日本血吸虫与HBV感染协同致肝癌作用的研究

以血吸虫病流行地区和非流行地区常住居民1175人为对象，用ELISA法检测HBV、HCV血清学标志，用快速双抗体夹心ELISA检测抗体判断血吸虫感染。结果，流行地区感染率分别为：HBV（63．8％）、抗-HCV（2．2％），血吸虫（70．2％）；非流行地区感染率分别为HBV（49．7％），抗-HCV（0．9％），血吸虫（5．2％）。共检测490人血吸虫抗体，阳性176人（35．9％），阳性者HBV、HCV、肝硬变率显著高于阴性者。HBV、HCV，血吸中两种以上合并感染，均较单独感染对肝功能及肝硬变影响大，合并感染比上述感染阴性者的肝硬变患病率增长3．7－7．1倍，并发现HBV与血吸虫感染有相加致癌作用。     

病毒性肝炎患者血清AFP与临床、病理的关系

目的：探讨肝炎患者AFP水平与临床,病理的关系。方法：临床诊断为病毒性肝炎并经肝穿刺活检的310例患者,常规检测血清TB－ALT,AST,A／G,AFP及肝炎病毒标志,观察异常AFP水平与临床类型,病理类型,有无家族史和病因等的关系。结果：310例肝炎患者中发现AFP异常115例,阳性率为37．1％,急性肝炎,慢性肝炎,慢性重型肝炎患者中均见有AFP异常者,根据病理,急性肝炎患者AFP阳性率最低,慢性肝炎,慢性肝炎肝硬化患者较高,慢性重型肝炎患者阳性率最高,分别为11．7％．34．2％,57．5％和66．7％,按临床表现诊断,阳性率以慢性重型肝炎最高,慢性肝炎最低,而急性肝炎居中,在肝炎病因分类中单纯HBV感染或HBV基础上又有HAV／HEV感染者AFP阳性率较高,为35．3％和62．8％,HBV与HCV双重感染者为27．3％,单一HCV感染者6例中1例AFP阳性,单纯HAV或HEV阳性者未见AFP异常,此外,有肝癌家族史的肝炎患者AFP阳性率为57．9％,高于无肝癌家族史者。结论：肝炎患者AFP异常颇为常见,一旦发现肝炎患者AFP异常时,应考虑患者有HBV感染的背景,或为单纯HBV感染的慢性乙型肝炎,或HBV基础上有HAV或HEV重叠感染者。     

庚型肝炎——不同临床型肝病患者中庚型肝炎病毒感染的研究

目的：了解不同临床型肝病患的庚型肝炎病毒（HGV）感染状况。方法：应用酶联免疫法（ELIS）检测不同临床肝病患血清中抗-HGV,并对抗-HGV阳性血清应用逆转录套式聚合酶链反应法（RT-nPCR）检测HGVRNA。结果：肝硬变，慢性乙型和丙型肝炎病人及HBsAg携带的抗-HGV阳性率（分别为36．36％、26．2％、12．5％和12．0％）均显高于急性肝炎（4．17％）。急性和慢性非甲-戊型肝炎病人的抗-HGV阳性率也较高，分别为33．3％（1／3）和16．67％（1／6）。各临床型肝病患中，抗-HGV阳性和阴性组血清天门冬氨酸转氨酶（AST）水平无明显差异。结论：HGV与乙型和丙型肝炎病毒（HBV和HCV）具有较高的共同感染率，部分非甲-戊型肝炎为HGV感染：重叠感染HGV似乎并不加重肝损害程度。     

各型肝炎病毒单纯及重叠感染的研究

目的 探讨病毒性肝炎患者甲～戊，庚型肝炎病毒(HAV-HEV，HGV)单纯感染及重叠感染情况。方法 采用EIA法检测病毒性肝炎患者血清抗-HAV IgM，HBV标志物、抗-HCV IgM、抗-HDV IgM、抗-HEV IgM、抗-HGV IgM。结果 共检测210例病毒性肝炎患者HAV-HEV、HGV血清标志物，20例未检出(9．5％)，190例患者检出标志物阳性(90．5％)。HBV感染率89，5％(188／210，其中有34例为既往感染，占16．2％，现症感染154例，占73．3％)；HAV感染率29．0％(61／210)，HCV、HDV感染率均为8．1％(17／210)、HEV、HGV感染率依次为10．0％(21／210)、7．1％(15／210)。各临床类型中单纯感染占61．4％(129／210)，二重感染占32．4％(68／210)，以HAV HBV、HBV HDV、HBV HEV感染模式最常见，三重感染占6．2％(13／210)，以HAV HBV HDV感染模式最常见；临床上以肝炎肝硬化、重型肝炎重叠感染常见，急性肝炎最少见。结论 病毒性肝炎中HBV感染最常见，其次为HAV感染；单纯感染、二重感染多见，三重感染少见；重叠感染发生率随病情加重而增加。     

重庆地区肝胆疾病患者中A～G型病毒性肝炎血清标志初步分析

目的：探讨重庆地区肝胆疾病患者中A～G型肝炎病毒感染状况。方法：EIA法检测12种A～G型病毒性肝炎血清标志。结果：总阳性数为320／455例(70．18％)，其中抗HAV IgM阳性率为8．99％(41／456例)，HBVM53．07％(242／456例)，抗HCV5．48％(25／456例)，HDVM24．12％(110/456例)，抗HEV和抗HGV分别为12．5％(57／456例)和12．28％(56／456例)。在320例A～G型肝炎病毒感染者中，仅146例(35.63%)检测出一种肝炎：病毒感染标志，其余均为混合感染，计两种肝炎病毒血清感染标志阳性，113例(35.31％)，三种混合感染者41例(12.81％)，四种的18例(563％)，还有2例同时检出五种肝炎病毒感染标志，结论：重庆地区肝胆疾病患者中存在A～G型肝炎病毒感染者，以HBV最高，HBV最低，HDV约占四分之一，但仍可能存在A～G型型以外的其他肝炎病毒感染者。几种肝炎病毒混合型感染可能是造成，肝炎重型化重要因素之一。     

2006～2012年天津市住院精神病患者病毒性肝炎感染状况调查

目的调查分析天津市住院精神病患者病毒性肝炎感染情况。方法2006年1月-2012年12月住院精神病患者19994例,采用酶联免疫法检测血清HBsAg、抗-HBs、HBeAg、抗-HBe、抗-HBc、抗-HCV、抗-HEV—IgM。结果HBsAg阳性627例,阳性率3．14％;抗．HCV阳性102例,阳性率0．51％;抗-HEV—IgM阳性24例,阳性率0．12％;HbsAg＋抗-HCV阳性5例,阳性率0．03％;HbsAg＋抗-HEV—IgM阳性2例,阳性率0．01％;HbsAg＋抗-HBe＋抗-HBc阳性（小三阳）385例,阳性率1．93％;HBsAg＋HBeAg＋抗-HBc阳性（大三阳）115例,阳性率0．58％;Hb-sAg＋抗．HBc阳性127例,阳性率0．64％。结论住院精神病患者病毒性肝炎感染率高,应根据精神病住院患者的特点,加强病房管理,防止病毒性肝炎院内感染及长期用药加重肝损伤。     

血清HGVRNA阳性病毒性肝炎94例研究

目的分析血清HGVRNA阳性病毒性肝炎的临床特点。方法全部病例入院后即检测血清AB，C，D，E型肝炎病毒标志及肝功能试验，抗-HGV采用ELISA法，HGVRNA采用RT-PCR法，均由302医院免疫室统一检测．结果在94例血清HGVRNA阳性患者中，单纯HGV感染（单纯感染组）18例，HGV合并其他肝炎病毒感染（合并感染组）76例，单纯感染组中以急性肝炎为主（61．1％），合并感染组以HBV＋HGV感染最多，占引例（5．3％）．51例中，以慢性肝炎（41．2％）及肝硬变（37．2％）为主，单纯HGV感染临床可表现为急、慢性肝炎及重型肝炎，其中，急性肝炎临床特点为：消化道症状较轻：半数以上有轻-中度黄疸，也可有重度黄疸者；ALT轻度增高；全部病例恢复顺利，合并感染组病情恢复也较顺利．11例重型肝炎，生存率45．4％．HGV与HBV合并感染者中，住院期间，HBsAg阴转率24．0％，HBeAg阴转率62．5％，HBVDNA阴转率55．6％结论单纯HGV感染以急性肝炎为主，亦可见于慢性肝炎及重型肝炎，合并感染级以慢性肝炎及肝硬变为主，并分析各自临床特点HGV与HBV合并感染时，对HBV可能有抑制作用.     

重组抗原检测戊型肝炎病毒IgM抗体及其意义

用戊型肝炎病毒(HEV)重组抗原建立酶联免疫吸附试验(ELISA)，检测肝炎患者和健康供血人群血清中抗戊型肝炎病毒IgM类抗体(抗-HEV IgM)，并评价其检测意义。在与合成肽抗原比较检测的77份急性戊型肝炎患者血清中，有54份(70.1%)由重组抗原捡测抗-HEV IgM阳性。其阳性率明显高于台成酞抗原(21/77,27．3％)。15例戊型肝炎患者双份血清用重组抗原ELISA检铡，急性期血清有11份抗-HEV IgM阳性，恢复期血清仅1份阳性。抗-HEV IgG阳性的健康供血者(8人)和甲、乙、丙型肝炎患者(11例)无1例IgM抗体阳性。结果表明，抗-HEV IgM可以作为戊型肝炎病毒新近感染的标志。HEV重组抗原检铡抗-HEV IgM敏感性高，特异性强，有助于戊型肝炎病毒感染的早期诊断。     

广西新发现肝癌高发点的初步流行病学研究

目的探讨广西少数民族瑶族地区新发现肝癌高发村肝癌高发的危险因素,为对肝癌进行有效防控提供科学依据。方法采用现场和实验流行病学方法相结合,以广西新发现的肝癌高发村及相对低发村原藉居民作为研究对象．对其肝癌发生状况、肝炎病毒感染及复制、生活环境因素进行初步调查。结果肝癌高发村和相对低发村肝癌的粗年平均死亡率分别为104．90／10万和55．76／10万．两村比较无显著性差别（P〉0．05）;两村居民HBsAg和HBVDNA的阳性率分别为17．8％（11／62）、12．9％（8／62）和9．4％（10／107）、4．7％（5／107）。两村比较HBsAg的阳性率无显著性差别（χ2=2．54,P=0．11）。但两村HBVDNA阳性率差别有显著性意义（r=3．75,P=0．05）;两村抗-HBs的阳性率分别为53．2％（33／62）和60．7％（65／107）,两村比较无显著性差别（χ2=0．91,P=0．34）。高发村10年前以塘水作为饮用水．而低发村一直以山泉水作为饮用水;两村均未检出丙型肝炎病毒感染者。结论在广西少数民族瑶族地区新发现的肝癌高发村肝癌高发的主要危险因素为HBV感染．尤其是HBV的复制、饮用塘水和遗传因素的共同作用;黄曲霉毒素及丙型肝炎病毒的感染在此地区肝癌的发生中所起的作用不明显。     

肝病与乙型、丙型肝炎病毒感染关系的探讨

本文采用ELISA法对25例慢性肝炎，105例肝硬化，64例肝癌，以及8例急性黄疸型肝炎进行了HBV标志物及抗－HCV的检测，结果：HBV感染率为80．6％，抗－HCV检测阳性率为46％，二者均阳性的双重感染率为32％。其中肝癌组双重感染明显高于肝硬化组，P＜0．001。单纯抗-HCV检出率为10．8％，说明HBV是引起肝炎，肝硬化，肝癌的主要原因，而CV感染也是其致病因素。本文对有输血史的慢性肝炎，肝硬化，肝癌100例进行抗－HCV检测其阳性率为59％，而02例无输血史的肝病患者抗－HCV检出率为25％，输血组抗－HCV检出率明显高于无输血组，P＜0．001。其中慢性肝炎，肝硬化，肝癌病人输血组抗－HCV检出率亦明显高于无输血组，各组P＜0．001，故提示，HCV感染与输血有密切关系。50例HBV标志物阴性的健康献血员抗－HCV阳性率为6％。     

Hepatitis B virus reactivation in breast cancer patients undergoing chemotherapy: A review and meta‐analysis of prophylaxis management

Hepatitis B virus (HBV) reactivation during or after chemotherapy in patients with breast cancer has become a remarkable clinical problem. Prophylactic nucleos(t)ide analogues (NAs) are recommended for patients with breast cancer who are hepatitis B surface antigen (HBsAg) positive before chemotherapy. We performed an up‐to‐date meta‐analysis to compare the efficacy of prophylactic lamivudine use with nonprophylaxis in HBsAg‐positive breast cancer patients undergoing chemotherapy. PubMed, the Cochrane Library and China National Knowledge Infrastructure (CNKI) databases were searched for relevant articles until June 2016. Eligible articles comparing the efficacy of prophylactic lamivudine use with nonprophylaxis in HBsAg‐positive breast cancer patients undergoing chemotherapy were identified. Eight studies which had enrolled 709 HBsAg‐positive breast cancer patients undergoing chemotherapy were analysed. Lamivudine prophylaxis significantly reduced the rates of chemotherapy‐associated hepatitis B flares in chronic hepatitis B in breast cancer compared with patients with nonprophylaxis (odds ratio [OR]=0.15, 95% confidence interval [CI]: 0.07‐0.35, P<.00001). Chemotherapy disruption rates attributed to HBV reactivation in the prophylaxis groups were significantly lower than the nonprophylaxis groups (OR=0.17, 95% CI: 0.07‐0.43, P=.0002). Patients with lamivudine prophylaxis had a higher risk for tyrosine‐methionine‐aspartate‐aspartate (YMDD) motif mutations than patients with nonprophylaxis (OR=6.33, 95% CI: 1.01‐39.60, P=.05). Prophylactic antiviral therapy management is necessary for HBsAg‐positive breast cancer patients undergoing chemotherapy, in spite of high correlation with lamivudine‐resistant HBV variants with YMDD motif mutations.     

慢性肝病患者组织中生存素与VEGF-A的表达

目的研究慢性肝病患者组织中生存素与血管内皮生长因子-A(VEGF-A)的表达意义。方法选取2011年1月-2013年5月广西壮族自治区南溪山医院肝病科收治的原发性肝癌患者50例作为研究对象,所有患者均行手术治疗,同时经病理学检查后证实为原发性肝癌,比较乙肝肝硬化、慢性乙型肝炎、原发性肝癌患者组织中的生存素与VEGF-A的表达。结果生存素在乙肝肝硬化、慢性乙型肝炎、原发性肝癌患者组织中的阳性表达率分别为46.9%、31.6%、84.0%,在三者之间的表达,差异具有统计学意义(P0.05);VEGF-A的表达率分别为75.0%、26.3%、68.0%,VEGF-A在原发性肝癌患者中的阳性表达率比乙肝肝硬化、慢性乙型肝炎患者较高,差异具有统计学意义(P0.05)。结论将生存素与VEGF-A作为早期原发性肝癌的检测标志物,能有效提高肝癌的诊断率,值得临床推广使用。     

p16基因在原发性肝癌中表达缺损的研究

目的：探讨p16基因的异常表达与原发性肝癌发生、发展的关系。方法：应用PCR、SSCP分析及DNA序列测定技术研究了30例原发性肝癌组织中的p16基因外显子2（E2）的缺损情况。结果：（1）p16基因缺损的检出率与肝癌的肿瘤组织类型无关，在肝细胞癌与胆管细胞癌中p16基因缺损的检出率分别为33．33％和20．00％，两组间无显著差异（P＞0．05）；（2）p16基因缺损率的高低与组织学分级密切相关（P＜0．05）。结论：结果提示p16基因的缺损与原发性肝癌的组织学分级相关，它可能参与原发性肝癌的发生、发展过程。     

Hepatitis BS antigen, malaria titers, and primary liver cancer in South Vietnam.

A total of 306 individuals from South Vietnam were studied: 61 had a diagnosis of primary liver cancer (38 had a tissue diagnosis, and 23 had a clinical diagnosis and a positive alpha-fetoprotein); 9 had viral hepatitis; 101 were hospitalized patients (60 with various other forms of liver disease and 41 without liver disease); 94 were blood donors; 29 were drug users, and 12 were medical students. Alpha-fetoprotein was present in 45 of 61 (74%) of those with a diagnois of primary liver cancer (PLC) and in none of the other patients. Using immunoelectroosmophoresis, hepatitis BS antigen (HBSAg) was found no more frequently in those with PLC than in the other groups studied. In contrast, using a radioimmunoassay technique HBSAg was present 3 to 8 times as frequently in the PLC patients as in other subjects without viral hepatitis. There was a close relationship between the presence of alpha-fetoprotein and HBSAg in the patients with PLC. Malaria seropositivity rates were no different in the PLC groups than the other groups. It appears that in South Vietnam PLC is associated with an increased frequency of HBSAg.     

Prevalence and significance of the C virus antibody in chronic hepatopathy not related to B virus in alcoholics]

The presence of antibody to the hepatitis C virus was determined in 254 alcoholic patients with non-B chronic hepatitis and a titre of antinuclear antibodies of 1/40 or lower. Alcoholic hepatitis was present in 12 patients, steatohepatitis in 20, active chronic hepatitis in 22, cirrhosis in 181, and hepatocarcinoma in 19. Twenty patients had previously received blood transfusion alone or during surgery, 49 had undergone previous surgery without transfusion, a clinical episode of hepatitis could be traced in 14, 4 patients were drug addicts, 41 had received blood transfusion after the diagnosis was made, and 128 presented with alcoholism alone. Anti-hepatitis C antibody was found in 20 out of 2,000 blood donors (1%) in our hospital. Anti-hepatitis C antibody was found in 87 patients (34.2%) in our series, a figure unaltered by past medical history. Patients with anti-HC antibody had higher levels of AST, ALT, total proteins, gamma-globulin, and IgG. The incidence of active chronic hepatitis was higher among patients with anti-HC antibody, whereas the incidence of steatohepatitis was higher among patients without anti-HC. Regarding findings on liver biopsy, the incidence of anti-HC was significantly higher (p less than 0.001) among patients with active chronic hepatitis (72.7%) than in any other group; no significant differences were found between patients with cirrhosis (33.3%), hepatocarcinoma (31.5%), steatohepatitis (15%), or alcoholic hepatitis (16.7%). Among HBsAg-negative patients, the incidence of anti-HC was similar between those with (39.7%) and without other serum markers of HB (32.9%).(ABSTRACT TRUNCATED AT 250 WORDS)     

Serum levels of c-erbB-2 protein in digestive diseases

The clinical significance of the measurement of c-erbB-2 oncogene product was evaluated. The subjects consisted of 404 patients, including 248 with cancer of the digestive organs and 128 with benign digestive diseases. Serum c-rebB-2 protein levels were measured by sandwich immunoenzyme assay. The positive rates of c-erbB-2 protein, at a cut-off value of 17.0 U/ml, were, for cancers: hepatocellular carcinoma 61.6%, biliary tract cancer 54.8%, pancreatic cancer 25.0%, esophageal cancer 33.3%, gastric cancer 16.9%, and colorectal cancer 5.0%. For benign digestive diseases, the rates were: liver cirrhosis 63.3%, chronic hepatitis 43.2%, acute hepatitis 42.9%, other liver diseases 42.8%, cholelithiasis 30.0%, and chronic pancreatitis 0%. Serum c-erbB-2 protein levels were significantly correlated with the markers of hepatic functional reserve, the indocyanine green retention rate and the hepaplastin test. These findings suggest that serum c-erbB-2 protein levels are greatly influenced by liver dysfunction and that their clinical usefulness as a serum tumor marker is questionable.     

蛋白翻译起始因子C_2在原发性肝细胞肝癌中表达的意义

目的研究C_2mRNA及其蛋白在原发性肝细胞肝癌(HCC)中的表达及意义。方法用原位杂交检测C_2mRNA住21例HCC及其癌旁组织中的表达,ABC免疫组化法检测C_2蛋白在60例HCC及其42例癌旁组织中的表达,Western blot法检测C_2蛋白在HCC及其癌旁组织中的表达。结果 21例HCC及其癌旁组织中,C_2mRNA阳性率分别占23.8％(5/21)和85.7％(18/21),60例HCC及42例癌旁组织中,C_2蛋白阳性分别占27.3％(17/60)和83.3％(35/42),27例肝硬变中,C_2蛋白阳性率为77.8％(21/27)。χ~2检验:C_2mRNA及其蛋白在HCC癌旁组织中表达明显高于癌组织(P<0.001);C_2蛋白在肝硬变中的表达明显高于HCC癌组织(P<0.01);C_2的表达与患者年龄、HBsAg及AFP有明显关系(P<0.05);而与癌组织的分化程度、肿瘤大小、淋巴转移无关;Western blot与免疫组化结果一致。结论 C_2基因表达下调可能与HCC的发生、发展及早期诊断有关。     

Hepatitis C virus in elderly cancer patients

BACKGROUND: There are few studies about the relationship between HCV and the development of other tumors. We consider the prevalence of HCV infection in elderly cancer patients who have tumors different from that in hepatocellular carcinoma and non-Hodgkin's lymphoma. METHODS: We evaluated the prevalence of HCV infection in 236 elderly cancer patients in comparison with 300 elderly volunteers. Cancer patients presented a variety of tumors other than hepatocarcinoma and lymphoma, namely, colorectal (n=66), breast (n=44), bladder (n=40), prostate (n=30), lung (n=22), kidney (n=15), pancreatic (n=6), thyroid (n=5), cervical (n=4), melanoma (n=3) and vaginal (n=1). RESULTS: Among the 236 elderly cancer patients, 87 were positive for HCV antibodies (36%) and, among the 300 elderly patients, 32 were positive (10%). A comparison between the two groups revealed a statistically significant difference (p<0.001) between patients with kidney cancer, bladder cancer or prostate cancer, and the control group. CONCLUSIONS: The high anti-HCV prevalence in elderly cancer patients may be due to several mechanisms. These patients are more prone to acquire an HCV infection because of their frequent hospitalizations and the immunological changes in patients with tumors may lower their threshold for HCV infection.     

Thyroid disorders in chronic hepatitis C

PURPOSE: To explore the association of hepatitis C virus (HCV) infection with thyroid disorders. METHODS: We investigated the prevalence of thyroid disorders in 630 consecutive patients with chronic hepatitis due to HCV infection; all patients were free of cirrhosis and hepatocarcinoma, and were not on interferon treatment. Also included were a control group of 389 subjects from an iodine-deficient area, another control group of 268 persons living in an area of iodine sufficiency, and 86 patients >40 years of age with chronic hepatitis B. Levels of thyroid-stimulating hormone (TSH), free thyroxine (T(4)), and triiodothyronine (T(3)), as well as anti-thyroglobulin and anti-thyroid peroxidase antibodies, were measured. RESULTS: Mean TSH levels were higher (P = 0.001), and free T(3) and free T(4) levels were lower (P <0.0001), in patients with chronic hepatitis C than in all other groups. Patients with chronic hepatitis C were more likely to have hypothyroidism (13% [n = 82]), anti-thyroglobulin antibodies (17% [n = 108]), and anti-thyroid peroxidase antibodies (21% [n = 132]) than were any of the other groups. CONCLUSION: Both hypothyroidism and thyroid autoimmunity are more common in patients with chronic hepatitis C-even in the absence of cirrhosis, hepatocellular carcinoma, or interferon treatment-than in normal controls or those with chronic hepatitis B infection.     

肝硬变和肝细胞癌组织中CD54,CD80,CD86和HLA-ABC的表达

目的探讨CD54,CD80,CD86和HLA-ABC在肝硬变的免疫损伤和抗肝癌免疫中的意义.方法用免疫组化方法检测CD54,CD80,CD86和HLA-ABC在肝硬变(n=30)和肝癌(n=48)中的表达、定位和分布.结果在LC中,CD54阳性率为40%(12/30),CD80为50%(15/30),CD86为37%(11/30),HLA-ABC为63%(19/30);在HCC中,CD54阳性率为77%(37/48),CD80为19%(9/47),CD86为13%(6/47),HLA-ABC为30%(12/40);在癌周围组织(PCT)中,CD54为阴性,CD80阳性率为44%(14/32),CD86为47%(15/32),HLA-ABC为53%(17/32).统计学处理显示,在LC中,CD54阳性率显著低于HCC(P＜0.01);CD80(P＜0.01),CD86(P＜0.05)和HLA-ABC(P＜0.01)均显著高于HCC;而与PCT无显著差别.在HCC中,CD80(P＜0.05),CD86(P＜0.01),HLA-ABC(P＜0.05),均显著低于PCT.结论 CD54,CD80,CD86和HLA-ABC在LC和HCC中的同时足量表达有可能引起肝细胞损伤和有效抗肿瘤免疫应答,而CD80,CD86表达的缺失或不足可能是HCC产生免疫逃避的主要原因.