慢性乙型肝炎患者肝组织中HBV抗原表达特征及其临床意义

目的探讨慢性乙型病毒性肝炎肝活检组织中检测乙肝表面抗原(HBsAg)和乙肝核心抗原(HBcAg)表达强度及表达方式的必要性。方法采用EnVision免疫组织化学法检测196例慢性乙型肝炎患者肝穿组织中HBsAg和HBcAg的表达水平,并用荧光定量PCR检测其血清中的HBV DNA的含量。对肝组织进行炎症活动度分级和纤维化分期。结果肝组织中的HBsAg表达强度和表达方式与炎症分级、纤维化分期和血清乙肝病毒载量均无相关性(P>0.05)。HBcAg表达强度与炎症分级无相关性(r=-0.02,P>0.05);与纤维化分期呈负相关(r=-0.28,P<0.01);与血清乙肝病毒载量呈正相关(r=0.53,P<0.01)。HBcAg表达方式与炎症分级为负相关(r=-0.27,P<0.01),其中浆型组炎症活动度分级高于核型组和混合型组(P<0.01),混合型组高于核型组(P<0.01)。HBcAg表达方式与纤维化分期亦呈较弱的负相关(r=-0.23,P<0.01),其中浆型组纤维化分期高于核型组和混合型组(P<0.05)。HBcAg表达方式与血清乙肝病毒载量呈正相关(r=0.22,P<0.01)。结论区分肝组织中的HBsAg表达强度和表达方式无益于了解慢性乙型肝炎患者肝损害的程度,而检测肝组织中的HBcAg则有助于临床抗病毒治疗。     

Morphologic, immunohistochemical, and ultrastructural studies of the production of hepatitis B virus in vitro

Well differentiated human hepatoblastoma Hep G2 cells after transfection with cloned hepatitis B virus (HBV) genomes produce replicative HBV DNA intermediates, high levels of HBsAg, HBeAg and HBcAg as well as mature Dane particles. To analyze the replication cycle of HBV, we studied the expression of HBV antigens with monoclonal antibodies by immunomorphologic methods in the transfected cells at various time intervals after plating. HBcAg and HBeAg were detected in the cytoplasm and less frequently in the nuclei of transfected cells. The percentage of positive cells increased with time after plating and reached a plateau of about 50% positive cells at 10 days. HBsAg and the large and middle HBsAg polypeptides were observed in the cytoplasm of transfected cells and a maximum of 20 to 30% positive cells was reached during the 3rd week after plating. Examination of viable cells in suspension revealed HBcAg/HBeAg and HBsAg expression on the cell surface. Electron microscopy demonstrated characteristic core particles in the nuclei and cytoplasm and Dane particles in cytoplasmic vesicles and culture media of transfected cells. The HBV producing cells did not show any evidence of a cytopathic effect. These observations demonstrate significant similarities between the HBV DNA transfected cells and infected human hepatocytes which support active HBV replication in vivo. Taken together, the results suggest that the cultured cells may serve as a model to elucidate a number of unsolved problems of the molecular and cellular pathobiology of hepatitis B.     

Hepatitis B virus (HBV) infections in turtles

Thirty turtles (15 Clemys mutica and 15 Geoclemys reevesii) which were inoculated with human sera those were positive for hepatitis B surface antigen (HBsAg) and hepatitis B "e" antigen (HBeAg) were found to be infected with hepatitis B virus (HBV). The levels of HBV infection markers, such as HBsAg and antibody to HBsAg (anti-HBsAg), were retinely monitored in the turtles' serum for 46 weeks. Within two weeks of the inoculation, 42% of the turtles tested were positive for HBsAg, and their reciprocal titers as measured by reverse passive hemagglutination (RPHA) and enzyme linked immunoabsorbance assay (ELISA) ranged from 16 to 96. Within 20 weeks, the remaining turtles tested HBsAg positive, as confirmed by ELISA. At 20 weeks, all but one of the turtles exhibited changes in HBV blood marker from HBsAg to anti-HBs; the one exception was positive for both HBsAg and anti-HBs. At the 47th week, 7 animals were killed and their organs were examined for HBV infected cells utilizing an immunofluorescent technique. Numerous fluorescent cells which reacted with human anti-HBs nad anti-HBc were observed in the following organs: pancreas, liver, kidney, and brain. Histopathologically, edematous changes in hepatocytes and minor cellular infiltration attributed to an inflammatory response were noted. Liver and kidney cells from the infected animals were cultured, and HBV antigen positive cells for HBsAg and HBcAg were detected in the cultures. Throughout the experiment, HBsAg was detected in the supernatant by ELISA. Virus particles which were indistinguishable from Dane particles were seen in the cytoplasmic vacuoles of the cultured cells by electron microscopy. Finally, the presence of HBV DNA was established by molecular hybridization techniques in the culture supernatants of kidney cells from the infected turtles.     

The IgM antibody responses to the core antigen of hepatitis B virus

Little is known about the immunoglobulin class of antibodies to HBcAg. In the present study sera containing anti-HBc were fractionated by sucrose density-gradient centrifugation, and all serum fractions were tested against HBcAg by immunoelectro-osmophoresis. In addition selected fractions were examined by complement fixation test, immune adherence hemagglutination and immune electron microscopy. Anti-HBc activity in IgG serum fractions was demonstrated by all four techniques used, but HBcAg-specific IgM was detected only by immunoelectro-osmophoresis and by immune electron microscopy. In acute hepatitis B, HBcAg-specific IgM was detected for up to eight weeks after the onset of jaundice. It was also found transiently in two patients who developed chronic hepatitis B without an icteric episode and in one out of thirteen patients with HBsAg-positive chronic liver disease, but in none of eight healthy HBsAg carriers. The results suggested that HBc Agspecific IgM is formed transiently in response to primary HBV infection but is generally undetectable in established HBsAg carriers.     

HBV体外感染卵巢颗粒细胞

目的建立HBV体外感染颗粒细胞模型,研究HBV在颗粒细胞中的复制情况,为深入研究HBV经卵细胞母婴垂直传播提供研究平台。方法原代颗粒细胞体外培养后用HBV阳性血清感染。收集培养上清,在不同时点检测HBsAg、HBeAg定量,实时定量PCR检测HBVDNA。免疫组化检测培养细胞中的HBsAg和HBcAg。巢式PCR检测细胞中的HBVDNA及HBV-mRNA。原位杂交检测细胞内的HBVDNA。结果成功建立了HBV体外感染颗粒细胞模型,在培养上清中可以持续96h检测到HBsAg和HBV DNA,在细胞内检测到HBsAg和HBcAg的阳性信号,PCR扩增显示细胞内有HBVD-NA及HBV-mRNA的存在,原位杂交证实细胞内HBVDNA阳性。结论 HBV能够在体外感染颗粒细胞,并在其内复制,该结果为深入研究HBV经卵细胞传播机制提供了很好的研究平台。     

Hepatitis B virus infection and replication in primary cultured human granulosa cells

To investigate the infection and replication of hepatitis B virus (HBV) in primary cultured human granulosa cells. Human granulosa cells were cultured with HBV-positive serum. Media were collected and assayed for HBsAg and HBeAg by ELISA, and HBV DNA by quantitative PCR. HBsAg and HBcAg were detected by immunocytochemistry in cultured cells. HBV DNA and RNA were extracted and amplified by nested PCR. Intracellular HBV DNA was localized by in situ hybridization. By co-cultivation of human GCs with HBV-positive serum, a system was established to study HBV infection and replication in GCs. HBsAg in medium could be detected from 4 to 96 h, and HBV DNA could be detected from 12 to 96 h after exposure. HBsAg and HBcAg showed positive signals by immunocytochemistry. A 206-bp fragment was amplified by nested PCR to detect HBV DNA and RNA in granulosa cells. HBV DNA was detected in GC nuclei by in situ hybridization. HBV can infect and replicate in human primary granulosa cells. This culture system could enable us to study infection of ova by HBV.     

Hepatitis B Virus Antigens in Peripheral Blood Mononuclear Cells during the Course of Viral Infection

We studied the expression of surface (HBsAg) and core (HBcAg) proteins of hepatitis B virus (HBV) on the surface of peripheral blood mononuclear cells (PBMC) from HBV-infected patients. A total of 122 patients with different liver viral diseases was analyzed by indirect immunofluorescence with monoclonal antibodies. The 35 patients with HBV chronic active hepatitis (CAH) and 38 of 60 patients with acute hepatitis B (63%) expressed HBsAg on the PBMC. No expression was detected on the cells from both normal and HBV-unrelated viral hepatitis control groups. Serial follow-up of patients with acute hepatitis B showed that HBsAg expression by PBMC tended to be undetectable 4 months after the onset of the disease and at the same time the clinical improvement was evident. Cell cultures of EBV-transformed B lymphocytes were established from PBMC of HBV-infected patients; immunoelectron microscopy demonstrated the HBsAg on the cellular membrane. One-third of HBV-infected patients who were studied showed the expression of HBcAg by PBMC. HBcAg was detected in patients with acute hepatitis B at the early stage of infection. The cells of these patients also expressed HBsAg in PBMC. In CAH patients, a positive association was observed between the expression of HBcAg and the presence of serum HBeAg.     

慢性乙型肝炎血清及肝组织病毒学标志与病理损伤的关系

目的探讨慢性乙型肝炎(CHB)患者血清及肝组织病毒学标志与肝组织病理损伤的关系。方法对647例CHB患者血清病毒学标志HBsAg、HBsAb、HBeAg、HBeAb、HBcAb、HBVDNA及其中418例肝细胞病毒学标志HBsAg、HBcAg的表达与肝组织病理损伤进行对比分析。结果CHB患者血清及肝组织病毒学标志与肝组织病理损伤密切相关。结论血清HBsAg、HBeAb、HBcAb阳性,HBVDNA阴性的患者肝组织炎症及纤维化程度较轻;HBVDNA与肝组织炎症分级及纤维化分期无明显相关;肝细胞HBsAg、HBcAg均阴性表达的肝组织炎症及纤维化程度较重。     

The ultrastructural morphology of native hepatitis B virus

Cell lines (2.2.15 cells) capable of supporting the replication of hepatitis B virus (HBV) DNA and intact viral particles have been established by HBV DNA transfection into HepG2 cells. The purpose of this study was to determine the ultrastructural morphology of native HBV particles without purification in the culture supernatants and in sera from patients. Electron microscopy (EM) and immunogold EM of the samples were carried out using polyclonal and monoclonal anti-hepatitis B surface antigen antibodies. HBV particles in the purified samples from the culture supernatants by density-gradient centrifugation were examined to compare the morphology with that of unpurified samples. EM and immunogold EM studies demonstrated the presence of Dane particles (41.8 nm in diameter), cobra-shaped (head diameter, 42.4 nm), and horn-shaped (head diameter, 43.5 nm) particles in the culture supernatants and in the sera from two patients. The tail of the cobra-like particles had a diameter of 21.0 nm and a length of 214 nm. The hornlike particles had a long branch 20.1 nm in diameter with a length of 189 nm, and a short branch 21.4 nm in diameter with a length of 112 nm. The ratio of Dane particles and cobra- and horn-shaped particles in the supernatants was 5 : 4 : 1. After ultracentrifugation, the cobra- and horn-shaped particles completely disappeared; there were only Dane particles together with spheres of 22 nm and filaments. In conclusion, this study showed for the first time that the native replicative form of HBV is cobra- and horn-shaped.     

HBV DNA及HBV抗原在血清HBV标志物阴性肝炎肝组织中表达的研究

目的 研究HBV DNA及HBV抗原在血清HBV标志阴性的肝炎肝组织中的表达。方法 对45例HBV血清标志阴性阴性肝炎患者，进行肝组织HBV DNA的原位杂交及免疫组织化学染色检测。结果 原位杂交表明，HBV DNA阳性者7例，（阳性率15．56％），阳性信号主要存在于肝细胞的胞核中，少数位于胞浆内；免疫组化染色表明，HBsAg及HBcAg均呈阴性。结论 血清HBV标志阴性的肝炎肝组织中可检出HBV DNA，有利于提高对HBV感染的诊断。     

IgA nephropathy associated with chronic hepatitis B virus infection in adults: the pathogenetic role of HBsAG

Five adult cases of IgA nephropathy associated with chronic hepatitis B virus infection were studied. Serum HBsAg and anti-HBc were present in five patients and HBeAg in four patients. Glomerular changes were typical of primary IgA nephropathy in four patients, and a mixed picture of IgA and membranous nephropathy was demonstrated in one patient. Immunofluorescence microscopy using polyclonal and monoclonal antibodies against HBsAg, HBcAg, and HBeAg revealed mesangial deposits of HBsAg in renal biopsies from four patients. One renal biopsy showed only mesangial and capillary HBcAg by polyclonal antiserum, and virus-like particles were demonstrated in the intramembranous electron-dense deposits on ultrastructural examination. Mesangial HBeAg was not detected in the renal biopsies from these patients with IgA nephropathy. As for the single patient with a mixed picture of IgA and membranous nephropathy, granular deposits of HBeAg with a distribution similar to IgG were detected in the glomerular capillary walls in addition to the mesangial deposition of HBsAg. These findings suggest that HBsAg rather than HBeAg may play a role of the pathogenesis in some of the adult patients with IgA nephropathy associated with chronic hepatitis B virus infection.     

反义锁核酸在转基因小鼠体内阻断乙肝病毒C基因表达

目的 探讨针对乙肝病毒C基因反义锁核酸在转基因小鼠体内阻断病毒基因表达的效果.方法 各实验组经尾静脉给药后,采用real-time PCR、时间分辨免疫荧光技术、免疫组织化学法等技术分别检测血清HBV DNA、HBeAg含量及肝细胞内HBcAg的表达情况.结果 注射锁核酸后,对乙肝病毒核酸的复制和乙肝病毒e抗原的合成均有较强的抑制作用,注射后1、3 和5 d,HBV DNA的平均抑制率分别19.24％、39.20％和44.47％;HBeAg的平均抑制分别为30.71％、51.14％和63.46％;小鼠肝细胞的HBcAg阳性细胞数也较对照组明显减少.结论 针对乙肝病毒C基因的反义锁核酸在转基因小鼠体内能有效抑制病毒基因的复制和表达,提示C基因可作核酸药物治疗的有效靶位.     

HBV感染者血清HBcAg SP RIA测定的临床分析

目的:研究HBcAg在HBV感染者中的阳性检出率、分布规律及与其他乙肝标志物的关系,探讨其在反映HBV复制及传染性和观察疗效方面的临床价值.方法:采用SP RIA对461例HBV感染者进行血清乙肝六项指标测定,按其不同阳性结果分9种模式对比分析.结果:HBV感染者中HBcAg阳性总检出率达50.75%,而未感染者及69例抗-HBs单项阳性者中无阳性检出.结论:SP RIA测定血清HBcAg在HBV感染者中的阳性检出具有特异性,并可作为疑有抗-HBe阳性"逆转"为HBeAg阳性者的筛选检测,对判断HBV复制程度、病程、疗效及预后评估均有临床价值.     

慢性乙肝患者抗病毒治疗前后特异性T细胞免疫观察

目的 了解抗病毒治疗前后慢性乙型肝炎患者特异性T淋巴细胞对HBV抗原蛋白免疫应答的变化及其特征.方法 收集17例慢性乙型肝炎患者抗病毒治疗前及治疗后1个月、3个月的外周血单个核细胞,以HBV特异性抗原蛋白HBsAg、HBcAg和HBeAg为刺激物,酶联免疫斑点法检测其分泌IFN-γ产生斑点的情况.同时对血清HBV DNA和HBsAg、HBeAg等病毒学指标及谷丙转氨酶(ALT)等生化学指标进行榆测并分析其相关性.结果 治疗前,所有患者ALT、总胆红素(TBiL)均高于正常上限,17例患者HBV DNA均大于104拷贝/ml;治疗1个月后,ALT复常率为35.3%,9例患者HBV DNA降为检测下限以下;治疗3个月后,ALT复常率为58.8%,有11例患者HBV DNA降为检测下限以下.抗病毒治疗前、治疗1个月、治疗3个月患者针对HBV特异性蛋白总的T细胞反应阳性率分别为64.7%、76.5%和82.4%,其差别无统计学意义.不论治疗前后,患者对HBeAg的特异性T细胞反应频率和平均反应强度最高;治疗后,对3种蛋白的特异性T细胞反应频率和平均反应强度各有不同程度的增加,其中以对HBcAg蛋白的平均反应强度的增强最明显,治疗前和治疗3个月,治疗1个月和治疗3个月之间的差别都有统计学意义.患者对HBcAg蛋白的特异性T细胞反应平均反应强度与病毒载量有明娃负相关,与血清ALT无明显相关性.结论 本研究结果提示抗病毒治疗后,患者对HBV的特异性T细胞免疫应答有所增强,这种改变可能与HBV DNA的下降有关,检测HBV特异性T细胞反应对丁解患者的免疫状态有重要的意义.

Abstract：

Objective To explore the responses of antigen-specific T cells stimulated by hepatitis B virus(HBV)-specific proteins in chronic hepatitis B patients accepting antiviral therapy. Methods Seventeen patients with chronic hepatitis B (CHB) accepting antiviral therapy were included in this study. The peripheral blood monocular cell ( PBMC) were separated from the whole blood collected at the three different time of before and one and three months after accepting antiviral therapy. ELISPOT assay was used to detect the frequency and strength of secreting IFN-γ cells of PBMC stimulated by HBsAg, HBcAg and HBeAg. HBV virus loading, HBsAg, HBeAg, ALT and AST in serum were detected at the same time. Results After three months therapy, ALT, TBiL were improved in all patients, and HBV DNA level were dropped and undetectable in 11 cases. The rates of T cell response in patients to HBV specific proteins were 64. 7% , 76. 5% and 82. 4% at the time of before and one and three months after accepting antiviral therapy, respectively. The frequency of responses of antigen-specific T cells stimulated by HBcAg was higher than that stimulated by HBsAg or HBeAg, and the frequency was enhanced after antiviral therapy. The average response magnitude was expressed as spot forming cells (SFC) per million input cells. SFC of T cell responses to HBcAg was also higher than to HBsAg or HBeAg. There was no significant difference in SFC of T cell responses to HBsAg or HBeAg at the time of before and after antiviral therapy, but there were significant difference in SFC of T cell responses to HBcAg at the time of before and after antiviral therapy. SFC of T cell responses to HBcAg was negatively associated with HBV DNA, and no associated with level of ALT in serum. Conclusion The responses of antigen-specific T cells were improved in CHB patients accepting antiviral therapy which associated with the decrease of HBV DNA. It suggested to investigate HBV specific T cell responses was important.     

Morphology of hepatitis C and hepatitis B virus particles as detected by immunogold electron microscopy

We performed indirect immunogold electron microscopy (EM) for immunological identification and characterization of hepatitis C virus (HCV). To clarify the morphology of HCV, an indirect immunogold EM of two plasma samples from patients with high HCV RNA titers was carried out using antibodies specific for the putative HCV envelope protein (E) 1. Spherical virus particles 55–65 nm in diameter with delicate spike projections were detected in the 1.14–1.16 g/ml fractions after sucrose density gradient centrifugation. Polyclonal and monoclonal antibodies to the putative HCV E1 specifically recognized these particles. In addition, immunogold EM of the samples was also performed to uncover the morphology of HCV core particles. Spherical particles 33–40 nm in diameter (average, 37 nm) were detected in the 1.22- to 1.25-g/ml fractions by conventional EM after sucrose density gradient centrifugation. Immunogold EM using rabbit polyclonal antibody (RR8) specific for the putative HCV core protein and colloidal gold-labeled goat antirabbit IgG showed binding of the gold particles with RR8. Some of the HCV core particles showed icosahedric morphology. Optical rotation technique showed that the HCV core particles exhibit sixfold symmetry and that the length of the regular hexagon side is approximately 20 nm, suggesting that they have an icosahedric structure. Further, the detection limit of the indirect immunogold EM was evaluated in 11 plasma samples from chronic hepatitis B patients with different degrees of hepatitis B virus (HBV) DNA titers using antihepatitis B surface antigen antibody. The study showed that the detection limit of virus using this method is 10⁷ virions/ml.     

194例慢性乙型肝炎病理及其与血清HBV DNA、HBeAg、ALT关系的研究

目的探讨慢性乙型肝炎病理及其与血清HBV DNA、HBeAg、ALT关系。方法对194例慢乙肝患者进行肝组织病理、HBV免疫组化检查,并检测肝功能、血清HBVM和HBV DNA。结果血清HBeAg阳性组的肝组织G2、G3~4、S2、S3~4发生率与阴性组比较差异有统计学意义,肝组织S0组与S1~4组比较差异有统计学意义,肝组织G0~1组与G2~4组、HBcAg阳性组与阴性组的HBV DNA含量比较差异亦有统计学意义,肝组织HBsAg表达为" "者与" ~ "者血清HBV DNA含量比较差异无统计学意义,肝组织达S1或(和)G2以上者血清ALT水平分别为:<40U/L组占28.57%,40~80U/L组占53.33%,81~400U/L占80.15%,>400U/L组占77.88%。结论血清HBV DNA与肝组织HBcAg表达有一致性,与肝内HBsAg无关,HBV DNA含量低可能是肝组织炎症活动度和纤维化程度高,ASC和轻度肝损害者应争取肝活检,以及时判断肝组织病理程度和治疗时机。     

慢性HBV感染肝脏病理变化和生化ALT及病毒学关系

目的 探讨慢性HBV感染ALT、HBV DNA与肝脏病理的关系.方法 对81例慢性HBV感染患者检测血清ALT、HBV DNA.并进行肝活检病理检查.结果 肝脏炎症分级和纤维化分期与ALT明显相关(r值分别为0.683和0.419),与HBV DNA无相关性.随着肝脏炎症活动度和纤维化程度的加重,ALT有升高趋势(χ2趋势值分别为25.81和12.012),HBV DNA无升高趋势,而随着HBVDNA的升高,肝脏炎症活动度和纤维化程度并无加重趋势.肝组织HBsAg、HBcAg阳性组与阴性组的ALT、HBV DNA差异无统计学意义.结论 ALT与肝脏炎症活动度有明显相关性,仍是观察炎症变化的敏感指标,HBV DNA与肝组织炎症分级及纤维化分期无相关性.     

Electron microscopy of hepatitis B virus components in chronic active liver disease.

Eighteen liver biopsy specimens from patients with hepatitis B surface antigen (HBsAg) positive chronic aggressive hepatitis were studied by electron microscopy. All cases were selected on the basis of positive liver cell membrane fluorescence for HBsAg on immunohistochemical investigation. Striking changes in the morphology of the liver cell membrane were observed in nearly all cases. Furthermore, a dual aspect of hepatitis B core antigen (HBcAg) is described. HBcAg particles may occur as either 'naked' or 'cloudy' particles surrounded by semi electron dense material. The nature of the 'cloud' remains to be identified.     

Relationship between HBcAg in serum and liver and HBV replication in patients with HBsAg-positive chronic liver disease

The expression of hepatitis B core antigen (HBcAg) in serum and in hepatocytes was evaluated in relation to HBV replication. Fifty chronic HBsAg carriers with histological evidence of liver disease were studied, including 24 HBeAg-positive patients, 2 HBeAg/anti-HBe-negative patients, and 24 anti-HBe-positive cases, two of them with evidence of delta agent infection. Serum HBV-DNA was evaluated in all patients and related to HBcAg examined at the same time in frozen liver biopsies by immunofluorescence and to HBcAg detected in the corresponding serum by a recently developed radioimmunoassay. HBV-DNA was present in serum in 20 (83%) HBeAg-positive patients, all positive for serum HBeAg, whereas liver core antigen was detected in 14 (73%) of 19 cases. Among HBeAg-negative patients, 50% showed the presence of circulating DNA viral sequences, and HBcAg was identified in five of 26 (19%) cases in serum and in six of 24 (25%) in the liver respectively. In 15 patients, liver fragments permitted examination in parallel by immunofluorescence for HBcAg and molecular hybridization for viral DNA in liver cells. A DNA pattern characteristic of viral replication was found in cases with evidence of active virion production, independently from HBeAg and anti-HBe, and in these patients HBcAg was present both in serum and in hepatocytes. In two cases with free HBV-DNA, without evidence of replicative activity, core antigen was not detected in the liver, but in one patient HBcAg was found in the serum. A similar finding was also noted in another patient, in whom the hybridization pattern was consistent with integration of viral genome into high-molecular-weight cellular DNA. Whether serum HBcAg detected in these patients without HBV-DNA in serum reflects the presence of defective viral particles or of core antigen released as a viral protein remains to be determined.