晚期血吸虫病合并HBV感染患者临床表现与肝脏病理关系的探讨

本文对88例肝内乙肝抗原阳性的晚期血吸虫病手术患者进行肝脏病理和临床分析,发现晚期血吸虫病合并HBV感染患者有四种肝脏病理类型:单纯血吸虫病性肝纤维化(13.6％);肝纤维化合并慢性肝炎(18.2％);肝纤维化合并静止性肝硬化(29.6％)和肝纤维化合并活动性肝硬化(38.6％).88例患者中,43例(48.9％)无肝功能损害的临床指征,患者的临床表现可以与肝脏病理变化程度不一致.     

晚期血吸虫病与乙型肝炎关系的临床病理研究

100例临床诊断晚期血吸虫病(晚血)患者的临床资料和肝活组织病理检查、乙型肝炎病毒(HBV)标志检查结果对照分析,发现100例中病理诊断为单纯血吸虫病仅12例,血吸虫病伴有乙型肝炎(乙肝)53例,单纯乙肝35例。血清HBV标志阳性率为67.1％,肝活组织地依红染色HBsAg阳性38％,提示临床诊断晚血的绝大多数患者伴有HBV感染。     

肝安治疗血吸虫病并发乙型肝炎45例

血吸虫病可引起肝脏损害,血吸虫病并发乙型肝炎（乙肝）时对肝脏的损害加重。本院内科2005年3月～2006年12月,采用肝安（15氧基酸）为主共治疗慢性血吸虫病并发乙肝37例,晚期血吸虫病并发乙肝8例,报告如下。     

乙型肝炎抗原携带者经胃肠道传染乙型肝炎病毒的作用

本文研究乙型肝炎抗原(HBAg)携带者对其家庭成员的传染性。HBAg携带者29例中,11例为“健康”携带者,HBAg持续阳性6个月或以上,但无临床或生化方面的肝功能损害;与他们接触的家庭成员19例,其中包括血缘关系11例和配偶关系8例。其余的18例HBAg携带者有肝脏疾患,其中肝活检证实肝硬化者12例,慢性持续性炎肝炎6例(内3例经肝活     

肝病患者肝组织内CMV感染的初步研究

本文应用免疫组织化学方法检测140例急、慢性肝炎患者肝组织内CMV抗原,发现15例阳性(10.7%),有9例同时存在HBV感染,其中3例为三重感染。15例CMV抗原阳性肝炎中,11例为慢性肝炎。以同法检测20例肝细胞性肝癌患者肝组织中CMV抗原,发现1例阳性。结果提示CMV感染为病毒性肝炎的病因之一;CMV肝炎与其他病毒性肝炎及慢性肝脏疾病可同时存在;CMV肝炎可能存在慢性化倾向。     

慢性肝病与乙型肝炎抗原

为了比较乙型肝炎抗原(HBAg)阳性与HBAg阴性病者的临床过程有无不同,对86例慢性肝病者作了前瞻性研究。其中慢性肝炎45例,肝硬化41例,每例都经临床检查、肝功能及血清学试验,腹腔镜肝脏检查与活检等证实。随访时间平均38个月。慢性肝炎中,19例HBAg阳性。HBAg阳性与阴性病者的临床过程无显著不同(P>0.05)。HBAg阳性的19例中,12例在整个随访时间持续阳性;3例暂时阳性,临床并无明显改变;另4例转阴,均属慢性持续性肝炎,内2例再次活检示病变消散,另2例亦无不适,肝功能接近正常,提示病情无重大发展。34例慢性肝炎病者中,14例有自身抗体(抗核因子、平滑肌抗体、线粒体抗体),其中7例HBAg阳性。HBAg阳性和阴性病者的自身抗体发现率无显著不同     

高复制型慢性乙型肝炎患者肝内HBV复制指标与肝脏病变的关系

33例均为HBsAg、HBeAg及抗HBc三项阳性(部分伴HBcAg、DNA P或HBV DNA阳性)。病理报告慢性小叶性肝炎6例,慢性持续性肝炎27例.应用Southern Blot法共查肝内HBV DNA25例,其中阳性13例(52％),包括游离型9例,游离十整合型2例,整合型2例,应用双桥PAP法共查HBsAg及HBcAg23例,其中HBsAg阳性15例(65.2％),HBcAg阳性11例(43.8％)。提示肝内HBV DNA及HBcAg阳性组各项旰脏病变检出率在50％以上,项目(7项)比阴性组(5项)为高,并与血中DNAP、HBV DNA复制指标及ALT异常率相一致,肝内HBV DNA游离型及游离十整合型各项肝脏病变检出率也比整合型为高。因而,慢乙肝肝脏病变持续存在,与乙肝病毒复制有关,抗病毒治疗应予重视。     

日本血吸虫病肝纤维化的危险因素探讨

[目的 ]探讨日本血吸虫病患者肝纤维化的影响因素。 [方法 ]日本血吸虫病 2级和 3级肝纤维化患者 81例 ,1级肝纤维化患者 6 1例和无肝纤维化的血吸虫感染者 5 0例 ,就可能影响肝脏损伤的因素进行研究 ,对所有因素用有序回归模型分析。 [结果 ]可能与日本血吸虫病肝纤维化有关的危险因素有 :血吸虫病治疗次数(OR =1 75 ) ,血吸虫感染间期 (OR =1 40 ) ) ,经常饮酒 (每天多于 1次 ,5年以上 ) (OR =1 95 )和晚期血吸虫病 (巨脾型和腹水型 )家族史 (OR =2 11)。 [结论 ]血吸虫反复感染、感染间期越长、经常饮酒和有晚期血吸虫病家族史的血吸虫病患者肝组织发生纤维化的危险性也越大。     

晚期血吸虫病肝脏病理变化及分型的探讨

本文报道我院1977～1981年106例临床诊断为晚期血吸虫病手术时所取肝组织活检结果。其中67例(63.2％)确诊为单纯血吸虫病性肝硬变,39例(36.3％)为血吸虫病混合病毒性肝炎后肝硬变。后者的血吸虫卵沉积数较少而肝脏实质性损害较为明显。     

肝活检对晚期血吸虫病诊断的价值

晚期血吸虫病在血吸虫病流行区常见,近年来病毒性肝炎后肝硬化的发病率也颇为多见。两者预后和治疗措施各不相同,因此,其鉴别诊断已成为临床医师亟待解决的问题。江陵血防所自1982～1985年对临床诊断为晚期血吸虫病而行脾切除术、断流术或分流术患者的肝组织作了病理检查,结果如下: 一、临床资料及术中所见: (一)97例中男性52例、女性45例,年龄11～63岁。有消化道大出血者18例;乙肝病毒表面抗原阳性5例;术前经病原检查证实为血吸虫病患者78人(80.4％),均经多次病原治疗。从未查到血吸虫卵、毛蚴者19人。 (二)术时肝脏肉眼观察: 肝左叶肿大者46例(47.42％);右叶肿大2例(2.06％);左右叶均肿大44例(45.36％);肝不肿大5例     

丁型肝炎患者肝组织HDAg和HBsAg/HBcAg的免疫组化检测

目的 探讨HDAg和HBsAg/HBcAg在丁型肝炎患者肝组织中表达及关系。方法 应用免疫组化双重染色,检测79例丁型肝炎患者肝组织HDAg、HBsAg和HBcAg表达,以52例乙型肝炎作对照。结果 丁型肝炎HBsAg、HBcAg检出率(81％、71％)较乙型肝炎(94％、92％)低(P<0.05或0.01)。HDAg以肝细胞核表达为主,HBsAg以肝细胞浆表达为主,HDAg和HBsAg表达强度及阳性细胞分布呈一致性,且均与肝组织的炎症活动和病理损害程度相关(P<0.01)。HBcAg以肝细胞核表达为主,阳性细胞主要呈单个细胞或点状分布,且HBcAg阳性细胞明显少于HDAg阳性细胞。结论 HDV感染会抑制HBV病毒抗原(HBcAg)表达;HDV致病机制中既有HDV的直接细胞毒性作用,也有HBV和HDV的协同作用。     

The significance of HBsAg and HBcAg levels in the liver and their relation to histopathologic activity

The results of histological and immunohistological studies on the liver biopsies from patients with positive serum HBsAg, HBeAg, HBVDNA, and HBVDNAp showed: 1. In addition to the inclusion body like, marginal, diffuse and membranous patterns of HBsAg, we found that marginal and diffuse patterns of HBsAg may appear within one hepatocyte and this is named as transitional pattern. A preliminary suggestion about the process of formation and evolution of different patterns of HBsAg and HBcAg was raised. 2. There is a relationship between HBV replication and the activity of hepatitis. Different patterns and distributions of HBAg affect the lesion of the liver significantly. 3. According to the morphology of HBsAg and HBcAg, we suggest to divide their patterns into the following two categories: The first includes the diffuse and membranous patterns of HBsAg and the cytoplasmic and membranous HBcAg; these are related to the replication of HBVDNA. The second includes inclusion body like and marginal patterns of HBsAg with and without nuclear pattern of HBcAg; these probably reflect the integration of HBVDNA to the host genome.     

乙型慢活肝患者肝组织内乙肝病毒抗原表达与病变程度的关系

目的:通过肝穿刺病理学检查,研究慢活肝患者肝组织内HBsAg及HBcAg的麦达与肝脏病理损害的关系。方法:40例乙型慢活肝患者血清HBV标志物检测,采用固相放射免疫法,肝穿刺活检标本采用HE及Masson染色法检查肝组织病理损害程度。肝组织内HBsAg及HBcAg表达的检测采用双桥PAP法。结果:肝组织病理损害较重的中型及重型慢活肝患者,肝组织内HBsAg表达多呈胞浆包涵体型及膜型(74 3％,26/35);5例轻型慢活肝中4例为均质型,无1例属胞浆包涵体型者。中型慢活肝患者肝细胞内HBcAg表达半数呈弥漫型和膜型(51.5％,16/31);4例重型慢活肝患者肝细胞内HBcAg表达均属弥漫型和膜型,轻型慢活肝无1例呈此两种表达者。结论:肝细胞内HBsAg表达呈胞浆包涵体型和膜型,HBcAg呈弥漫型和膜型者,由于易受免疫攻击,肝脏病理损害较为重。单纯核型HBcAg者肝损害轻,且少见。     

Role of hepatitis B virus infection in pathogenesis of IgA nephropathy

AIM: To investigate the role of hepatitis B virus (HBV) in the pathogenesis of IgA nephropathy (IgAN). METHODS: HBV antigens (HBAg, or HBsAg, HBcAg, and HBeAg) in renal tissues with IgAN were detected by immunohistochemical technique. The distribution and localization of HBV DNA were observed by using in situ hybridization. Southern blot analysis was performed to reveal the state of renal HBV DNA. RESULTS: Among 100 patients with IgAN, HBs antigenemia was detected in 18 patients (18.00 %). HBAg in renal tissues was detected in 31 patients (31.00 %), the positive rate of HBAg, HBsAg and HBcAg was 64.52 % (20/31), 32.26 % (10/31), 32.26 % (10/31), respectively in glomeruli. HBcAg was also found in tubular epithelia and interstitia, which was 45.16 % (14/31) and 6.45 % (2/31), respectively. Five out of six cases with positive HBV DNA by in situ hybridization were proved to be HBV DNA positive by Southern blot analysis, and all were of the integrated form. Eight specimens were demonstrated to be HBV DNA positive by in situ hybridization, which was localized in the nuclei of tubular epithelial cells and glomerular mesangial cells as well as in infiltrated interstitial lymphocytes. CONCLUSION: There is a relationship between HBV infection and IgAN. In addition to the humoral immune damage mediated by HBAg-HBAb immune complex, the cellular mechanism mediated by HBV originating from renal cells in situ may be also involved in the pathogenesis of IgAN.     

隐匿性乙型肝炎病毒感染者临床特点和肝组织病理学检查

目的了解血清肝炎病毒标志物阴性、肝功能反复异常患者中HBV隐匿性感染的比例及其临床和病理学特点。方法对27例血清肝炎病毒标志物阴性、肝功能反复异常患者采用免疫组化法检测肝组织HBsAg、HBcAg和HCVAg，并进行常规的病理学检查。结果肝组织HBsAg和（或）HBcAg阳性9例（33．3％）；HBsAg和（或）HBcAg及HCVAg阳性10例（37．0％）；全阴性8例（29．6％）。在HBV隐匿性感染的19例患者中，慢性肝炎8例，肝硬化11例。结论HBV和HCV感染为血清肝炎病毒标志物阴性患者肝功能反复异常的主要原因之一，尤其是HBV感染。这种HBV隐匿性感染与慢性肝炎、肝硬化的发生关系密切，应引起重视。     

晚期血吸虫病患者乙型肝炎病毒DNA的检测及其意义

３１例晚期血吸虫病患者血清及肝组织乙型肝炎病毒ＤＮＡ（ＨＢＶ－ＤＮＡ）阳性率分别为９．７％及１９．４％低于血清及肝组织乙型肝炎病毒表面抗原（ＨＢｓＡｇ）检出率（分别为２９％及４８．４％），ＨＢＶ－ＤＮＡ阳性者病死率高（６６．６％），且死亡与肝病直接相关（肝衰竭及原发性肝癌）。ＨＢＶ－ＤＮＡ阴性患者病死率较低（１２％），其死亡与肝病无直接关系。结果提示，检测晚期血吸虫病患者ＨＢＶ－ＤＮＡ有重要意义。抗乙型肝炎病毒治疗对改善存在ＨＢＶ复制的晚期血吸虫病患者预后可能有重要作用，在血吸虫病疫区普及乙肝疫苗接种将对血吸虫病防治工作产生重大效益。     

Existence and significance of hepatitis B virus DNA in kidneys of IgA nephropathy

AIM: To investigate the existence and significance of hepatitis B virus (HBV) DNA in the pathogenesis of IgA nephropathy (IgAN). METHODS: Fifty cases of IgAN with HBV antigenaemia and/or hepatitis B virus antigens (HBAg, or HBsAg, HBcAg) detected by immunohistochemistry in renal tissues were enrolled in our study. The distribution and localization of HBV DNA were observed using in situ hybridization. Southern blot analysis was performed to reveal the state of renal HBV DNA. RESULTS: Among the 50 patients with IgAN, HBs antigenemia was detected in 17 patients (34%). HBAg in renal tissues was detected in 48 patients (96%), the positive rate of HBAg, HBsAg, and HBcAg was 82% (41/50), 58% (29/50), and 42% (21/50) in glomeruli, respectively; and was 94% (47/50), 56% (28/50) and 78% (39/50) in tubular epithelia, respectively. Positive HBV DNA was detected in 72% (36/50) and 82% (41/50) cases in tubular epithelia and glomeruli respectively by in situ hybridization, and the positive signals were localized in the nuclei of tubular epithelial cells and glomerular mesangial cells as well as infiltrated interstitial lymphocytes. Moreover, 68% (34/50) cases were proved to be HBV DNA positive by Southern blot analysis, and all were the integrated form. CONCLUSION: HBV infection might play an important role in occurrence and progress of IgAN. In addition to humoral immune damages mediated by HBAg-HBAb immune complex, renal tissues of some IgAN are directly infected with HBV and express HBAg in situ, and the cellular mechanism mediated by HBV originating from renal cells in situ may also be involved in the pathogenesis of IgAN.     

Correlation of hepatitis B virus DNA and antigens in the liver. A study in chronic liver disease

Hepatitis B virus deoxyribonucleic acid (DNA) and antigens (HBsAg and HBcAg) were studied in liver biopsy specimens from 105 HBsAg-positive patients with chronic liver diseases. Free or integrated viral DNA, or both, was detected in 83 of 105 (79%) patients, whereas HBsAg and HBcAg were demonstrated immunohistologically in 96 (91%) and 39 (37%), respectively. Of 60 patients with detectable free viral DNA, 38 (63%) were positive for HBcAg, whereas only 1 of 45 (2%) with either integrated viral DNA alone (n = 23) or no detectable viral DNA (n = 22) was positive for HBcAg (p less than 0.001). Furthermore, the amount of HBcAg was positively correlated with the amount of free viral DNA in the liver tissue. In contrast, HBsAg was well expressed not only in the liver with free viral DNA, but also in the liver with integrated DNA. These data suggest that the synthesis of HBcAg is primarily directed by free viral DNA, whereas that of HBsAg may be directed by free as well as integrated viral DNAs.     

Role of hepatitis B virus infection in pathogenesis of TgA nephropathy

AIM: To investigate the role of hepatitis B virus (HBV) inthe pathogenesis of IgA nephropathy (IgAN).METHODS: HBV antigens (HBAg, or HBsAg, HBcAg, andHBeAg) in renal tissues with IgAN were detected byimmunohistochemical technique. The distribution andlocalization of HBV DNA were observed by using in situhybridization. Southern blot analysis was performed to revealthe state of renal HBV DNA.RESULTS: Among 100 patients with IgAN, HBs antigenemiawas detected in 18 patients (18.00%). HBAg in renal tissueswas detected in 31 patients (31.00%), the positive rate ofHBAg, HBsAg and HBcAg was 64.52%(20/31), 32.26%(10/31), 32.26% (10/31), respectively in glomeruli. HBcAgwas also found in tubular epithelia and interstitia, whichwas 45.16% (14/31) and 6.45% (2/31), respectively. Fiveout of six cases with positive HBV DNA byin situ hybridizationwere proved to be HBV DNA positive by Southern blotanalysis, and all were of the integrated form. Eight specimenswere demonstrated to be HBV DNA positive by in situhybridization, which was localized in the nuclei of tubularepithelial cells and glomerular mesangial cells as well as ininfiltrated interstitial lymphocytes.CONCLUSION: There is a relationship between HBV infectionand IgAN. In addition to the humoral immune damagemediated by HBAg-HBAb immune complex, the cellularmechanism mediated by HBV originating from renal cells insitu may be also involved in the pathogenesis of TgAN.     

晚期血吸虫病与HBV感染的关系

目的 探讨晚期血吸虫病（晚血）与HBV感染的关系。方法 对250例住院晚血患者进行B超、肝功能、HBsAg等检查,观察晚血合并HBV感染与晚血分型、肝功能异常、肝癌发生率及死亡率等相关因素的关系。结果 250例晚血患者中HBsAg阳性者占58.4%。晚血合并HBsAg阳性者的ALT升高率（46.6%）、黄疸发生率（23.3%）、肝癌发生率（17.8%）和死亡率（23.3%）均明显高于单纯晚血患者（P＜0.05或P＜0.01）。结论 晚血合并HBV感染在血吸虫病损害的基础上加重了对肝脏的损害,促进了肝脏病变的发展。