Hepatitis delta virus infection and Labrea hepatitis. Prevalence and role in fulminant hepatitis in the Amazon Basin

To define more exactly the epidemiology of delta virus infection and confirm its role in causing fulminant Labrea hepatitis in the Amazon Basin, we studied the prevalence of delta virus infection among persons with acute and chronic hepatitis B virus infection in the Boca do Acre district of the southern Amazon Basin. Delta virus infection was found in 24% of asymptomatic hepatitis B virus carriers, 29% of acute nonfulminant hepatitis B cases, 74% of fulminant hepatitis B cases, and 100% of chronic hepatitis B cases. Chronic delta virus infection occurred primarily in older children and adults, while acute and fulminant delta virus infection occurred in young children as well. In fulminant hepatitis cases, delta virus superinfection of hepatitis B virus carriers was the most common serological pattern; histopathologic examination showed features identical to those described in fulminant hepatitis cases of similar etiology in Colombia and Venezuela. Delta virus infection is highly endemic in the southern Amazon Basin and is the principal cause of Labrea hepatitis.     

A case of aplastic anaemia associated with fulminant hepatitis B

Aplastic anaemia is a rare complication of Acute Viral Hepatitis. This complication occurs during the resolving phase of the hepatitis or can be delayed as long as six months after resolution. Most cases reported were associated with Non A and Non B hepatitis. We report a case associated with Acute Hepatitis B. The onset of aplasia during the acute phase of hepatitis, and patient's subsequent progression to fulminant hepatitis were the interesting features of this case.     

Lack of evidence of hepatitis D (delta) infection in Newfoundland and Labrador.

Epidemiologic knowledge of hepatitis D virus (HDV) infection is limited. A seroepidemiologic study was undertaken to determine the prevalence of the infection in Newfoundland and Labrador. Between October 1983 and October 1985 over 200 people were recognized through routine serodiagnosis and screening as having hepatitis B seromarkers. A total of 223 serum samples from 186 of these people were tested for anti-HDV. The subjects were mainly asymptomatic carriers of hepatitis B surface antigen or patients with acute or chronic hepatitis B from the native Indian and Inuit and the non-native populations. None of the serum samples were positive for anti-HDV. The absence of anti-HDV in a substantial number of people in the province who are infected with hepatitis B virus is strong evidence that HDV infection is not prevalent in the local population, including native people.     

乙型肝炎病毒宫内感染及其相关因素的研究

追踪随访８１例乙型肝炎表面抗原（ＨＢｓＡｇ）阳性母亲所生婴儿，乙肝病毒宫内感染率为１３．６％，对国产血源性疫苗阳性反应率为８６．４％，通过分析母血ＨＢＶ标志，发现；（１）母血中ＨＢｓＡｇ高滴度，ｅ抗原阳性是宫内感染的重要危险因素；（２）宫内感染与婴儿免疫无应答有关。     

合并乙型病毒性肝炎的冠心病病人应用他汀类药物临床观察研究

目的分析应用不同剂量阿托伐他汀钙联合降脂胶囊对合并乙型病毒性肝炎的冠心病病人的血脂指标、肝功和内皮功能的影响。方法随机选取某院2014年1月~2017年1月接受治疗的120例合并乙型病毒性肝炎的冠心病病人,采用随机数字表法分为A组、B组和C组,每组40例。A组病人给予10 mg/d的阿托伐他汀钙联合降脂胶囊治疗,B组病人给予20 mg/d的阿托伐他汀钙联合降脂胶囊治疗,C组病人给予5 mg/d的阿托伐他汀钙联合降脂胶囊治疗。比较3组病人在治疗前和治疗后6个月的血脂指标三酰甘油(Three Glycerol,TG)、总胆固醇(Tatal Cholesterol,TC)、低密度脂蛋白胆固醇(Low Density Lipoprotein Cholesterol,LDL-C)、高密度脂蛋白胆固醇(High Density Lipoprotein Cholesterol,HDL-C)、肝功血清谷丙转氨酶(Alanine transaminase,ALT)水平、肝功能损害发生率、内皮功能指标内皮素-1(endothelin-1,ET-1)和一氧化氮(nitric oxide,NO)水平。结果治疗后,B组病人的血清ALT水平和肝功能损害发生率比A组和C组明显升高,差异有统计学意义(P0.05),A组和C组病人的ALT水平和肝功能损害发生率差异均无统计学意义(P0.05);C组病人的TC、TG、LDL-C和ET-1水平均比A组和B组明显升高,差异有统计学意义(P0.05),C组病人的NO水平比A组和B组明显降低,差异有统计学意义(P0.05),A组和B组的ET-1、NO、TC、TG、LDL-C水平差异均无统计学意义(P0.05),3组病人的HDL-C水平差异无统计学意义(P0.05)。结论剂量为10 mg/d的阿托伐他汀钙联合降脂胶囊方案的疗效最佳,能有效地减轻合并乙型病毒性肝炎的冠心病病人的肝功损害,调节机体血脂代谢,且不会影响病人内皮功能的恢复,值得临床广泛应用。     

戊型肝炎重叠慢性乙型肝炎病毒感染临床分析

目的 了解戊型肝炎患者重叠慢性乙型肝炎病毒感染后的临床表现、肝功能变化及预后.方法 收集急性戊型肝炎患者65例和急性戊型肝炎重叠慢性乙型肝炎感染48例,对两组患者进行临床分析,应用酶联免疫吸附试验检测两组患者HBV标志物及抗HEV IgM.结果 总胆红素、凝血酶原活动度、白蛋白、重型肝炎发病率及病死率在重叠感染组和单纯急性戊型肝炎组之间比较,差异有显著性.结论 戊型肝炎重叠慢性乙型肝炎病毒感染患者肝功能损害严重,病死率高,预后差.     

114例妊娠合并乙型肝炎病毒感染临床分析

[背景]分析妊娠合并乙型肝炎病毒感染对妊娠孕妇的生物化学指标水平及妊娠结局的影响.[病例报告]选择2017年5月—2018年5月间收治的114例妊娠合并乙型肝炎病毒感染患者作为感染组,另选择同期的114例正常妊娠妇女作为正常组,检查两组孕妇的生物化学指标水平进行分析.感染组TP,ALB指标水平明显低于正常组(P<0.05),TB,DB,ALT,AST及GOT指标水平均明显高于正常组(P<0.05);感染组尿液生物化学指标异常率显著高于正常组(P<0.05).感染组并发症发生率为41.2%,显著高于正常组的4.4%(P<0.05);感染组患者新生儿发生早产、黄疸、肺炎及窒息的例数共为55例,显著多于正常组11例(P<0.05).[讨论]妊娠合并乙型肝炎病毒感染易造成早产、胎膜早破,且产后出血、胎儿窘迫、妊娠期高血压的发生率亦显著增高.     

肺结核合并乙型肝炎病毒携带治疗的临床分析

目的探讨抗结核药物联合拉米夫定对肺结核合并乙型肝炎病毒携带患者的疗效。方法选择2010年2月—2013年12月进行诊治的肺结核合并乙型肝炎病毒携带患者82例,随机分为两组。对照组采用国家推荐的抗结核药物治疗方案治疗,观察组在对照组的基础上联合拉米夫定治疗。在治疗后不同时间随访,对比两组的肝功能、HBV-DNA阴转率、治愈率、失败率、复发率、不良反应发生率和病死率。结果治疗后,观察组肝损伤总发生率、AST、ALT、TBIL和TBA分别为19.51%、(98.42±21.53)μ/L、(121.46±26.38)μ/L、(31.62±3.25)μmol/L、(17.42±4.15)μmol/L,均明显低于对照组的46.34%、(326.79±143.92)μ/L、(453.27±146.28)μ/L、(61.42±13.79)μmol/L、(35.12±8.43)μmol/L,差异均有统计学意义(P0.05);随访1年,观察组的HBV-DNA阴转率和结核病治愈率分别为21.95%、90.24%,明显高于对照组4.88%、68.29%(P0.05),失败率、复发率、不良反应发生率和死亡率分别为9.76%、2.70%、26.83%、0.00%,明显低于对照组的31.71%、10.71%、56.10%、7.31%(P0.05)。结论拉米夫定能减轻使用抗结核药物治疗肺结核合并乙型肝炎病毒携带所引起的肝损伤,具有较高的HBV-DNA阴转率和治愈率,且复发率、不良反应发生率和死亡率较低,值得应用推广。     

Hyperglycaemia as an indicator of concurrent acute pancreatitis in fulminant hepatic failure associated with hepatitis B infection

Pancreatitis occurring concurrently with fulminant hepatic failure (FHF) is primarily detected on autopsy and is seldom clinically apparent. We report a fatal case of FHF in a 25-year-old woman which was related to acute hepatitis B infection. In this patient, hyperglycaemia needing insulin infusions led to the detection of acute pancreatitis. FHF complicated by acute pancreatitis has a poor prognosis. A high index of suspicion is necessary for its diagnosis. The role of orthotopic liver transplantation and use of antiviral therapies need further evaluation in this situation.     

拉米夫定治疗50例慢性乙型肝炎患者自身前后对照试验

目的：探讨拉米夫定对慢性乙型肝炎病人的临床疗效。免疫学状态（HBeAg血清转换）、HBV DNA水平及YMDD耐药株（YIDD／YVDD）的影响。方法；观察50例乙肝病人口服拉米夫定治疗前和治疗后12周，24周，36周，48周的肝功能（ALT）及免疫学指标的变化，并采用荧光定量PCR技术检测HBV DNA含量和YMDD耐药变异株。结果：治疗前50例病人中有3例抗－HBe阳性，47例HBeAg阳性。治疗后12－24周有9例（19％，9／47）HBeAg转阴，其中3例出现抗－HBe，有1例HBeAg和HBsAg先后消失，治疗前病人血清YMDD变异检测结果为YMDD4例，YVDD22例，YMDD＋YVDD11例，其他尚不明确，在治疗后36－48周时，14例（14／50，28％）出现反跳，HBV DNA升高超过两个数量级，其中只有3例伴ALT升高但未超过治疗前的基线值，并在36周时由YMDD变异为YIDD，结论：拉米夫定用药9－12个月后28％出现HBV DNA升高，但不伴严重的临床改变，治疗前野生型YMDD仅是少数，而YVDD占多数，个别IDD诉出现常伴ALT的和HBV DNA的升高。     

重症肝炎和肝硬化并发医院感染临床分析

目的：探讨导致肝硬化和重症肝炎并发医院感染的因素,为防治医院感染提供参考。方法：收集2008年3月～2009年3月248例收住我院的重症肝炎和肝硬化患者,记录其发生医院感染的情况,进行回顾性调查。结果：248例患者中,89例发生医院感染,感染率为35.9%,恶化或死亡的医院感染率（17.5%）高于好转或痊愈组（11.6%）（P〈0.05）。并发医院感染的多少与患者的年龄有密切关系。腹腔感染占院内感染的首位,致病菌中革兰阴性菌占的比例最高;发生感染的因素主要有免疫抑制剂的使用、广谱抗生素的使用、侵入性诊疗以及同时患有其他疾病等。结论：重症肝炎及肝硬化患者易发生医院感染,发生院内感染的患者一般都会发生病情恶化,预后差,医护人员应该努力找到发生感染的原因,尽最大努力降低感染率。     

Treatment for hepatitis B virus (HBV) and hepatitis C virus (HCV) infection - Danish national guidelines 2011

The Danish Society of Infectious Diseases and Danish Society of Gastroenterology and Hepatology set up a committee in 2007 to produce national guidelines for treatment of viral hepatitis B and C. The 2011 version of the guidelines have been endorsed by the scientific societies and are presented below. Annual updates will be available at the websites of the societies. As this present English version has been written six months after the Danish 2011 version, it contains minor changes that will be integrated in the Danish 2012 version, available at the end this year. EPIDEMIOLOGY: Viral hepatitis is not common in Denmark. The prevalence has not been determined by national surveys, but it is estimated that 10,000-15,000 patients are chronically infected with hepatitis B and 15,000-20,000 with chronic hepatitis C. The majority of patients with HBV infection in Denmark are emigrants from high endemic countries, probably infected at birth or early childhood in their country of origin, while the majority of patients with HCV infection have been infected by drug use. For both groups it is estimated that only half of the patients have been diagnosed, of whom only 20% attends specialized care for their chronic viral hepatitis. CLINICAL CARE: According to the Danish National Board of Health, patients with chronic viral hepatitis should be followed with regular intervals, at clinics specialized in either infectious diseases or gastroenterology/hepatology. The primary aim is to identify patients with significant liver disease to initiate treatment in order to prevent development of cirrhosis and death. This is primarily done by liver biopsy, but screening for fibrosis with non-invasive methods such as elastography may be sufficient in some patients. Patients with established cirrhosis should enter screening programs for complications such as esophageal varices and hepatocellular carcinoma.     

不良结局家族聚集性乙肝感染者HBV基因分型

目的 探讨不良结局家族聚集性乙肝感染者HBV基因分型情况。方法 A组选择15个家系中54份HBV感染者血清,其中HBV携带者（ASC）30例,慢性乙型肝炎（CHB）7例,肝硬化（LC）13例,肝细胞癌（HCC）4例。B组选择非家族聚集性乙肝感染者60份血清,其中HBV携带者（ASC）36例,慢性乙型肝炎（CHB）10例,肝硬化（LC）9例,肝细胞癌（HCC）5例;应用HBV基因型特异性引物进行聚合酶链反应,经琼脂糖凝胶电泳分析其基因型并进行HBVDNA定量检测。结果 114份血清标本中109份HBVDNA阳性,A组有5份血清HBVDNA检测失败,余49份血清标本中,HBV基因型为C型46例,B/C混合型3例,未检测到其他基因型。B组60份血清标本中,HBV基因型为C型44例,B/C混合型5例,B型11例。两组相比在不同临床类型分布方面均无显著差异。但在肝硬化及肝细胞癌患者中,C型所占比例高,分别为80%和100%。结论 不良结局家族聚集性乙肝感染者,以C型为主,基因型与乙肝病情发展有一定关系。     

Epidemiology of hepatitis D virus (delta) infection in Melbourne over a 15-year period

The prevalence of delta infection was studied in 3986 individuals seropositive for hepatitis B surface antigen (HBsAg), who were seen in Melbourne between 1971 and 1985. The group comprised 2004 patients with acute hepatitis B, 1820 asymptomatic HBsAg carriers, 139 HBsAg carriers with evidence of chronic liver disease, and 23 carriers who had suffered more than two separate attacks of acute hepatitis. Markers of delta infection were found almost exclusively among intravenous drug abusers and their close contacts. Studies of stored sera suggest that delta infection was introduced into this group about 1970. In carriers with no evidence of chronic liver disease, the prevalence of delta infection was highest among intravenous drug abusers (19.2%). In carriers with evidence of chronic liver disease, delta markers were present in 20.1% and all 23 carriers with recurrent acute hepatitis had evidence of infection with the delta virus.