佛山地区存在经输血传播病毒(TTV)感染

我们应用Ｎｅｓｔｅｄ－ＰＣＲ法检测了４５例甲到戊型标志物均阴性的肝炎患者和４４例献血员血清中的ＴＴＶＤＮＡ。资料与方法：４５例肝炎患者均为我院传染科或门诊病人,血清经ＥＬＩＳＡ法检测抗－ＨＡＶ,ＨＢｓＡｇ,ＨＢｃＡｂ,抗－ＨＣＶ,抗－ＨＥＶ均阴性,ＰＣＲ检测ＨＢＶＤＮＡ,ＨＣＶＲＮＡ均阴性。４４例某院献血员检测抗－ＨＡＶ,ＨＢｓＡｇ,ＨＢｃＡｇ,ＨＢｃＡｂ,抗－ＨＣＶ,抗－ＨＥＶ为阴性,肝功能正常。抽提标本血清ＤＮＡ进行Ｎｅｓｔｅｄ－ＰＣＲ：以ＲＤ０３７和ＲＤ０３８为引物进行第一次ＰＣＲ,再以Ｒ…     

聚合酶链反应检测HBV－DNA的临床意义

本文采用聚合酶链反应（ＰＣＲ）和ＥＬＩＳＡ法对２７３７例乙肝患者血清中ＨＢＶ－ＤＮＡ和乙肝病毒标志物进行检测，结果发现各组ＨＢＶ－ＤＮＡ的检出率：①ＨＢｓＡｇ（＋）、ＨＢｅＡｇ（＋）和抗ＨＢｃ（＋）组为９９．２７％；②ＨＢｓＡｇ（＋）、抗ＨＢｅ（＋）和抗ＨＢｃ（＋）组为４４．７７％；③ＨＢｓＡｇ（＋）和抗ＨＢｃ（＋）组为４２．８６％；④ＨＢＶ标志物均阴性为１５．９２％。结果表明ＨＢＶ－ＤＮＡＰＣＲ检出先于其它乙肝病毒标志物，可早期发现乙肝。ＰＣＲ法直接检测ＨＢＶ－ＤＮＡ更有利于临床对乙肝的诊断和治疗。     

前S1蛋白在乙型肝炎诊断,治疗和预后的作用

目的：评价前Ｓ１蛋白在乙型病毒性肝炎早期诊断，疗效及预后等方面的作用，方法，用乙型肝炎病毒（ＨＢＶ）前Ｓ１合成肽及其免疫血清建立前Ｓ１抗朱和抗体ＥＬＩＳＡ检测方法，分别检测２１９份生乙型肝炎（ＡＨＢ）患者（４４例）系列血清，５３５份慢性肝炎患者及ＨＢｓＡｇ携带者系列血清和６３份ＨＢｓＡｇ阳性患者血清ＨＢＶＤＮＡ检测采用核酸斑点杂交法和ＰＣＲ法，其余指标检测采用ＥＬＩＳＡ法，结果：前Ｓ１抗体在血清中     

孕妇HBV感染状态与垂直传播关系的研究

用聚合酶链反应（ＰＣＲ－ＥＢ）技术,对ＨＢｓＡｇ阳性孕妇７８例（实验组）和ＨＢｓＡｇ阴性孕妇４３例（对照组）的血清、脐血和乳汁中的ＨＢＶ－ＤＮＡ进行检测,同时用酶联免疫吸附法（ＥＬＩＳＡ）检测两组孕妇血清ＨＢＶ标志物,结合孕妇感染状态做相关性分析。结果：实验组血清ＨＢＶＤＮＡ检出率为５１．３％,对照组未检出,两组有极显著性差异（Ｐ＜０．００１）。实验组乳汁、脐血中ＨＢＶ－ＤＮＡ阳性率分别为２９．５％、３９．７％,对照组未检出,两组有极显著性差异（Ｐ＜０．００１）。提示母婴ＨＢＶ垂直传播与孕妇ＨＢＶ感染状态和ＨＢＶ－ＤＮＡ的检出率有关     

用PCR技术检测HBV－DNA的临床意义

用ＰＣＲ技术对３２３例肝病患者和５０例健康献血员血清进行ＨＢＶ－ＤＮＡ检测，同时用ＥＬＩＳＡ法检测ＨＢＶＭ。结果：５０例健康献血员有８％ＨＢＶ－ＤＮＡ阳性，表明ＨＢＶ－ＤＮＡ单项阳性的携带者对于乙肝的传播具有很大的危险性；ＨＢｓＡｇ、ＨＢｅＡｇ、抗ＨＢｃ阳性者ＨＢＶ－ＤＮＡ检出率为８８．７％，说明ＨＢＶ－ＤＮＡ与ＨＢｅＡｇ阳性呈正相关；抗ＨＢｅ阳性的慢性肝病患者有４３．６８％ＨＢＶ－ＤＮＡ阳性，提示不能把抗ＨＢｅ作为无传染性的指标。     

聚合酶链反应检测HBV DNA的临床意义

应用ＰＣＲ对１７１例肝病血清检测结果，ＨＢＶＤＮＡ阳性率５９．１％，ＥｌｉＳＡ检测ＨＢｓＡｇ阳性率４３．２７％，二者比较有显著性差异（Ｐ〈０．０１），ＨＢｓＡｇ（＋）／ＨＢｅＡｇ（＋）组ＨＢＶＤＮＡ阳性率７９．５％，而ＨＢｓＡｇ（＋）抗－ＨＢｅ（＋）组主５７．９％，ＨＢｓＡｇ（－）／抗－ＨＢｓ（＋）组，ＨＢＶＤＮＡ阳性率３６．８％。     

庚型肝炎病毒（GBV—C／HGV）与HBV和HCV联合或重叠感染的初步研究

目的 研究庚型肝炎病毒（ＧＢＶ－Ｃ／ＨＧＶ）与ＨＢＶ和ＨＣＶ联合或重叠感染的情况，方法 采用ＥＬＩＳＡ的方法检测血液制剂和血源乙肝疫苗原料血浆中的ＨＢｓＡｇ和抗－ＨＣＶ；并用５′非编码区的引物，用逆转录聚合酶链反应（ＲＴ－ＰＣＲ）法检测ＧＢＶ－Ｃ／ＨＧＶＲＮＡ。结果 ＨＢｓＡｇ和抗ＨＣＶ均阴性血浆的ＧＢＶ－Ｃ／ＨＧＶＲＮＡ阳性率为１８．８％（１５／８０）；ＨＢｓＡｇ阳性而抗ＨＣＶ阴性血浆的ＧＢＶ－     

套式及免疫套式聚合酶链反应检测乙型肝炎表面抗原阴性肝病患者血清中乙型肝炎病毒DNA

为了更准确、简便而又快速地了解乙型肝炎表面抗原（ＨＢｓＡｇ）阴性肝病患者的病因，建立了套式和免疫套式聚合酶链反应（ＰＣＲ）检测血清中乙型肝炎病毒（ＨＢＶ）ＤＮＡ的技术，结合丙型肝炎病毒（ＨＣＶ）感染指标的检测，对ＨＢｓＡｇ阴性肝病患者的病因进行了研究。发现套式ＰＣＲ能将单次ＰＣＲ的敏感性稳定地提高１０００倍；免疫套式ＰＣＲ可检测到０．１～０．０１ｐｇ／Ｌ水平。检测ＨＢｓＡｇ阴性肝硬化２２例（Ａ组）、ＨＢｓＡｇ阴性慢性肝炎１３例（Ｂ组）、ＨＢｓＡｇ阴性和乙型肝炎病毒核心抗体（抗－ＨＢｃ）阳性正常对照组３０例（Ｃ组）及ＨＢｓＡｇ（＋）／ＨＢｅＡｇ（－）肝硬化患者１２例（Ｄ组），分别有４５．５％、３０．８％、１３．３％和１００％患者血清中ＨＢＶＤＮＡ阳性。ＨＢＶＤＮＡ在一些抗－ＨＢｓ（＋）肝病患者和所谓健康人的血清中也存在。Ａ、Ｂ两组检出有ＨＢＶ和（或）ＨＣＶ感染患者分别占８１．８％和５３．８％。提示套式和免疫套式ＰＣＲ是简便、快速而又高度敏感的检测方法；ＨＢＶ感染可能是引起ＨＢｓＡｇ阴性慢性肝病的重要原因，且ＨＢｓＡｇ阴性肝病病因大多与病毒感染有关；应该重新认识自然感染者血清中抗－ＨＢｓ的临床意义。     

用套式聚合酶链反应检测乙型肝炎疫苗免疫后无抗体反应者血清HBVDNA

为了解乙型肝炎（乙肝）疫苗接种后不产生抗－ＨＢｓ的原因，作者用套式聚合酶链反应（ＰＣＲ）技术检测了正常人群中乙肝疫苗免疫后１５例不产生抗－ＨＢｓ和２０例产生抗－ＨＢｓ者血清的ＨＢＶＤＮＡ，同时用Ａｂｂｏｔｔ试剂检测血清的ＨＢｅＡｇ。结果发现，不产生抗－ＨＢｓ的１５例中有６例（４０％）第２次ＰＣＲ扩增ＨＢＶＤＮＡ为阳性，其中３例（５０％）为ＨＢｅＡｇ阳性，产生抗－ＨＢｓ者的２０例其血清ＨＢＶＤＮＡ和ＨＢｅＡｇ均为阴性。提示：常规方法漏检的低水平ＨＢＶ感染可能是造成乙肝疫苗免疫后不产生抗－ＨＢｓ的原因之一。     

HBV—DNA在各型乙肝中的分布规律探讨

采用聚合酶链反应（ＰＣＲ）技术检测乙肝患者的血清ＨＢＶ－ＤＮＡ，商时用ＥＬＩＳＡ法检测ＨＢＶ各抗原抗体指标。结果显示，９０４例乙肝患者的ＨＢｅＡｇ阳性率为３７．９％，而ＨＢＶ－ＤＮＡ阳性率达６８．８％，血清ＨＢＶＤ－ＮＡ阳性率明显高于ＨＢｅＡｇ（Ｐ〈０．０５）。在ＨＢｅＡｇ阴性病例中，ＨＢＶ－ＤＮＡ阳性率达５４．４％，其中有活动性肝病者阳性率为７２．３％，肝病静止期仅１９．９％，差异极显著（Ｐ〈０     

The conditions of HBV infection in myeloid cells in patients with hepatitis

In this study, HBsAg, HBcAg and HBV DNA in myeloid cells of 57 patients with hepatitis have been examined by using ABC staining method. The results show that in the myeloid cells of 54 patients with positive HBVM in serum, there are 4 cases with HBV positive antigen, HBcAg has been found in a case of acute hepatitis and HBsAg in a case of chronic hepatitis and a case of liver cirrhosis respectively, HBsAg and HBcAg were found simultaneously in another case of liver cirrhosis. Nothing has been found the myeloid cells of 3 cases with negative HBVM in serum. All these findings suggest that myeloid cells are probably another breeding ground for duplicating HBV.     

Hepatitis B virus DNA in sera and liver tissue of HBsAg negative patients with chronic hepatitis C

BACKGROUND/AIMS: Hepatitis B virus (HBV) DNA has been detected in HBsAg-negative patients with hepatitis C. We determined the rate and explored the clinical significance of HBsAg negative HBV coinfections in Austrian patients with chronic hepatitis C. METHODS: Sera (n=82, group I) or liver tissue (n=16, group II) from 98 HBsAg negative Austrian patients with chronic hepatitis C were examined for HBV DNA by nested polymerase chain reaction (PCR). For control purposes, sera from 15 patients with chronic HBV infection (8 HBsAg positive, 7 HBsAg negative, all HBV PCR positive) were examined. RESULTS: HBV DNA was detected in 22% of sera and 19% of liver tissue specimens of patients with chronic hepatitis C. No significant difference in mean aminotransferase values, markers of HBV infection, inflammatory disease activity, or degree of hepatic fibrosis was observed in patients with or without HBV DNA. Anti-HBc alone as a marker of past HBV infection was more frequent in chronic hepatitis C patients compared to control individuals. Negative HCV PCR was more common (p=0.009) among patients with positive HBV PCR in serum. When examining repeat sera for HBV DNA, positive results were obtained in previously negative, but also negative results in previously positive patients. CONCLUSIONS: Coinfection with HBV can be demonstrated by PCR in a considerable number of HBsAg negative Austrian patients with chronic hepatitis C. HBV infection seems to suppress HCV replication even in HBsAg negative patients with dual infection. HBV coinfection in HCV infected patients cannot be excluded by negative HBsAg status alone. Repeat PCR examinations are needed to exclude dual infections.     

海南地区原发性肝癌与HBV感染关系的探讨

对 771例原发性肝癌患者及同期 794例其他消化道恶性肿瘤患者的血清HBV标记进行回顾性对比分析。结果发现肝癌组HBVM阳性 72 6例 (94 16 % ) ,非肝癌组HBVM阳性 138例 (17 38% ) ,有显著差异 (P <0 0 1)。在感染HBV模式中 ,肝癌组HBVM以“小三阳”为主 ,占全部肝癌患者的 6 7 0 6 % (5 17/ 771) ,明显高于非肝癌组的 13 4 8% (10 7/ 794 ) ,“小三阳”中HBVDNA阳性明显高于其他HBVM阳性模式组。说明原发性肝癌的发生与HBV有着非常密切的关系 ,而HBV与肝细胞的整合及不同的HBV基因型可能是其发生癌变的重要病理生理学基础     

乙肝病毒感染对慢性乙肝肝硬化患者胃黏膜病变的影响

目的探讨乙肝病毒(HBV)感染对慢性乙肝、肝硬化患者胃黏膜病变的影响及其发病机制。方法2003-06～2004-02对河北医科大学第三医院感染科60例慢性乙肝、肝硬化患者同时行肝穿、胃镜、肝功能、血清肝炎病毒标志物检查,采用SP法检测肝及胃黏膜组织中HBsAg、HBcAg。结果(1)肝组织病理损害程度与胃黏膜病变程度成正比(r=0.483,P<0.01)。(2)56例中26例胃黏膜组织中可检测到HBsAg和(或)HBcAg,其病变以中重度为主。34例HBVM阴性患者中,病变以轻中度为主(P<0.01)。(3)肝组织与胃黏膜组织中HBsAg同时阳性17例;HBcAg同时阳性6例(P>0.05)。(4)血清及胃黏膜组织中HBsAg和(或)HBcAg同时阳性26例;HBVDNA同时阳性22例(P>0.05)。结论进一步证实了HBV可侵犯胃黏膜组织,并在其中复制,是导致慢性乙肝患者胃黏膜病变的重要因素。胃黏膜病变程度与胃黏膜组织HBV感染、肝组织病变程度密切相关;与血清及肝组织中HBV分布无关。     

慢性肝病患者乙肝病毒血清学标志物转换规律及其意义

目的探讨乙肝病毒血清学标志物（HBVM）在慢性肝病患者中的转换规律及临床意义。方法选择慢性肝病患者包括慢性病毒性乙型肝炎、慢性重型乙型肝炎、肝炎肝硬化和原发性肝癌患者183例,采用ELISA方法对HBVM（HBsAg、HBsAb、HBeAg、HBeAb和HBcAb）进行检测,采用荧光定量聚酶链反应法进行HBV DNA检测,将HBV DNA检测值进行对数转换行统计学分析。结果慢性肝病患者的HBVM共有3种模式：大三阳（L3PP：HB-sAg、HBeAg和HBcAb）、小三阳（S3PP：HBsAg、HBeAb和HBcAb）和小二阳（S2PP：HBsAg和HBcAb）。L3PP HBVDNA水平高于S3PP和S2PP（P〈0.01）。随着慢性肝病病情发展,L3PP阳性率呈下降趋势,S3PP和S2PP阳性率呈上升趋势（P均〈0.01）;不同临床类型的慢性肝病患者3种HBVM模式的分布存在统计学差异（P〈0.01）。结论 L3PP慢性肝病患者HBV DNA复制水平高于S3PP或S2PP模式。随着慢性肝病病情的进展,HBVM的模式可发生转换,HBeAg阴转,L2PP转为S3PP或S2PP。     

慢性乙型肝炎病毒感染者家族隐匿性乙型肝炎病毒感染的调查

目的 了解慢性HBV感染者家族隐匿性HBV感染的发生率及其与HBV标志物、年龄和性别等的关系.方法 ELISA方法检测慢性HBV感染者家族成员的HBV血清学标志物,套式PCR法检测136例HBsAg阴性家族成员的血清HBV DNA,并将隐匿性HBV感染者和HBsAg、HBV DNA均阴性者分别作为试验组和对照组进行HBV标志物、年龄、性别和生物化学检测结果的比较.两组均数比较采用t检验.率的比较采用χ~2检验或Fisher确切概率法检验.结果 在52个慢性HBV感染者家族中共检测到92例HBsAg阳性者和136例HBsAg阴性者,其中15例为隐匿性HBV感染者,慢性HBV感染者家族HBsAg阳性率和隐匿性HBV感染的发生率分别为40.4%和11.0%,15例隐匿性HBV感染者中有7例抗-HBc阳性(χ~2=5.341,P=0.02),但隐匿性HBV感染的存在与年龄、性别等无关.结论 HBV感染存在家庭聚集现象,且在其家族中存在隐匿性HBV感染,并在抗-HBc阳性者中发生率较高.     

Relationship between HBV viremia level of pregnant women and intrauterine infection:neated PCR for detection of HBV DNA

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202例散发性成人急性乙型肝炎患者的流行病学特征和血清学变化

目的了解散发成人急性乙型肝炎(AHB)流行病学特征及其血清病毒标志物(HBV M)演变规律。方法以202例成人AHB患者为研究对象,收集患者流行病学资料并定期随访检测ALT、TBil、HBV DNA、HBV M及其定量,观察其动态变化,随访期为48周。计数资料采用非参数秩和检验,计量资料组间比较采用成组t检验,相关性分析采用Person检验。结果 AHB患者男性明显多于女性,平均(42.99±7.31)岁。微量血传播方式最多,占29.20%,异性性传播占17.33%,但高达48.02%的患者传播途径不明。就诊时仅49.01%的患者HBV DNA阳性。HBV DNA阳性组血清ALT平均值为(1973.2±445.3)U/L;阴性组为(1500.3±287.7)U/L,两者差异无统计学意义(t=1.852,P0.05);HBV DNA阳性组血清TBil平均值为(118.40±37.33)μmol/L;阴性组为(81.06±23.24)μmol/L,两者差异有统计学意义(t=2.765,P0.01)。初诊时HBV M呈现8种模式,以HBsAg、HBeAg、抗-HBc、抗-HBc IgM阳性和HBsAg、抗-HBe、抗-HBc、抗-HBc IgM阳性2种模式最多见,分别占39.11%和29.27%。资料完整的99例AHB患者HBV M动态观测显示:观测期内HBsAg阴转率为97.98%,平均阴转时间为2.5周;抗-HBs累计阳转率为83.84%;HBeAg阳性患者HBeAg阴转率为100.00%,全部于发病4周内阴转;在48周的随访期内抗-HBe阳转率为80.81%;血清抗-HBc始终为阳性。202例患者急性期HBsAg定量均低于200 ng/ml;急性期HBsAg定量水平与HBsAg阴转时间呈反比。结论经微量血传播及性接触传播已成为成人散发AHB的主要传播途径;HBV DNA快速清除和HBsAg、HBeAg快速血清学转换是成人散发AHB的显著特点;急性期HBsAg定量水平对判定AHB转归有一定意义,本文2例患者最终转化为慢性HBV感染。     

小儿乙型肝炎病毒标志物与HBV DNA的关系研究

了解小儿乙型肝炎HBVM与HBV DNA含量之间的关系及临床意义.采用微粒子酶免分析法(MEIA)检测HBVM,PCB法检测HBV DNA.乙肝患儿血清HBeAg滴度与HBV DNA密切相关(P＜0.005).HBsAg,ALT与HBVDNA则无关联(P＞0.05).慢性重度乙肝患儿血清HBV DNA水平明显低于慢性轻度(P＜0.001)及慢性中度(P＜0.05).HBVM及HBV DNA定量检测,能准确地评价HBV在宿主体内的复制情况,可作为临床上评价病毒复制程度和抗病毒疗效观察的指标.     

Occult hepatitis B virus infection in patients with autoimmune liver diseases

Background: Occult hepatitis B virus (HBV) infection is characterized by undetectable serum HBV surface antigen (HBsAg) but detectable HBV‐DNA in serum or liver. Aims: To determine the prevalence and clinical impact of occult HBV in autoimmune liver diseases as similar data are missing. Methods: One hundred and ninety‐six sera samples from HBsAg‐negative patients, including 66 autoimmune hepatitis (AIH), 93 primary biliary cirrhosis (PBC) and 37 primary sclerosing cholangitis (PSC), were investigated for HBV‐DNA using the polymerase chain reaction (PCR) before treatment initiation. One hundred and three serial samples from 38 AIH patients under immunosuppression and 282 selected blood donors (HBsAg negative; antibodies to HBV‐core antigen positive) were also investigated. Fourteen available paraffin‐embedded AIH liver samples were also investigated for HBV‐DNA by nested‐PCR. Results: Hepatitis B virus DNA was detected in the serum of 24/196 patients (12.2%) and 0/282 donors (P=0.0000). Nine patients had AIH (13.6%), eight had PBC (8.6%) and seven had PSC (18.9%) (P=0.0000 vs healthy). HBV‐DNA detection in AIH livers was higher than in serum. HBV‐DNA was associated neither with HBV markers nor with epidemiological, laboratory and clinical data. Serial testing of AIH patients revealed two HBV‐DNA‐negative patients before treatment becoming positive during treatment, while all HBV‐DNA‐positive patients before immunosuppression became negative. Conclusion: Based mainly on serum HBV‐DNA, we found a significant proportion of autoimmune liver disease patients with occult HBV compared with donors. However, taking into account our results in a small number of liver tissues, it should be emphasized that occult HBV could be even higher when both serum and liver specimens are investigated. Occult HBV does not seem to affect the clinical and laboratory features of the diseases, while AIH patients with occult HBV under immunosuppression do not deteriorate during follow‐up.