沈阳地区不同人群HCV感染及HCV基因型分布研究

应用酶联免疫检测技术 ,检测沈阳地区 390 2例不同人群血清的抗 - HCV,并应用引物特异 PCR法对其中 10 0例血清标本进行 HCV基因分型。结果 :正常人群抗 - HCV阳性率为 0 .4 2 %～ 1.66% ;输血后及散发性肝炎 (除外 HAV、HBV、EBV、CMV感染 )、乙型肝炎、肝炎后肝硬化 (除外 HBV感染 )、原发性肝癌等组抗 - HCV阳性率显著高于无输血史的非肝病病人组 ( P<0 .0 1) ;10 0例血清标本中 HCV- 型感染占 58%、HCV- 型 2 7%、 / 混合型 14%、未分型 1% ,正常人群HCV感染者中 HCV基因型以 型为主 ( 80 % ) ,丙型肝炎后肝硬化病人 HCV基因型以 型为主( 91.7% )。提示 :各类肝病病人是 HCV感染的高危人群 ;沈阳地区 HCV感染以 型为主 ,其次为 型及 / 混合型 ,HCV基因型可能与丙型肝炎病情轻重有关。     

血清HCVRNA荧光定量与丙型肝炎诊断意义

目的探讨血清HCVRNA荧光定量在丙型肝炎诊断中的意义。方法采用ELISA法和荧光定量PCR法检测292例慢性丙肝患者抗-HCV和HCVRNA。结果抗-HCV及HCVRNA检出率分别为71.9%(210/292)和51.3%(150/292);抗HCV( )组和抗-HCV(-)组HCVRNA的检出率分别为75.9%(82/108)和10.5%(4/83)。结论抗HCV( )组HCVRNA检出率高于抗-HCV(-)组;血清HCVRNA荧光定量是临床诊断丙型肝炎的直接证据;抗-HCV诊断丙肝感染有漏诊现象。     

皖南地区丙型肝炎病毒基因型研究

目的 探讨安徽南方地区慢性丙型肝炎患者血清ALT水平、HCV RNA定量检测和HCV基因分型的相关性.方法 用速率法和荧光定量PCR法,检测141例安徽南方地区慢性丙型肝炎患者血清ALT水平和HCVRNA定量结果,应用RT-PCR和型特异性引物法对其中50例标本进行基因分型.结果 141例患者的血清ALT与HCV RNA两指标间的相关性采用Spearman等级相关分析显示,rs=0.213,P=0.011<0.05,差异有统计学意义,存在正相关;在50例标本中,HCV基因分型Ⅰ型有45例(95.7%),Ⅱ型2例(4.3%),未分型3例.结论 安徽南方地区丙型肝炎病毒感染以Ⅰ型为主;ALT、HCV RNA和基因型是可靠且重要的治疗反应指标.     

丙型肝炎病毒母婴传播血清学检测诊断分析

目的探讨婴幼儿丙型肝炎血清标志物特点及HCV核心抗原检测对丙型肝炎母婴传播诊断的应用价值。方法采用ELISA法对72例抗HCV(IgG)阳性的孕妇所生新生儿脐血进行HCV抗体(IgG)、HCV核心抗原检测,荧光定量PCR法检测HCVRNA。结果 72例新生儿脐血抗HCVIgG均为阳性。72例HCVIgG阳性婴幼儿血清HCVcAg阳性10例,阳性率为13.9%;HCVRNA阳性11例,阳性率为15.3%,两者相比较,差异无统计学意义(χ2=0.5,P﹥0.05);6个月后婴幼儿抗HCVIgG与HCVRNA检测比较,阳性率差异无统计学意义。结论新生儿脐血抗HCV(lgG)阳性不能作为HCV宫内感染的依据,HCVcAg检测与HCVRNA的检测方法一致性较好,对新生儿HCV感染有一定的诊断价值,对于出生后6个月婴幼儿抗HCV(lgG)检测可作为HCV感染的诊断。     

不同感染途径丙型肝炎患者HCV基因分型

目的探讨江苏省丙型肝炎病毒(HCV)基因型的分布及其与感染途径、肝功能等因素的关系。方法按照Simmonds分型方法对505例不同感染途径的丙型肝炎患者进行HCV基因型分型检测并分析年龄、性别、肝功能以及感染途径与HCV基因型的关系。结果 505例HCV RNA阳性标本中,1a型8例(1.6%),1b型348例(68.9%),2型24例(4.8%),3型40例(7.9%),1b/2混合型67例(13.3%),1b/3混合型13例(2.6%),2/3混合型4例(0.8%),1a/1b混合型1例(0.2%);不同性别、年龄人群HCV基因型分布差异均无统计学意义(均P>0.05);不同HCV基因型人群丙氨酸转氨酶(ALT)、天门冬氨酸转氨酶(AST)水平差异均无统计学意义(均P>0.05);不同感染途径人群HCV基因型分布差异有统计学意义(χ2=73.348,P<0.001)。结论江苏省丙型肝炎患者HCV基因型以1b型为主,1a型HCV在中国大陆地区流行程度有扩大趋势,HCV基因型与其感染途径有关。     

丙型肝炎病毒基因分型与肝病程度关系的研究

目的探索丙型肝炎病毒（HCV）基因型在辽宁省大连地区的分布及流行的优势型,并探讨HCV基因型与肝病程度的关系。方法采用型特异性引物逆转录巢式PCR法和限制性片段长度多态性分析（RFLP）法对85例抗-HCV阳性的慢性丙型肝炎、丙肝肝硬化、丙肝相关肝癌病人进行HCV的基因分型。结果85份抗HCV阳性标本中,HCVRNA检出率为61例,占71．76％（61／85）。在85份抗HCV阳性血清中,仅检出了61例1b和2a型感染者,其中1b型32例,占52％（32／61）;2a型29例,占48％（29／61）。结论大连地区基因型为1b型和2a型两种型,符合中国丙肝病毒基因分型,大连地区1b型和2a型基本相等。未发现1b和2a基因型因肝病严重程度而有所不同。     

庚型肝炎病毒感染研究

目的　了解山东省HGV感染状况,探讨HGV感染与HCV或HBV感染的关系。方法　应用酶联免疫吸附试验(ELISA)对1082例病毒性肝炎患者、77例非甲至戊型肝炎患者和361名献血员进行了血清抗-HGV检测。结果　共检出血清抗-HGV阳性者53例,阳性率3.49%。丙型肝炎患者血清抗-HGV阳性率(8.93%)显著高于乙型肝炎患者(3.32%)(χ2=8.80,P<0.01)。慢性肝炎患者血清抗-HGV阳性率(4.82%)显著高于急性肝炎患者(0.79%)(χ2=10.79,P<0.01)。重型肝炎患者血清抗-HGV阳性率(8.00%)显著高于急性肝炎患者(χ2=10.23,P<0.01)。结论　HGV感染可表现为病毒携带状态、亚临床型和不同临床类型,丙型肝炎患者较乙型肝炎患者更易重叠感染HGV,HGV与HCV或HBV重叠感染可能与病情加重和慢性化的形成有关     

血液透析患者HCV感染的基因分型及其危险因素

为了解血透患者HCV感染水平及其危险因素,我们调查了安徽省七所医院中104例血透患者。主要检测指标:抗-HCV选用EIA法,HCVRNA选用逆转录-聚合酶链反应（RT－PCR）法,HCV基因分型选用限制性片段长度多态性分析（RFLP）法。结果表明本组血透患者抗-HCV阳性率为5769％,HCVRNA阳性率为24．04％,HCV基因型有Ⅱ、Ⅲ、Ⅱ、／Ⅲ混合型,检出率分别为32％、20％、36％。提示血透患者HCV感染以Ⅱ／Ⅲ混合型为主。血透患者感染HCV与透析次数多少及输血次数多少有关,血液透析的危险性高于输血,两者有交互作用。     

维持性血液透析及肾移植患者乙型及丙型肝炎病毒感染调查

目的 了解维持性血液透析及肾移植患者乙型及丙型肝炎病毒感染状况。方法 采用ELISA及PCR法测定HBVm、抗—HCV、HCVRNA，型特异性HCV亚基因探针杂交分型。结果长期血透者HCV阳性率为37．24％，肾移植术后再透析者达47．57％，且与透析时间、输血次数、受血量正相关；HCV基因型以混合型为主，占63．64％。结论 本组患者HBV、HCV感染率与输血次数、输血量及透析时间密切相关。     

派罗欣联合利巴韦林治疗慢性丙型肝炎的早期不良反应观察及处理

目的 观察派罗欣(聚乙二醇干扰素α-2a)联合利巴韦林治疗的慢性丙型肝炎患者的早期不良反应.方法 回顾性分析了58例应用派罗欣联合利巴韦林治疗的慢性丙型肝炎患者治疗4周的临床资料.结果 派罗欣联合利巴韦林治疗的早期不良反应有发热40例(69%),头痛及肌肉关节酸痛36例(62%),胃肠道反应10例(17%),白细胞(WBC)减少44例(76%),血小板(PLT)减少10例(17%),血红蛋白(HGB)下降31例(53%),4例患者因中性细胞数降低而将派罗欣减量,6例患者因胃肠道反应或HGB明显下降将利巴韦林减量.结论 派罗欣联合利巴韦林治疗慢性丙型肝炎早期最常见的不良反应是类流感样症状、胃肠道反应、白细胞、中性粒细胞、血小板减少及血红蛋白下降,中性粒细胞减少、胃肠道反应及血红蛋白下降可以导致干扰素及利巴韦林减量,从而影响丙型肝炎的抗病毒疗效.     

Zinc supplementation prevents the increase of transaminase in chronic hepatitis C patients during combination therapy with pegylated interferon alpha-2b and ribavirin

We investigated the effects of zinc supplementation on clinical observations in chronic hepatitis C patients receiving pegylated interferon (PEG-IFN) alpha-2b plus ribavirin combination therapy. Patients were randomly allocated to receive 150 mg polaprezinc (zinc group, n=11) or no supplement (control group, n=12) daily in addition to PEG-IFN alpha-2b plus ribavirin therapy and 300 mg vitamin E and 600 mg vitamin C supplementation daily for 48 wk. Among the patients who continued treatment, the serum alanine aminotransferase (ALT) level at 12 wk in the zinc group was significantly lower than that in the control group. All patients in the zinc group (9/9) and 67% (8/12) of the control patients at 24 wk, and all patients in the zinc group (7/7) and 60% (6/10) of the control patients at 48 wk showed a decrease in serum ALT levels to within the normal range (7-44 U/L). HCV RNA disappeared in all patients (7/7) in the zinc group and in 8 of 10 control patients at 48 wk. Polaprezinc supplementation decreased plasma thiobarbituric acid reactive substances and prevented the decrease of polyunsaturated fatty acids of erythrocyte membrane phospholipids. No significant differences were observed in the dosage of medicines or other clinical data during the treatment. These observations indicate that polaprezinc supplementation may have induced some antioxidative functions in the liver which resulted in reduced hepatocyte injury during PEG-IFN alpha-2b plus ribavirin therapy.     

聚乙二醇干扰素α 2a治疗慢性丙型肝炎的疗效观察

目的研究聚乙二醇干扰素α-2a治疗慢性丙型肝炎的疗效。方法设观察组（接受聚乙二醇干扰素α-2a治疗,联合利巴韦林口服）36例,对照组（接受普通干扰素α-2a治疗,联合利巴韦林口服）32例,在治疗前、治疗中、48周治疗结束及随访24周后,分别检测丙型肝炎病毒（HCV）RNA、血清丙氨酸转氨酶（ALT）,比较两组治疗效果。结果48周治疗结束时,观察组的病毒学应答率和生物化学应答率均为88．89％,对照组分别为75．00％、81．25％,两组治疗结束时疗效无明显差异（均P〉0．05）。观察组早期病毒学应答率、持续应答率分别为47．22％、81）．55％,明显高于对照组的12．50％、31．25％（分别Χ^2=9．57,P〈0．05;Χ^2=16．84,P〈0．05）;观察组复发率为8．33％,显著低于对照组的43．75％（Χ^2=11．33,P〈0．05）。结论聚乙二醇干扰素α-2a治疗慢性丙型肝炎的疗效优于普通干扰素α-2a。     

苏南地区丙型肝炎病毒基因型分布及其与NK细胞比例异常的关系

目的①了解苏南地区丙型肝炎病毒的基因型分布。②测定丙型肝炎患者外周血中NK细胞的百分数。方法用基因芯片方法对103例丙型肝炎患者的血清进行病毒基因分型,并测定这103例丙肝患者外周血淋巴细胞中NK细胞的百分数。结果 103例丙型肝炎中1b型95例（92.2%）,2a型4例（3.9%）,3b型1例（1.0%）,1b＋2a混合型3例（2.9%）,未发现1a、3a。103例丙型肝炎患者外周血中NK细胞的百分数低于正常对照组（P〈0.01）,不同丙肝基因型患者NK细胞的百分比无显著性差异（P〉0.05）。结论①苏南地区丙肝患者基因分型以1b型为优势株。②NK细胞的减少是导致丙型肝炎的慢性化过程与迁延不愈的一个重要因素。     

Immunology of HCV infection: the causes of impaired cellular immune response and the effect of antiviral treatment

BACKGROUND: The outcome of HCV infection and the response to antiviral treatment depend on both viral and host factors. Host immune response contributes not only to viral control, clinical recovery and protective immunity, but also to chronic hepatitis and liver cirrhosis. Establishing immunological status and identifying pretreatment immunological factors associated with better response to therapy might be of importance in the understanding of the successful immune response and in the future of combination therapy to HCV infection. AIMS: The authors delivered a review on the immunology of HCV infection and characterized the cause of impaired cellular immune response in chronic HCV infection. Natural killer (NK) cell activity, perforin and the inhibitory CD81 HCV co-receptor expression, and Th1/Th2 cytokine production of the monocytes and lymphocytes have been investigated. PATIENTS AND METHODS: 42 patients with chronic hepatitis C, out of them 25 being on interferon (PEG-IFN) + ribavirin (RBV) therapy, 12 sustained virological responders, 26 HCV carriers with normal transaminase values and 22 healthy controls were studied. NK cell activity, perforin and CD81 expression, the IFNgamma, TNFalpha, IL-2 (Th1) and IL-4, IL-6, IL-10 (Th2) production of LPS stimulated monocytes and PMA + ionomycine stimulated lymphocytes were measured by flow-cytometry. RESULTS: In patients with chronic hepatitis C we demonstrated decreased NK cell activity associated with increased CD81 expression. The perforin expression of lymphocytes was also impaired in HCV patients. The pretreatment capacity of the macrophages to produce TNFalpha was predictive for sustained virological response. This increased TNFalpha production of the monocytes counteracted the observed impaired Th1 type cytokine production of the lymphocytes. IL-10 and IL-4 production showed positive correlation with HCV RNA levels, and negative correlation with histological activity index was noted. PEG-IFN + RBV treatment increased NK activity, perforin expression, Th1 type cytokine production of thr lymphocytes and downregulated CD81 expression inducing effective cellular immune response against HCV. The author's results provide further data to understand the causes of impaired cellular immune response in chronic HCV hepatitis and may be useful in the developement of immunotherapy as an adjunctive treatment to cure patients with chronic hepatitis C.     

抗-HCV阳性血清HCV RNA检测与基因分型的研究

目的 检测抗-HCV阳件血清巾的HCV RNA并进行HCV基因分型.方法 采用荧光定量PCR法检测85例大连地区抗-HCV阳性患者血清中HCV RNA,应用型特异性引物逆转录套式PCR法对HCV RNA阳性样本进行基因分型.结果 85例的抗-HCV阳性患者中,HCV RNA阳性65例(76.5%),其中基因分型1b型32例(49.2%),2a型29例(44.6%),未分型4例(6.2%).结论 抗-HCV阳性并非HCV直接标志,大连地区HCV基冈1b型和2a型基本相等.     

Hepatitis C virus infection--after 12 years. Advances in the management of chronic hepatitis C

Therapy of different manifestations of HCV infection is discussed--after 12 years of the discovery of HCV. In acute hepatitis C the antiviral treatment of the early phase is debated, but if 3 months after the onset the HCV viremia persists, interferon (IFN) therapy may be recommended. Asymptomatic HCV carriers with normal alanine aminotransferase (ALT) do not need antivirals. However, their serum ALT, GGT, gammaglobulin values and liver ultrasound findings should be monitored, to disclose an underlying liver disease, and biopsy is considered, if suspicion of hepatitis raises. In patients with chronic hepatitis C biopsy is mandatory, it may prove mild, moderate or severe histological activity (HAI). Moderate or severe active hepatitis C (> 2 x normal ALT, HAI > 7) should be treated. In the first period of the antiviral treatment for HCV, a standard IFN monotherapy (3 x 3 MU s.c. IFN weekly for 6-12 months) has been used, which resulted in 15-20% sustained response (SR) rate. In the second half of nineties, combination of IFN with an oral nucleoside analogue ribavirin increased the SR to 30-30%, by means of decrease in relapse rate. Recently, pegylated IFN (PEG-IFN) in combination with ribavirin can lead to 60% SR. (Genotype HCV1 patients may show SR of about 40%, HCV 2.3 ones about 80%, respectively). Compensated HCV cirrhosis patients may also be treated with this type of combination, which can possibly inhibit progression. Decompensated cirrhosis needs liver transplantation. In the prevention of HCV infection, screening of blood donors, viral inactivation of blood products, disposable needles and education of risk populations are of basic importance, HCV vaccination, however is not on the horizon yet. Thus, antiviral treatment remains of great significance. Searches for new therapeutic modalities, such as multiple antiviral combinations (e.g amantadin + ribavirin + IFN), protease- and helicase inhibitors, ribozymes and cytokines may result further advances.     

海口地区丙型肝炎病毒基因分型研究

目的 为制定治疗方案提供参考,了解海口地区丙型肝炎病毒基因分型的特征.方法 选择2010年1月～2011年1月某院经临床检测HCV-RNA阳性的72例患者血清,回顾分析HCV测序分型结果、套式PCR结果,对照分析不同HCV-RNA阳性人群HCV基因分型及不同基因型HCV-RNA定量检测值.结果 本组共72份血清标本,基因型构成比次序依次为:1b型构成比为62.5％ (45/72);2a型构成比为29.2％ (21/72); 3a型构成比为8.3％ (6/72).不同HCV-RNA阳性人群HCV基因分型结果对照显示,差异无统计学意义(P＞0.05).1b型HCV-RNA定量检测值显著高于2a型和3a型(P＜0.05),2a型HCV-RNA定量检测值显著高于3a型(P＜0.05).结论 海口地区丙型肝炎病毒基因分型和国内多数地区相同,以1b型为主,2a型次之,同时基因分型也有助于了解患者体内病毒复制情况,为治疗提供参考.     

Detection of HGV in serum and peripheral blood mononuclear cells of maintenance haemodialysis patients.

The aim of the present study was to investigate the prevalence of hepatitis G virus (HGV) and also hepatitis C virus (HCV) infections in maintenance haemodialysis patients, and to identify extrahepatic sites as HGV reservoirs. HGV RNA was detected in the serum of 6/61 (10%) patients and in the peripheral blood mononuclear cells of 2/61 (3%) patients (one of whom was serum negative). These findings suggest that lymphoid cells constitute an extrahepatic HGV reservoir. HCV RNA was detected in 7/61 (11%) patients. Five of these patients (71%) were identified as carrying HCV genotype 1b. Co-infection with HCV and HGV was detected only in one patient. Haemodialysis patients are at risk for HGV infection, by nosocomial routes or via transfusions. HGV itself does not seem to be an important cause of hepatitis since all six HGV RNA positive patients not co-infected by HCV or HBV showed normal ALT values.     

艾滋病毒和丙型肝炎病毒合并感染的相关分析

目的 探讨HIV/HCV合并感染者HCV的基因型分布情况及感染途径.方法 收集昆明市第三人民院2008年7月至2009年3月收治的52例HIV/HCV合并感染者血清,对HCV RNA阳性的28例患者采用型特异性探针杂交法进行HCV基因分型.结果 在28例HCV RNA阳性合并感染者中,共检出4种HCV基因亚型,分别为3b型9例(32.1%),3a型8例(28.6%),1b型7例(25.0%),6a型3例(10.7%),1例未测出(3.6%).静脉吸毒感染共23例,占82.14%,非静脉吸毒感染5例.结论 HIV/HCV合并感染者的HCV基因型以3b、3a、1b型为主要基因,并以静脉吸毒为主要感染方式.