丙型肝炎病毒准种感染及干扰素疗效的预测

丙型肝炎患者体内常有丙型肝炎病毒准种感染。准种感染不仅是引起不同临床表现的重要原因之一，而且与干扰素治疗的疗效有关。干扰素治疗丙型肝炎疗效的影响因素很多，其中ＨＣＶ基因型的变异是一个重要因素，对ＨＣＶ感染者体内ＨＣＶ基因型的分析将有助于干扰素疗效的预测。并减少治疗的盲目性。     

丙型肝炎病毒准种研究近况

丙型肝炎病毒以准种形式在体仙存在，使机体难以清除病毒地致病情慢性化，同时也使干扰素疗效不佳。本文对准种形式机制、检测手段、研究近况及干扰素治疗等和一综述。     

丙型肝炎病毒准种研究近况

丙型肝炎病毒以准种形式在体内存在,使机体难以清除病毒而导致病情慢性化,同时也使干扰素疗效不佳。本文对准种形成机制、检测手段、研究近况及干扰素治疗等方面作一概述。     

丙型肝炎病毒准种感染及干扰素疗效的预测

丙型肝炎患者体内常有丙型肝炎病毒(HCV)准种感染。准种感染不仅是引起不同临床表现的重要原因之一,而且与干扰素治疗的疗效有关。干扰素治疗丙型肝炎疗效的影响因素很多,其中HCV基因型的变异是一个重要原因。对HCV感染者体内HCV基因型的分析将有助于干扰素疗效的预测,并减少治疗的盲目性。     

丙型肝炎病毒基因的干扰素敏感决定区

丙型肝炎病毒（ＨＣＶ）感染的慢性化率高达６０％￣８０％以上,决定ＨＶＣ感染慢性化的因素是多种多样的。根据ＨＣＶ对α干扰素（ＩＦＮ－α）敏感株与抗性株核苷酸序列的比较,发现ＨＣＶ ＮＳ５Ａ区的核苷酸序列的变异是影响ＨＣＶ感染慢性化的重要机制之一,并提出了ＨＣＶ ＮＳＡ５区存在ＩＦＮ－α敏感决定区（ＩＳＤＲ）的概念。应用基因的转移与表达技术,证实ＩＳＤＲ的表达可使宿主细胞处于显著的抗ＩＦＮ－α的状态。     

HCV准种复杂性与干扰素疗效关系的初步探讨

目的　探讨丙型肝炎病毒 (HCV) 1b型患者HVR1 ,NS5A区准种复杂性与干扰素疗效的关系。方法　应用单链构象多态性聚合酶链反应 (SSCP)法检测慢性丙型肝炎患者干扰素治疗前后HCV准种的动态变化。结果　治疗前HCVHVR1准种的SSCP条带数 (复杂性 )≤ 3者在经干扰素治疗后HCVRNA阴转率为 71 .4 3% ,>3者HCVRNA阴转率为 1 5 .38% ,两者相比 ,差异有显著性 (P <0 .0 5 ) ;治疗有效组SSCP条带数为 2 .4 3± 0 .98( x±s) ,无效组为 4 .4 6± 0 .88,两者相比 ,差异亦具显著性 (P <0 .0 1 )。而NS5A区SSCP条带数则无差异。结论　HCV1b型慢性丙型肝炎患者HVR1区准种的复杂性与干扰素疗效有关 ;而NS5A区准种的复杂性与干扰素疗效无关。     

丙型肝炎病毒基因的干扰素敏感决定区

丙型肝炎病毒(HCV)感染的慢性化率高达60％～80％以上,决定HCV感染慢性化的因素是多种多样的。根据HCV对α干扰素(IFN-α)敏感株与抗性株核苷酸序列的比较,发现HCV NS5A区的核苷酸序列的变异是影响HCV感染慢性化的重要机制之一,并提出了HCVNS5A区存在IFN-α敏感决定区(ISDR)的概念。应用基因的转移与表达技术,证实ISDR的表达可使宿主细胞处于显著的抗IFN-α的状态。最近的研究表明,HCV NS5A区ISDR与双链RNA依赖性蛋白激酶(PKR)的结合可阻断PKR的抗病毒作用,是HCV慢性化的主要机制之一。     

宜兴地区丙型肝炎病毒基因型及变异情况分析

目的了解江苏宜兴地区丙型肝炎病毒（HCV）基因型分布特点和变异情况对疾病的影响。方法对宜兴市人民医院收治的166例HCV抗体阳性患者血清进行HCVRNA检测，采用5′非编码区（5′NCR）1，2，3，1b型特异性引物。对阳性标本进行Simmonds分型。选取未经干扰素治疗的43份慢性丙型肝炎患者的HCVRNA阳性血清，采用RT—PCR扩增HCV包膜区（E2），单链构象多态性聚合酶链反应法（SSCP）获得HCV准种条带数，准种数〉2为复杂准种，比较不同肝病活动度患者的准种复杂情况。结果166份血清中，有102份为HCVRNA阳性。其中1b型86份占84．3％，2型6份占5．9％，1b／2型的混合感染5份占4．9％，不能分型的5份占4．9％。男性和女性在基因型总体分布差异有统计学意义。在单一型感染和混合型感染的分布差异亦有统计学意义，而在不同年龄、不同临床类型的肝炎中分布差异无统计学意义。HCV包膜区准种复杂与否和丙氨酸转氨酶（ALT）的正常与否具有相关性。结论江苏宜兴地区的HCV感染主要为1b型，病毒的变异程度与ALT成正相关。     

丙型肝炎病毒与性传播

丙型肝炎病毒（ＨＣＶ）经血传播已被肯定，但ＨＣＶ感染者中无经血暴露血史者占４０～５０％，提示存在着非经血传播的途径。近年来，有不少文献报道了性接触传播ＨＣＶ的可能性，本文就这一方面的研究进展作一综述，着重介绍经性传播感染ＨＣＶ的危险人群及危险因素。     

丙型肝炎病毒基因变异与免疫

有关丙型肝炎病毒（ＨＣＶ）持续性感染和发生免疫逃逸的机制至今尚不清楚，但病毒基因组的高度变异性可能是重要原因，本文就ＨＣＶ基因变异，基因型，准种特性及变异与宿主免疫之间的关系作一综述。     

乙型肝炎病毒基因变异与干扰素的疗效

HBV的基因变异与IFN治疗慢性乙型肝炎的疗效有关.此文就HBV基因前C/C区变异、X基因BCP变异和P基因区末端蛋白变异对IFN疗效的影响作了综述.     

Understanding the molecular mechanism(s) of hepatitis C virus (HCV) induced interferon resistance

Hepatitis C virus (HCV) is one of the foremost causes of chronic liver disease affecting over 300 million globally. HCV contains a positive-stranded RNA of ∼9600 nt and is surrounded by the 5′ and 3′untranslated regions (UTR). The only successful treatment regimen includes interferon (IFN) and ribavirin. Like many other viruses, HCV has also evolved various mechanisms to circumvent the IFN response by blocking (1) downstream signaling actions via STAT1, STAT2, IRF9 and JAK-STAT pathways and (2) repertoire of IFN Stimulatory Genes (ISGs). Several studies have identified complex host demographic and genetic factors as well as viral genetic heterogeneity associated with outcomes of IFN therapy. The genetic predispositions of over 2000 ISGS may render the patients to become resistant, thus identification of such parameters within a subset of population are necessary for management corollary. The ability of various HCV genotypes to diminish IFN antiviral responses plays critical role in the establishment of chronic infection at the acute stage of infection, thus highlighting importance of the resistance in HCV treated groups. The recently defined role of viral protein such as C, E2, NS3/NS4 and NS5A proteins in inducing the IFN resistance are discussed in this article. How the viral and host genetic composition and epistatic connectivity among polymorphic genomic sites synchronizes the evolutionary IFN resistance trend remains under investigation. However, these signals may have the potential to be employed for accurate prediction of therapeutic outcomes. In this review article, we accentuate the significance of host and viral components in IFN resistance with the aim to determine the successful outcome in patients.     

Hepatitis C virus infection in family setting

To evaluate risk factors associated with intrafamiliar transmission of hepatitis C virus (HCV), 113 hepatitis C virus index subjects with chronic HCV infection and their 267 family contacts were studied from January 1994 to October 1995. Overall, 16 family contacts (6%) were positive for anti-HCV by ELISA II generation. The prevalence was 11.3% in spouses and 2.9% in other relatives (odds ratios: 4.2; 95% CI: 1.4–12.6). Spouses who had been married to the index cases longer than 20 years had a 7.5–fold risk (95% CI: 1.0–336.3) of HCV seropositivity as compared to those married less than 20 years. In univariate analysis HCV seropositivity was associated with surgical intervention, use of glass syringes and hospitalization. The results of multivariate logistic analysis showed that any parenteral exposure (odds ratios: 3.8; 95% CI: 1.2–12.8) and sexual contact with an anti-HCV index case (odds ratios: 3.0; 95% CI: 1.0–9.4) were both independent predictors of HCV seropositivity among household contacts of HCV positive index cases. These findings indicate that sexual contact and any parenteral exposure both play an independent role in the spread of HCV infection in the family setting.     

联合检测丙肝病毒核心抗原和抗体在丙型肝炎早期诊断中的价值

目的:通过检测丙型肝炎抗体(HCV-Ab),同时对其进行丙型肝炎病毒核心抗原(HCV-cAg)和丙肝病毒RNA(HCV-RNA)两项指标进行检测,探讨HCV-cAg检测在丙型肝炎早期诊断中的意义。方法:对104例HCV-Ab阳性标本及108例高危人群但HCV-Ab阴性标本(包括血液透析患者55例、医务人员20例和丙型肝炎病人的家庭密切接触者33例)及健康对照组同时进行HCV-cAg和HCV-RNA的检测。结果:104例HCV-Ab阳性组中,HCV-cAg阳性25例,HCV-RNA阳性27例;108例HCV-Ab阴性组中,HCV-cAg阳性2例,HCV-RNA阳性1例;健康对照组全阴性。结论:HCV-cAg和HCV-RNA在丙型肝炎早期诊断上无显著性差异,但HCV-cAg检测在临床的应用前景上具有更大的优势,故可在临床推广HCV-Ab和HCV-cAg联合检测,有条件者可联合检测HCV-Ab、HCV-cAg和HCV-RNA。     

中国丙型肝炎病毒基因型分布

目的分析中国丙型肝炎病毒(HCV)基因型的分布及变化趋势。方法计算机检索1994年以来中国医院知识库(CHKD),1998年以来万方数据资源系统、中国生物医学文献数据库(CBMDisc)以及PubMed数据库,并结合文献追溯方法,收集国内HCV基因分型的相关文献。相同HCV亚型分别按地区、研究时间、人群分组,并进行简单数量合并,计算百分比。结果共纳人文献140篇(共168条记录)。不同地区HCV基因型存在差异,其中北方地区基因型较单一,以1b和2a型为主;南方地区HCV基因型种类较多,以1b型为主,2a,3a,3b及6a型各自占较大比例。早期HCV基因型较单一,随着时间推移,1b及2a亚型逐渐减少,而3a,3b及6a亚型逐年增加,亚型类型逐年增多。有偿献血人群lb,2a亚型所占比例较高;吸毒人群HCV基因亚型较多,3型(3a,3b亚型)及6a亚型所占比例较大,且有逐渐向普通人群扩散趋势。结论中国流行最广泛的HCV基因亚型为1b及2a,且分布地区差异较大,并随时间的推移,基因型分布产生较大变化。     

Hepatitis C virus infection in four haemodialysis units of southern Italy: Epidemiological report

The haemodialysis patients are an high risk population for hepatitis viral infections. While the incidence of HBV has decreased worldwide, HCV is now the major cause of viral infection in these patients. The aim of our study was to define a complete map of patients undergoing routine replacement therapy by haemodialysis in the province of Foggia, Southern Italy, who were HCV Ab positive, the presence of viraemia and their genotypes; moreover, we investigated the probable factors involved in determining the infection as well as the means of prevention. Materials and methods: We enrolled 330 patients treated in four haemodialysis centres (DC) and six secondary units; mean age was 57 years and mean duration of dialysis 76 months. Samples were drawn to determine cytolysis indexes and the HCV Ab status; in HCV positive patients, we also looked for viraemia and HCV genotypes. Data were analysed by a transversal cross-section study. Results and conclusions: Prevalence of HCV infection was 0.43 (males 0.45, females 0.42). The risk of contracting the infection was shown to be significantly different in the various DCs and did not seem to be related to the severity of the preventive measures. There was no significant difference between the various DCs in the comparison between the odds of HCV-RNA+ and HCV-RNA– patients. No significant prevalence of a given genotype emerged from a cross-sectional study related to the comparison between different genotypes. Moreover, transfusions of blood products seemed to have no significant relation to HCV infection. Finally, patients treated with haemodialysis for more than 36 months run a seven time greater risk of contracting HCV infection.     

白细胞介素28B基因多态性与丙型肝炎病毒的清除

宿主因素在HCV自发清除或治疗诱导清除的过程中都发挥着重要作用。有证据表明,编码IFN λ3的IL-28B基因多态性和HCV的清除有关,IL-28B基因亚型和其他因素皆可预测聚乙二醇IFNα联合利巴韦林的抗病毒疗效。此文针对IL-28B基因多态性与HCV的清除、IFN λ生物学特性及其临床意义作了综述。     

Hepatitis C virus infection in Lebanese patients with B-cell non-Hodgkin's lymphoma

Several studies from many countries have reported a high prevalence (>9%) of hepatitis C virus (HCV) infection in patients with B-cell non-Hodgkin lymphoma (B-NHL) suggesting a possible etiological role of HCV in the development of B-NHL. Data from the United Kingdom and Turkey, however, did not confirm these observations. To determine the prevalence of HCV infection in patients with B-cell lymphoma in Lebanon, a controlled study was conducted in which 318 Lebanese patients were investigated. These included 35 patients with B-NHL, 63 patients with various malignant conditions (control group 1) and 220 patients with non-malignant conditions (control group 2). Samples were tested in duplicates for antibodies to HCV (anti-HCV) by enzyme-linked immunosorbant assay (ELISA). None of the 318 patients investigated were anti-HCV positive. Based on our findings, it can be concluded, that, there is no sufficient evidence to indicate that HCV plays role in the development of B-NHL in Lebanese patients. Predisposing factors in lymphoproliferative disorders are numerous including both genetic and environmental factors that could vary from one geographic region to another.     

焦炉工人接触PAH水平与肺癌的关系

焦炉工人接触ＰＡＨ水平与肺癌的关系王溪鸿，马会良，杨玉萍（辽宁本溪钢铁公司劳动卫生研究所，１１７０２１）选择焦炉作业各工种工人两名，配戴个体采样器，测得一个工作班的接触浓度，连续测五个工作班，计算各工种每班平均接触浓度。采用高压液相色谱测定多环芳烃总...     

肿瘤患者肝炎病毒感染分析

目的以2070例肿瘤患者为研究对象,分析其乙型肝炎(HBV)及丙型肝炎(HCV)感染率,研究HBV及HCV感染与恶性肿瘤的关系。方法采用回顾性分析方法,按肿瘤类别、年龄和性别进行分组,对检测结果进行统计分析。结果肝癌的HBV、HCV及混合感染的感染率最高,分别为82.87%、6.71%和4.86%;45～55岁年龄段HBV及HCV单项感染率最高,为22.26%、3.71%;而55～65岁年龄段HBV及HCV混合感染率最高,为2.91%;肝癌及胃癌HBV和HCV单项感染率男性高于女性,而肺癌及结肠癌HBV及HCV单项感染率男性低于女性,肝癌及结肠癌的HBV及HCV混合感染率男性高于女性,肺癌及胃癌则男性低于女性。结论肝癌的HBV、HCV及混合感染的感染率最高;在HBV及HCV单项感染情况下,45～55岁年龄段感染率最高并且男性高于女性。