岁以上的患者,12例G2S1,有1例40岁以上患者,8例为G2S0。18例抗HBe阳性患者中,有12例HBVDNA阳性患者,其中肝组织病理显示6例为G2S1,（有2例40岁以上）,6例为G2S0,有6例HBVDNA阴性患者,其中5例为G2S0,1例为G1S0。6例HBeAg与抗HBe均阴性的患者中,有HBVDNA阳性4例,其中2例为G2S1,2例为G2S0。HBVDNA阴性2例,其中1例为G2S1,1例为G2S0。结论 40岁以下的HBV携带者肝穿均指示有程度不等的炎症和有或无肝纤维化,且炎症程度和肝纤维化程度与HB-VDNA高低不成正比,无明确关系,与HBeAg是否阳性也无正比关系。     

HBV感染者HCV的重叠感染关系研究

目的 研究HBV感染患者中HCV的重叠感染状况及其相互关系。 方法 采用ELISA法对767例HBV感染患者同步检测HBV和HCV血清标志物,对可疑HCV感染但抗HCV阴性和/或抗-HCV阳性患者血清,采用PCR法检测HCV-RNA。 结果 HCV重叠感染率为4.82％,且在各类乙肝患者中存在非常显著差异(P<0.01);HBV/HCV感染组重症肝炎的发生率显著高于非HCV感染组(P<0.01);HBV/HCV感染组HBsAg阳性率显著低于单纯HBV感染组(P<0.05);HBV/HCV感染组HCV-RNA阳性率显著低于单纯HCV感染组(P<0.05)。 结论 HCV重叠感染与乙肝患者的发病、病情加重及重症肝炎的发生相关;HCV可抑制或中止HBsAg携带状态,但这种作用远不如对病情的加重作用重要;同时HBV对HCV的复制亦存在抑制作用。     

Impact of acute hepatitis C virus superinfection in patients with chronic hepatitis B virus infection

BACKGROUND & AIMS: Superinfection in patients with chronic hepatitis B virus (HBV) infection is not uncommon. Acute hepatitis delta virus (HDV) superinfection is associated with severe and/or progressive liver disease. The natural course following acute hepatitis C virus (HCV) superinfection has not been well studied. The aim of this study was to investigate the impact of acute HCV superinfection. METHODS: The clinical features during acute phase and long-term outcomes of acute HCV superinfection were studied and compared with a cohort of acute HDV superinfection and a matched control group of active chronic hepatitis B. RESULTS: Acute HCV superinfection typically occurs as acute icteric hepatitis. The severity is similar to acute HDV superinfection in that hepatic decompensation developed in 34% of patients, hepatitis failure occurred in 11%, and 10% died. During a follow-up period of 1-21 years, patients with acute HCV superinfection had a significantly higher cumulated incidence of cirrhosis (48% at 10 years) and hepatocellular carcinoma (14% at 10 years, 21% at 15 years, and 32% at 20 years) than acute HDV superinfection or active chronic hepatitis B. Hepatitis B surface antigen (HBsAg) seroclearance occurred earlier in HCV superinfected patients. Continuing hepatitis after HBsAg seroclearance was observed only in HCV superinfected patients. CONCLUSIONS: Acute HCV superinfection in patients with chronic HBV infection is clinically severe during its acute phase. The long-term prognosis following acute HCV superinfection is much worse than that following HDV superinfection or active hepatitis B in terms of continuing hepatitis activity after HBsAg loss and the development of cirrhosis or hepatocellular carcinoma.     

乙型肝炎病毒基因分型及其临床意义

目的了解慢性乙型肝炎病毒(HBV)感染者HBV基因分型及其对慢性肝病的影响,为制定针对不同HBV基因型抗病毒的个体化方案提供分子病毒学依据。方法临床确诊的慢性乙型肝炎、乙型肝炎肝硬化及肝癌患者314例,采用RDB法对HBV进行基因分型检测。结果山西地区的200例慢性乙型肝炎患者所感染的HBV均为B和C基因型,分别占56%、26%,并存在混合感染(17%);C与B基因型患者相比,血清病毒载量高、肝脏损伤严重;混合感染的患者与单一基因型感染者相比病毒载量更高、肝损伤更严重;肝硬化患者感染的HBV主要为C基因型及B、C混合感染,且肝损害严重、病毒复制率高;肝癌患者中C基因型感染占42.19%,B、C混合感染占37.5%,B基因型感染可能与年轻患者肝癌的发生有关。结论B基因型HBV感染与C基因型及混合感染相比,病毒载量低、肝损害轻,但年轻患者应监测肝癌的发生;C基因型及混合感染的患者预后较差,肝硬化、肝癌发生率高,应进行积极有效的治疗,防止严重肝病发生。