乙型与丙型肝炎病毒重叠感染临床分析

本文通过检测326例有HBV感染的各类肝病患者的丙型肝炎病毒抗体(抗-HCV),观察丙型肝炎病毒(HCV)在HBV感染患者中的感染情况,并对HBV,HCV重叠感染与单纯HBV感染的临床特点作一分析。 资料与方法 一、病例选择: 326例各类肝病系本院1991年4月～1994年2月住院患者。全部病例HBV标志均阳性。其中急性病毒性肝炎(AVH)8例,慢性迁延性肝炎(CPH)84例,慢性活动性肝炎(CAH)98例,亚急性重症肝炎     

丙型肝炎病毒重叠感染其它嗜肝病毒及其临床意义的研究

为了解丙型肝炎病毒（hspsttitisCvirus,HCV）重叠或混合感染其它嗜肝病毒的情况,我们对住院的245例抗-HCV阳性肝炎患者同时检测了甲型肝炎病毒、乙型肝炎病毒、丁型肝炎病毒、戊型肝炎病毒（HAV、HBV、HDV、HEV）的感染标志。报告如下。1临床资料1．1一般资料男172例．女73例;年龄12～77岁。其中急性肝炎（AH）78例,慢性肝炎（CH）126例,亚急性重症肝炎（SHF）1例,慢性重症肝炎（CHF）5例．肝炎肝硬化（HC）32例,肝细胞癌（HCC）3例。临床诊断参照1995年全国传染病与寄生虫病学术会议修订的诊断分型标准。1．2检测方…     

丙型肝炎病毒感染与各类肝病（附396例临床分析）

丙型肝炎病毒抗体(抗-HCV)检测方法的建立,为临床观察丙型肝炎病毒(HCV)在各类肝病中的作用提供了条件。抗-HCV阳性能基本反映HCV的感染。本文报道396例各类肝病中抗-HCV检测结果,观察HCV在各类肝病中的感染情况,并对乙型肝炎病毒(HBV)和HCV重叠感染与单纯HBV感染患者的临床、实验室检查及疾病的恢复、预后作一分析。     

乙型肝炎病毒与3种肝炎重叠感染的研究

目的研究乙型肝炎病毒(HBV)感染者是否存在双重或多重感染。方法对220例HBV感染者血清采用酶联免疫吸附试验法(ELISA)检测5种肝炎病毒:甲型(HAV)、乙型(HBV)、丙型(HCV)、丁型(HDV)、戊型(HEV)肝炎病毒。结果 5种肝炎病毒重叠感染者70例(32.8%),单纯HBV感染者150例(68.2%),HBV、HAV二重感染者9例(4.1%),HBV、HCV二重感染者16例(7.3%),HBV、HDV二重感染者28例(12.7%),HBV、HEV二重感染者13例(5.9%),HBV、HCV和HDV三重感染者3例(1.3%),HBV、HDV和HEV三重感染者1例(0.5%)。结论 5种肝炎病毒重叠感染情况比较严重,不仅存在双重感染,也存在多重感染。     

单纯 HBV 感染和 HBV HDV 重叠感染者血清标志物的比较

目的：通过比较单纯乙型肝炎病毒（HBV）和乙丁型肝炎病毒（HBV HDV）重叠感染的患者血清中 ALT、HBV DNA及 HBV 血清学标志（HBVM）等的异同,了解 HBV HDV 重叠感染特点,初步探讨 HDV 的致病机理。方法对95例 HBV HDV 重叠感染的患者生物化学指标、肝炎病毒标志物等作统计分析,以100例单纯 HBV 感染患者作为对照。结果在95例重叠感染者中,慢性乙型肝炎发生率最高,占66．32％,肝硬化次之。按 HBV DNA 载量分类,两者差异无统计学意义（P ＞0．05）,重叠感染组 ALT 异常率与 HBV DNA 呈正相关（r ＝0．90,P ＜0．05）。重叠感染组以 HBeAg 阴性模式为主（P ＜0．05）,按HBsAg＞250 IU/mL 统计,差异无统计学意义（P ＞0．05）;按 HBsAg＞250 IU/mL 且 HBeAg ＞1 S/CO 统计时,单纯 HBV 组高于重叠感染组（P ＜0．05）。HBcAb-IgM 阳性率在重叠感染组中明显高于单纯 HBV 感染（P ＜0．05）。结论乙、丁型肝炎病毒重叠感染在慢性 HBV 中的发生率高。随着 HBV 病毒 DNA 数量的增加,肝功能的异常率也增高,HDV 感染能抑制 HBeAg 表达,重叠感染组中 HBcAb-IgM 阳性率高,可能与慢性乙型肝炎病情加重反复有关。     

丙型肝炎病毒感染实验室筛查试验S/CO值与真阳性的相关性

正丙型肝炎病毒(HCV)是病毒性肝炎常见的病原体之一,也是急性肝炎及肝硬化、肝癌等慢性肝病主要的致病因子。1989年被研究者发现以来,全球约有1.7亿慢性HCV感染患者。约80%的新发HCV感染者转为慢性感染,其中10%~20%将进展为肝硬化,长期持续的慢性HCV感染患者中1%~5%进展为肝癌~([1])。因此HCV感染的准确诊断对于临床治疗以及患者心理影响等尤为重要。临床实验室检测HCV     

被忽视的丁型肝炎

丁型肝炎病毒(HDV)是一种有缺陷病毒, 需要乙型肝炎表面抗原(HBsAg)才能复制。HDV感染呈世界性流行, 但全球不同区域的HDV感染人数不一, 目前尚无丁型肝炎确切的全球流行率数据。我国属于抗-HDV低度流行地区, 然而内蒙古自治区和新疆维吾尔自治区抗-HDV阳性率较高。与HBV单独感染比较, 慢性HBV/HDV重叠感染会更快、更易进展为肝硬化、肝失代偿和肝细胞癌。抗HBV核苷酸类似物(NAs)对控制HDV感染无效, 新批准药物布尔韦肽(BLV)治疗慢性丁型肝炎有较好的安全性和有效性, 目前也未发现耐药突变。     

乙型病毒性肝炎4585例HDV感染的临床研究

目的：了解丁型肝炎病毒（ＨＤＶ）对ＨＢＶ感染者病情的影响及其感染现状。方法：ＨＢＶ ＤＮＡ采用ＰＣＲ法;ＨＢＶＭ,ＨＤＡｇ,抗－ＨＤＩｇＭ,抗－ＨＤ采用产免疫吸附法。结果：乙型肝炎（乙肝）患者中丁型肝炎感染率８．６２％,单纯乙肝、重叠感染在急慢性肝炎、肝硬化中比率有显著性差异,ＨＢｅＡｇ,ＨＢＶ ＤＮＡ阳性率在各型肝炎中均无明显差异,重叠感染慢性重症肝炎病死率高,与单纯乙肝有显著性差异。结论：ＨＤ     

肝病患者医院感染的特点及危险因素分析

目的分析肝病患者医院感染的特点及危险因素。方法对肝病合并院内感染的382例患者的临床资料进行回顾性分析。结果6 401例肝病患者中发生医院感染382例,医院感染率为5.97%。其中重型肝炎医院感染发生率占48.17%（184/382）,肝硬化占24.61%（94/382）,慢性重度肝炎占6.81%（26/382）,肝炎病毒重叠感染占13.52%（38/281）,提示肝功能损害越重,医院感染率越高。获病原菌187株,以大肠埃希菌（22.46%）及肺炎克雷伯杆菌（15.51%）居多。医院感染部位以呼吸道居首,其次为肠道、腹腔等。结论肝病患者特别是重型肝炎、肝硬化、肝癌易并发医院感染。积极治疗原发病,合理使用广谱抗生素,避免不必要的侵袭性操作,认真做好基础护理,是预防肝病患者医院感染发生的主要措施。     

不同类型肝病患者血清抗-HCV检测结果分析

目的探讨各种肝病患者血清丙型肝炎病毒抗体(抗-HCV)阳性率以及感染状况,研究其临床价值。方法采用酶联免疫吸附法检测1 024例各种肝病患者血清抗-HCV。结果 1 024例肝病患者抗-HCV阳性率为33.59%(344/1024),阳性率由高到低依次为丙型肝炎(65.22%)、乙丙型肝炎(48.89%)、肝癌(35.71%)、肝硬化(32.37%)、慢性乙肝(28.66%)、黄疸型肝炎(19.26%)、重型肝炎(16.67%)、甲型肝炎(8.82%);男性和女性肝病患者抗-HCV阳性率分别为24.86%(176/708)、53.16%(168/316),阳性率差异有统计学意义(χ2=78.47,P<0.05)。结论各种肝病患者均检出抗-HCV,以丙型肝炎、乙型肝炎、肝癌及肝硬化患者阳性率较高;女性肝病患者HCV感染率高于男性。     

Current status of hepatitis C virus infection in Korea

Chronic liver disease, including liver cirrhosis and hepatocellular carcinoma (HCC), has been a major cause of mortality in Korea. The prevalence rates of hepatitis C virus (HCV) and hepatitis B virus (HBV) infections in the general population of Korea are approximately 1 and 5%, respectively. The most common genotypes of HCV in Korea are 1b and 2a. The sustained virological response rates after antiviral therapies, including combined interferon-alpha and ribavirin, have been reported to be 38-59%. The annual incidence of HCC among HCV-related liver cirrhosis has been estimated at 5%, and approximately 12% of HCC is attributable to HCV and 68% to HBV in Korea. The mean age of patients with HCV-related HCC at the time of diagnosis was consistently 10 years older than that of patients with HBV-related HCC. Moreover, HCV-related HCC was accompanied by more advanced liver cirrhosis than HBV-related HCC. Coinfection with HBV seemed to increase the risk of developing HCC in chronic HCV infection. After the successful program of hepatitis B vaccination, HCV infection is now emerging as an important etiology of chronic liver disease in Korea, which warrants more detailed and large-scale studies.     

Hepatitis delta virus infection

The hepatitis delta virus (HDV) is a defective virus dependent for replication and infection on helper functions provided by the hepatitis B virus (HBV). HDV and HBV co-infection occurs mainly in acute hepatitis patients with frequent parenteral exposure such as intravenous drug addicts and transfused patients. In contrast, co-infection is very rare in patients with other sources of infection and usually is a self limited disease. HDV superinfection of HBsAg carriers may have a severe course and proceed to chronic active liver disease. Active immunoprophylaxis against HBV should be considered as the only preventive measure against HDV infection.     

乙肝相关性肝病患者幽门螺杆菌感染的研究

目的研究慢性乙型肝炎(乙肝)、乙肝肝硬化、乙肝后肝癌等肝病患者幽门螺杆菌(Hp)感染情况。方法收集慢性乙肝、乙肝肝硬化、乙肝后肝癌等肝脏疾病患者273例,日期正常体检人群60例,采用免疫层析法检测患者血清中抗Hp抗体(Hp-IgG),定量PCR检测HBV DNA。结果乙肝相关性肝病患者Hp感染率73.3%,正常体检人群为40.0%,2组比较差异有统计学意义(P<0.01);慢性乙肝、乙肝肝硬化、乙肝后肝癌3组患者Hp感染率分别为62.7%、77.0%、79.7%,后二者Hp明显高于慢性乙肝患者(P<0.05);按病毒载量分级,HBV DNA阴性组Hp感染率低于HBV DNA阳性组,而阳性组按低、中、高分组,各组间Hp感染率分别为69.4%、65.0%、66.1%(P>0.05);乙肝肝硬化患者按Child-push分级后,A、B、C各级之间的Hp感染率分别为51.9%、63.4%、65.6%(P>0.05)。结论 Hp感染可能参与乙肝肝病患者肝脏损伤,显示Hp具有肝细胞毒性作用;肝硬化、肝癌感染率高于慢性乙型肝炎,提示Hp感染与慢性肝病疾病进展和肝癌的发生有一定相关性。     

慢性乙型肝炎重叠戊型肝炎病毒感染与肝炎重症化关系的临床观察

目的 探讨慢性乙型肝炎重叠戊肝病毒（HEV）感染与肝炎重症化的关系。方法 对771例慢性乙肝患进行酶联免疫吸附试验（ELISA），放射免疫试验（RIA）和斑点杂交试验检测甲、丙、丁、戊型肝炎病毒感染和肝功能检测。结果 经临床观察、对照和分析。发现重叠HEV感染的慢性乙肝患的重型肝炎发生率和慢性乙肝重度发生率高。结论 提示HBV/HEV重叠感染在肝炎重症化过程中起着重要的作用。     

Increased risk of type 2 diabetes in noncirrhotic patients with chronic hepatitis C virus infection

OBJECTIVES: To investigate whether patients with chronic hepatitis C virus (HCV) infection without evidence of cirrhosis have an increased risk of diabetes mellitus (DM) and to evaluate possible risk factors for diabetes in this group. PATIENTS AND METHODS: We conducted a case-control study of 45 consecutive eligible patients with HCV infection and no clinical, scintigraphic, or histological evidence of cirrhosis, and a control group of 90 subjects without liver disease matched by age, sex, and body mass index and similar in their origin distribution. Eighty-eight patients with chronic hepatitis B virus (HBV) infection with no evidence of cirrhosis were also evaluated. The diagnosis of diabetes was based on the 1997 American Diabetes Association criteria. RESULTS: Fifteen patients (33%) with HCV infection were found to have type 2 diabetes compared with 5.6% in the control group without liver disease (P < .001) and 12% in the group with HBV infection (P = .004). Comparison of the patients with and without diabetes revealed that positive family history of diabetes, HCV 1b genotype, and a more severe liver histology were significantly associated with DM. CONCLUSIONS: Patients with chronic HCV infection have an increased prevalence of type 2 diabetes, and this prevalence is independent of cirrhosis. The pathogenesis is intriguing, appears to be unique to HCV, and requires further study.     

Virological pattern in plasma, peripheral blood mononuclear cells and liver tissue and clinical outcome in chronic hepatitis B and C virus coinfection

BackgrounD: We aim to evaluate in chronic hepatitis B virus-hepatitis C virus (HBV-HCV) coinfection the interplay of these viruses in liver tissue, peripheral blood mononuclear cells (PBMC), and plasma and to analyze the effect on disease course and response to treatment. METHODS: We enrolled 19 patients with chronic HBV-HCV coinfection, 20 with chronic HCV and 20 with chronic HBV infection at their first liver biopsy, all were naive for antiviral therapy. The patients' plasma, PBMC and liver biopsy samples were tested for HBV DNA and/or HCV RNA by real-time PCR, according to the presence/absence of hepatitis B surface antigen and antibodies against HCV in the serum. RESULTS: Contemporary presence of HBV DNA and HCV RNA was rare in plasma (5.3% of cases) and PBMC (10.6%), but frequent in liver tissue (52.6%). Of 10 cases circulating only HCV RNA and treated with pegylated interferon (PEG-IFN) plus ribavirin for 12 months, two showed a sustained response, and eight cleared HCV RNA but became HBV-DNA-positive in plasma; these eight had detectable HBV DNA in liver at baseline. One patient, who was plasma HBV-DNA-positive/HCV-RNA-negative at baseline, showed a sustained response after 18 months of PEG-IFN treatment; another, who was plasma HBV-DNA/HCV-RNA-positive at baseline, cleared only HCV RNA during 12 months of PEG-IFN plus ribavirin treatment. Seven cases remained untreated. CONCLUSION: Despite a reciprocal inhibition in plasma, HBV and HCV frequently coexist in liver tissue, a condition to be taken into consideration when deciding therapy.     

Hepatitis δ virus (HDV) infection and disease

Summary The conformational and biologic properties of the hepatitis δ virus (HDV), a defective RNA hepatotropic pathogen dependent on obligatory helper functions provided by the hepatitis B virus (HBV), are different from the properties of conventional RNA animal viruses but resemble in many aspects the characteristics of the satellite RNAs and satellite viruses of higher plants. The HBsAg coat provided to HDV by HBV makes the defective virus transmissible via the vectors and modes of transmission of the ubiquitous helper; alike HBV, HDV is prevalent in tropical and subtropical areas and in the Mediterranean basin. In contrast to HBV, HDV is highly pathogenic and its infection aggravates the underlying HBV infection upon which it thrives. The defective pathogen has been recognized worldwide as a major cause of fulminant hepatitis and of severe chronic hepatitides leading to cirrhosis and liver failure. There is yet no established therapy for this ominous disease.     

HCV-HBV infection

Chronic infection of hepatitis C (HCV) and B virus (HBV) frequently causes viral hepatitis. Patients with chronic viral hepatitis are at risk for liver cirrhosis and even hepatocellular carcinoma. In patients with chronic hepatitis C, the most effective therapy is elimination of HCV with interferon (IFN). The most effective initial IFN therapy is the combination of pegylated IFN alpha-2b plus ribavirin. Forty-eight weeks of this combination therapy produces sustained viral response rates of approximately 50%. Moreover, several reports showed that long-term IFN therapy also reduced the risk of liver carcinogenesis. In patients with chronic hepatitis B, seroconversion from HBeAg to anti-HBe antibodies suppresses viral replication and attenuates the hepatitis. Twenty-four weeks of IFN therapy produces HBeAg seroconversion rates approximately 30%.     

2型糖尿病患者HBV和HCV感染率的临床调查及分析

目的 了解2型糖尿病(T2DM)人群丙型肝炎病毒(HCV)和乙型肝炎病毒(HBV)的感染率,以及病程延长、胰岛素应用是否会增加肝炎病毒传播的风险.方法 采用横断面的研究比较188名住院T2DM患者和253名非住院T2DM患者HCV和HBV感染率的差异,并采用Logistic回归分析病程及注射胰岛素足否为肝炎病毒传播的危险因素.结果 住院T2DM患者HBsAg和抗-HCV的阳性率均高于流调的T2DM患者(12.2%vs.9.6%;2.7%vs.1.6%),但是差异没有统计学意义(P>0.05).结论 病程和胰岛素应用不增加HBV和HCV的传播风险.