病毒性肝炎

病毒性肝炎前两篇文章介绍了病毒性肝炎的诊断；乙肝、丁肝的有关知识，本篇将详细介绍甲肝、丙肝和戊肝。甲型肝炎（ＨＡ）抗－ＨＡＶ抗体出现较早，并伴随感染症状和生化改变。尽管甲型肝炎病毒（ＨＡＶ）有四个基因型，但只有一个血清型，故不影响血清学诊断。甲肝的血...     

不同类型慢性肝炎人群戊型病毒性肝炎感染率现状调查研究

目的 了解深圳地区不同类型慢性肝炎人群戊型病毒性(Hepatitis E/HE)肝炎(戊肝)感染现状,为戊肝的预防和治疗提供科学依据。方法随机收集2013年7月～2015年6月来深圳市龙华新区人民医院体检及就诊的无肝炎正常人群1 746例为对照组,慢性乙型病毒性肝炎(乙肝)人群1 320例为乙肝组,慢性丙型病毒性肝炎(丙肝)人群615例为丙肝组,分别应用酶联免疫吸附试验法(ELISA)检测血清中戊肝抗体-IgG(抗HEV-IgG),分析不同类型肝炎人群戊肝感染情况,并比较不同组间戊肝感染率是否存在差异性。结果 1 746例对照组血清中抗HEV-IgG阳性率为3.49%,其中男性4.22%,女性2.68%; 1 320例乙肝组为10.9%,其中男性12.29%,女性8.23%; 615例丙肝组为10.2%,其中男性12.35%,女性7.64%。乙肝组和丙肝组抗HEV-IgG阳性率与对照组比较差异有统计学意义(χ²=9.163～9.405,P<0.05),乙肝组与丙肝组抗HEV-IgG阳性率之间差异无统计学意义(χ²=0.614,P>0.05),戊肝男性感染率高于女性,差异有统计学意义(χ² =2.873～4.025,P<0.05)。结论 慢性乙型病毒性肝炎和丙型病毒性肝炎人群抗HEV-IgG阳性率高于无肝炎正常人群,戊肝感染率男性高于女性。因此,加强对慢性乙型病毒性肝炎和丙型病毒性肝炎人群的早发现、早诊断和早治疗,对降低戊肝感染率有重要的意义。     

老年戊型病毒性肝炎及其重叠感染的临床分析--附96例分析

目的 :探讨老年戊型病毒性肝炎及其重叠其它病毒性肝炎的临床特点 ,以便临床提前干预 ,提高疗效。方法 :根据肝炎病毒标志物检测结果 ,将 96例老年戊型病毒性肝炎患者分为单纯戊型病毒性肝炎组 (单纯戊肝组 )和戊型病毒性肝炎重叠其它肝炎组 (重叠感染组 ) ,对临床表现、肝功能、转归等资料进行分析和比较。结果 :96例老年戊型病毒性肝炎中单纯戊肝组 80例 (83% )、重叠感染组 16例 (17% ) ,P <0 0 1;重叠感染组的总胆红素水平明显高于单纯戊肝组 [(340± 12 7) μmol/L比 (177±99) μmol/L ,P <0 0 1];重叠感染组中的γ 谷氨酰转肽酶 [(32 1± 188)U/L]、碱性磷酸酶 [(35 6±136 )U/L]明显高于单纯戊肝组 [(12 9± 5 7)U/L、 (2 4 6± 79)U/L],均为P <0 0 1;重叠感染组黄疸消退时间明显长于单纯戊肝组 [(5 9± 2 4 )日比 (31± 15 )日 ,P <0 0 1];重叠感染组死亡 4例 (2 5 % ) ,明显高于单纯戊肝组的 1例 (1% ) ,P <0 0 1。结论 :老年戊型病毒性肝炎重叠其它肝炎患者 ,具有病情重 ,并发症和合并症多 ,黄疸深 ,黄疸消退缓慢 ,肝内淤胆明显 ,病死率高等临床特点。     

老年病毒性肝炎与戊型肝炎病毒感染

总结该院近３年老年病毒性肝炎中戊型肝炎病毒感染占５２．９％，明显高于非老年组的１７．９％，老年戊肝病毒感染的临床类型大部分表现为急性黄疸型肝炎（８８．９％），小部分在慢性肝病基础上急性发病（１１．１％），其病原类型７７．８％，为单独戊肝病毒感染，合并其它肝炎病毒感染占２２．２％，老年急性戊型肝炎的临床特点；（１）平均血胆红素水平及重要黄疸发生率均明显高于非老年组（Ｐ〈０．０１）；（２）血清白蛋白降     

1999-2008年浙江省宁波市戊型病毒性肝炎流行特征分析

目的探讨浙江省宁波市戊型病毒性肝炎(戊肝)发病趋势和流行病学特征。方法 采用描述性流行病学方法对宁波市1999-2008年戊肝监测资料进行分析。结果 1999-2008年宁波市戊肝年均发病率为2.56/10万;发病以春夏季为主,发病高峰在1-5月;宁波市所辖11个县(市、区)均有病例报告,个别县(区)发病率较高;戊肝发病以成年人为主,尤以40～59岁年龄组病例较多,且呈上升趋势。结论 应重视戊肝的控制工作,加强食品和水源的管理。     

急性戊型病毒性肝炎患者血清生长激素水平的变化

戊型病毒性肝炎（以下简称戊肝）由戊型肝炎病毒（Hepatitis E Virus，HEV）感染所致，经粪口传播。肝脏是体内代谢调节的重要场所，与激素关系十分密切，是许多激素作用的主要部位。国内少见关于重型肝炎GH与肝衰竭之间关系的报道，而在急性肝炎中的作用未见文献报道。因此，我们对39例急性戊肝患者进行了生长激素水平变化进行研究，探讨急性戊肝患者生长激素水平与肝细胞损伤及坏死之间的关系。     

132例散发性戊型肝炎临床分析

目的对该院1999年1月～2000年12月收治的戊型肝炎132例进行回顾性分析。方法诊断标准按1995年5月第5次全国传染病与寄生虫病学术会议修订的病毒性肝炎防治方案诊断标准进行,均为戊肝抗体(抗HEV—IgG)阳性的急性散发性肝炎,采用酶联免疫(ELISA)法检测各型病毒性肝炎血清标志物。庚肝抗体(抗HGV—IgM)和丁肝抗原(HDV—Ag)试剂盒为北京现代高达生物技术有限公司产品,其余乙肝标志物(HBV—M)和甲肝抗体(HAV—IgM)及丙肝抗体(抗HCV—IgG)和戊肝抗体(抗HEV—IgG)检测均为上海实业科华生物技术有限公司产品。结果132例散发性戊型肝炎中男105例,女27例,年龄20～82岁,平均46岁。其中急性黄疸型103例(78％),急性无黄疸型27例(20．45％),亚急性重症肝炎2例(1．5％),单纯戊肝98例(74．24％),戊肝重叠甲肝感染1例(0．75％),戊肝重叠乙肝感染12例(9％),戊肝重叠丙肝感染3例(2．27％),戊肝合并酒精性肝病9例(6．81％),戊肝合并脂肪肝9例(6．81％)。结论鞍山地区散发性戊型肝炎临床分析显示男性多于女性(3．8：1),青壮年76．5％,老年人多发(23．5％),均为散发,起病急,消化道症状重,血清总胆红素(TBIL)定量明显升高者占81％,60岁以上年长组较60岁以下青壮年组黄疸重,持续时间长,丙氨酸氨基转氨酶(ALT)明显升高(84．85％),ALT恢复正常时间较TBIL快,一般单纯戊肝感染愈后良好,临床治愈率为72％。     

2005-2011年杭州市西湖区病毒性肝炎流行特征分析

目的 分析杭州市西湖区病毒性肝炎流行特征,为制定防治策略提供参考依据。 方法 采用描述性流行病学分析方法对西湖区2005-2011年法定传染病报告的病毒性肝炎疫情资料进行统计分析。 结果 杭州市西湖区病毒性肝炎疫情总体均呈平稳流行态势,以散发为主,年平均发病率为29.02/10万;病毒性肝炎病例男性多于女性,街道高于乡镇,主要为工人、干部职员、离退休人员,20~49岁年龄组占70.77%;各型病毒性肝炎中甲型病毒性肝炎(甲肝)发病率最低,年均发病率为1.75/10万;乙型病毒性肝炎(乙肝)发病总体呈下降趋势,年发病率由2005年的19.40/10万下降到2011年的12.85/10万;戊型病毒性肝炎(戊肝)发病总体呈上升态势,年发病率由2005年的3.95/10万上升到2011年的10.49/10万。 结论 病毒性肝炎防治工作成效明显,但应调整和优化甲、乙肝免疫策略,加大戊肝疫苗的研发和预防接种工作。     

戊型病毒性肝炎患者血NPT的临床意义

目的通过对戊型病毒性肝炎急性期和恢复期血NPT的水平的观察,评价血NPT变化的临床意义。方法戊型肝炎及NPT均采用ELISA法,产品分别为上海实业科华生物技术有限公司、HAMBURG IBL公司提供。结果IgM阳性组;IgM、IgG同时阳性组;IgG阳性ALT非正常组;IgG阳性ALT正常组;对照组的血NPT值分别为(87.32±21.10)nmol/L,(48.68±10.27)nmol/L,(21.30±7.05)nmol/L,(9.04±3.75)nmol/L,(4.07±3.76)nmol/L。戊型病毒性肝炎组间比较:IgM阳性组与IgM、IgG同时阳性组,IgM、IgG阳性组与IgG阳性ALT非正常组,IgG阳性组ALT非正常组与IgG阳性组ALT正常组比较P值均<0.01;各组与对照组比较P值均<0.01。结论戊型病毒性肝炎患者急性期血NPT的水平高于恢复期病毒性肝炎患者。     

HEV国内外研究现状及目前所面临的问提

戊型肝炎（Hepatitis E，HE，简称戊肝）是由戊型肝炎病毒（HEV）引起的病毒性肝炎，占急性肝炎总数的10％-20％。本病主要经粪一口途径传播，常引起暴发性流行。戊肝的潜伏期为10—60天，平均40天。戊肝主要经粪-口途径传播，即经消化道传播。也可经血液传播，但由于HEV在血液中存在的时间不及在粪便中存在的时间长，经血传播不是戊肝的主要传播途径。     

海淀区2000年人群甲型肝炎血清流行病学调查

为探索当前甲肝流行规律 ,了解甲肝疫苗接种现况 ,在 2000年 10月对市区、城乡接合部、农村、流动人口的 404人进行甲肝血清流行病学调查。结果表明本区人群甲肝自然感染率为 62.95 % ,甲肝疫苗接种率11.50 % ,1- 19岁甲肝疫苗接种率 17.70 %。年龄感染高峰 2 0 - 24岁组 ,自然感染率为 80.50 % ,最低为 5 - 9岁组 ,自然感染率仅为 27.27%。地区感染无差异。流动人口自然感染率随年龄上升而升高 ,总的感染率为 50 % ,甲肝疫苗接种率 9.89%。调查证实全区人群中约 1/ 3为易感人群 ,而 5 - 9岁组人群属免疫低屏障人群 ,因此 ,本区仍有发生甲肝流行的可能 ,全区甲肝防治的重点人群为小学生。流动人口的甲肝防治工作有待进一步规范和加强.     

ADV联合LMV治疗LMV耐药慢性乙型肝炎临床疗效

目的 观察ADV联合LMV治疗LMV耐药慢性乙型肝炎临床疗效和安全性.方法 选择YMDD变异株患者68例,随机分为对照组(A组、34例)和治疗组(B组、34例),对照组继续予拉米夫定100 mg/d口服治疗、治疗组联合ADV10 mg/d口服治疗,疗程6月.检测肝、肾功能、HBV DNA,HB-sAg,治疗过程中的病情变化和不良事件的发生率.结果 B组在第6月时,ALT、HBV DNA水平下降明显,与A组比较有显著性差异(P<0.05);A组与B组比较,AL T复常率有显著性统计学差异(P<0.05),HBV DNA转阴率比较无显著性差异(P>0.05),在使用ADV联合LMV治疗过程中,监测肾功能均在正常范围内,未发现明显的毒副作用.结论 ADV联合LMV治疗LMV耐药慢性乙型肝炎患者具有良好的疗效和安全性.     

乙型、丙型肝炎病毒对肾移植术后巨细胞病毒感染的影响

目的 :探讨肝炎病毒对肾移植术后CMV感染的影响。方法 :对 384例肾移植患者术后CMV -IgM进行检测 ,比较肝炎病毒感染组与非病毒感染组术后CMV感染率。结果 :肝炎病毒感染组术后CMV感染率 (30 .5 % )明显高于无病毒感染组(11.3% ) (P <0 .0 5 ) ,若患者术前已有CMV感染 ,肝炎病毒感染组术后CMV感染率更高 (4 7.4 % )。结论 :肝炎病毒感染能够增加肾移植术后CMV感染率 ,对术前已有CMV感染的肝炎病毒感染者更应注意术后CMV的监测 ,以便及时发现病毒活动 ,避免病情进展。     

Hepatitis B and C seropositivity among nursing students at a Turkish university

IRMAK Z., EKINCI B. & AKGUL A.F. (2010) Hepatitis B and C seropositivity among nursing students at a Turkish university. International Nursing Review 57 , 365–369 Background: Viral hepatitis infections are major health problems, which are especially prevalent in developing countries. In particular, health care workers are at high risk for contracting viral hepatitis. Therefore, preventive measures to minimize occupational exposure to blood borne pathogens are needed to protect both health care workers and nursing students. Objectives: To determine the prevalence of Hepatitis B and C infections and risk factors among nursing students. Methods: Venous bloods were obtained from nursing students and were serologically tested using the ELISA method. A questionnaire form was also used to obtain data related to demographic and socio‐economic characteristics of the participants. Results: 0.7% of the nursing students were serologically positive for HBsAg, 17.0% for Anti‐HBs and 7.5% were positive for Anti‐HBc (IgG). No statistical relationship was determined between all independent variables and the results of serologic tests.     

ADV联合LMV治疗LMV耐药慢性乙型肝炎临床疗效

目的观察ADV联合LMV治疗LMV耐药慢性乙型肝炎临床疗效和安全性。方法选择YMDD变异株患者68例，随机分为对照组（A组、34例）和治疗组（B组、34例），对照组继续予拉米夫定100ms／a口服治疗、治疗组联合ADVIOmg／dVI服治疗，疗程6月。检测肝、肾功能、HBVDNA，HB—sAg，治疗过程中的病情变化和不良事件的发生率。结果B组在第6月时，ALT、HBVDNA水平下降明显，与A组比较有显著性差异（P〈0．05）；A组与B组比较，ALT复常率有显著性统计学差异（P〈0．05），HBVDNA转阴率比较无显著性差异（P〉0．05），在使用ADV联合LMV治疗过程中，监测肾功能均在正常范围内，未发现明显的毒副作用。结论ADV联合LMV治疗LMV耐药慢性乙型肝炎患者具有良好的疗效和安全性。     

Hepatitis A: A preventable threat

Hepatitis A is a major public health problem, particularly in the pediatric population. Although hepatitis A infection does not cause chronic liver disease, it is associated with significant morbidity. The virus is transmitted primarily by person-to-person contact via the fecal-oral route. The infection can be inapparent, subclinical, anicteric, or icteric. In general, the severity of the disease is inversely correlated with the age of the child. Occasionally, fulminant hepatitis, which is associated with a high mortality rate, may result. The diagnosis of acute hepatitis A is most commonly made through the detection of immunoglobulin M (IgM) anti-hepatitis A antibody. Treatment is generally supportive. General preventive measures include improved standards of hygiene and sanitation. Universal childhood vaccination is the most effective method for eradicating hepatitis A and preventing its transmission.     

拔牙术中乙型、丙型肝炎病毒污染的调查及对策

目的对常规拔牙术中乙型、丙型肝炎病毒污染情况进行调查，进一步控制医源性感染。方法随机抽取500例门诊拔牙患者的术中止血棉球，分别浸入2个（A、B）盛有1ml生理盐水的无菌试管内，其浸出液分别用两种方法进行肝炎病毒检测。结果A组（HBsAg）检测到40例阳性（8．00％），B组（IgG）检测到12例阳性（2．40％），HBsAg和IgG检测到A组和B组同时阳性2例（0．40％）；500例门诊拔牙患者中检测到被肝炎病毒感染的有54例，占调查总人数的10．8％。结论口腔门诊乙型、丙型肝炎感染率很高，迫切要求口腔医务工作者要加强职业防护，有效防治肝炎病毒通过口腔科诊疗传播。     

Nursing students' immunisation status and knowledge about viral hepatitis in Turkey: a multi-centre cross-sectional study

Yamazhan T., Durusoy R., Tasbakan M.I., Tokem Y., Pullukcu H., Sipahi O.R., Ulusoy S. & Turkish Nursing Hepatitis Study Group (2011) Nursing students' immunisation status and knowledge about viral hepatitis in Turkey: a multi‐centre cross‐sectional study. International Nursing Review 58 , 181–185 Background: The aims of this multi‐centre cross‐sectional survey were to detect Turkish nursing students' level of knowledge on viral hepatitis, to evaluate their rates of exposure to blood and to find out their hepatitis A (HAV), hepatitis B (HBV) vaccination status. Methods: This multi‐centre cross‐sectional study was conducted in 14 nursing schools located in the seven geographical regions of Turkey. A questionnaire composed of 47 questions on socio‐demographic factors, level of knowledge on HAV, HBV, hepatitis C (HCV) immunisation status, exposure history and attitudes was applied to the study group. Results: A total of 1491 third‐ and fourth‐year nursing students participated with an 89% response rate. The mean age of the participating students was 21.4 ± 1.3. Their mean knowledge score was 23.7 ± 4.6 (71/100) and was significantly higher in fourth‐year students than third‐year students. There were significant differences in mean scores among nursing schools. Among the participants, 85.3% had received HBV vaccine and 9.1% had received HAV vaccine. The percentage of students who signify themselves at increased risk of acquiring viral hepatitis was 97.3%. Of the students, 28.1% had sustained a needle‐stick injury and 5.4% had experienced conjunctival exposure to blood. Conclusions: Curriculum differences among nursing schools have a significant effect on nursing students' level of knowledge. For this reason, nursing schools should organize HBV immunisation programmes for their students to increase vaccination coverage.     

Transfusion-Transmitted Hepatitis E Virus Infection in France

There is growing concern regarding the risk of transfusion- transmitted (TT) hepatitis E. Since the first described case in 2006, several TT hepatitis E have been reported to the French hemovigilance network. We performed a retrospective analysis of all cases of TT hepatitis E reported between 2006 and 2016. Transfusion-transmitted hepatitis E with high imputability according to phylogenetic analysis occurred in 23 patients aged 8 to 88 years and involved mostly solid organ recipients (n = 9) or patients with malignant hematological diseases (n = 9, including 4 hematopoietic allograft recipients). Involved blood products were plasma (n = 7), among which 6 had undergone pathogen reduction with solvent/detergent (n = 4) or amotosalen + ultra-violet A (UVA) (n = 2 from 1 donation) treatments, red blood concentrates (n = 7), apheresis platelets concentrates (n = 3) and whole blood pooled platelets concentrates (n = 6), among which one had underwent amotosalen + UVA treatment. Median hepatitis E virus (HEV) RNA dose infused was 5.79 [4.36–10.10] log IU. HEV infection progressed to chronic hepatitis E in 14 (61%) immunocompromised patients, 2 of whom had advanced liver fibrosis at diagnosis. Chronic hepatitis E patients cleared HEV with ribavirin treatment (n = 10), after immunosuppressive drug reduction (n = 3), or spontaneously (n = 1). One additional organ transplant recipient with associated co-morbidities died with ongoing HEV infection and multiple organ failure. The other 8 (34.8%) patients with TT hepatitis E cleared HEV within 6 months with ribavirin treatment (n = 3), reduced immunosuppression (n = 1) or spontaneously (n = 4). Red cells, platelets, and plasma transfusions may be associated with TT hepatitis E that can evolve to chronic hepatitis E in immunocompromised patients. Hepatitis E virus has emerged in France as a clinically significant TT infection risk.     

Hepatitis A

The introduction of hepatitis A vaccines in 1995 led to a drop in the number of reported cases of hepatitis A and a shift to a higher percentage of cases occurring in older age groups. The hepatitis A virus survives for extended periods in the environment. Transmission primarily is fecal-oral, although there have been rare instances of transmission through blood products. The virus appears sporadically and is spread by close personal contact, with occasional food-borne outbreaks. Older persons infected by the virus usually develop a symptomatic infection with abrupt onset, fever, and jaundice lasting two months. Children usually have an asymptomatic infection and rarely develop jaundice. Laboratory diagnosis is made by detection of antihepatitis A virus immunoglobulin M in serum. Ten to 20 percent of symptomatic patients experience a prolonged or relapsing course of illness, but chronic infection has not been reported. Fulminant infection occurs in less than 1 percent of patients and can result in emergent liver transplant or death. Prevention starts with thorough handwashing and careful food handling. Prompt disease reporting, the identification of exposed persons, and expeditious administration of immune globulin prevent secondary transmission of the disease. Physicians should consider routine vaccination of children 12 to 23 months of age based on recommendations from the Centers for Disease Control and Prevention. Vaccination for children two years or older and adults should be included in routine preventive care for those at increased risk of contracting the disease (e.g., travelers to certain countries, men who have sex with men, drug abusers, recipients of clotting factor replacement) and for persons with chronic liver disease.