乙型肝炎病毒血清标志物与HBV-DNA关系探讨

目的探讨乙型肝炎病毒血清学标志物(HBV-M)含量与HBV-DNA载量之间的关系。方法运用电化学免疫发光法(ECLIA)和实时荧光定量PCR两种方法同时定量检测262份血清标本中血清标志物HBsAg、HBsAb、HBeAg、HBeAb、HBcAb含量和HBV-DNA载量,并对各项检测结果进行统计学分析。结果 262份血清标本出现了9种血清模式,其中152份HBV-DNA阳性,对HBVDNA阳性标本进行相关性分析,发现其与HBsAg、HBeAg、HBeAb呈正相关(r=0.207、0.542、0.607,P<0.05),且在HBeAg阳性组更显著(r=0.425、0.752、0.701,P<0.01)。152份HBV-DNA阳性中79例HBeAg阴性,其中29例HBV-DNA载量对数值≥5,占HBeAg阴性者的36.7%;25例HBsAg<250 IU/mL,其中12例HBV-DNA载量对数值≥5,占48%。结论 HBV血清标志物含量与HBV-DNA载量之间有相关性,但是单一检查难以对体内HBV感染情况作出准确诊断,需要将HBV血清标志物检测与HBV-DNA载量两者联合检测,以准确判断HBV在体内的存在情况。     

Stroke: a neglected complication of American trypanosomiasis (Chagas' disease)

American trypanosomiasis, also known as Chagas' disease (CD), is a major public health problem and a frequent cause of chronic cardiomyopathy and stroke in South America. The role of CD as an independent stroke risk factor is reviewed. Chronic cardiomyopathy can appear 10-30 years after the initial infection and affects about 30% of CD patients. Cardiac arrhythmias, congestive heart failure, apical aneurysm and mural thrombus are potential embolic factors that partially explain the genesis of chagasic stroke. Prevalence of apical aneurysm and mural thrombus in CD stroke patients has been estimated in 37 and 11.7%, respectively. Nevertheless, not all stroke chagasic patients have a severe myocardiopathy. Stroke may also be the first manifestation of CD in patients with mild or undetected systolic dysfunction. The diagnosis of CD may be established after stroke presentation in around 40% of patients. Awareness of stroke risk in chagasic patients is very poor and has been estimated in less than 5%. Chagasic cardiomyopathy is a neglected, frequently unrecognized, source of cardioembolic stroke in South America. Educational and prevention programs should be performed in order to prevent this complication of the chronic form of CD.     

启东乙型肝炎干预研究:2013年随访人群HBV感染及慢性肝病现患调查

目的 分析新生儿接种乙型肝炎(乙肝)疫苗人群在达到婚配年龄后罹患慢性乙肝、肝硬化的远期保护作用。方法 2013年1-10月采用横断面调查方法,对启东乙肝干预研究(QHBIS)的研究对象分层随机抽样,并行ALT、HBV感染血清学标志物(HBsAg、HBeAg、抗-HBs、抗-HBc、抗-HBe)检测及肝胆B超检查。计算HBV感染血清学标志物各指标的阳性率,慢性乙肝及肝硬化的患病率,疫苗组及对照组人群按性别分层后, χ²检验比较各组间率的差异。结果 共获得新生儿乙肝疫苗接种组(疫苗组)4 421人和对照组3 880人,平均年龄分别为(25.59±1.84)岁和(26.61±2.24)岁。疫苗组HBsAg、单独抗-HBs、抗-HBc、HBeAg、抗-HBe阳性率分别为2.38%、37.73%、3.78%、0.57%、2.15%,对照组分别为9.02%、29.41%、16.83%、2.73%、8.87%,两组间血清学标志物各指标的差异均有统计学意义(P <0.05)。疫苗组慢性乙肝活动期、肝纤维化及肝硬化患病率分别为0.45%和0.16%,对照组分别为1.29%和0.39%,组间差异均有统计学意义(P <0.05)。按性别分层后,疫苗组男性慢性乙肝活动期患病率高于女性,差异有统计学意义(P <0.05);在对照组,不管是慢性乙肝活动期患病率还是肝纤维化及肝硬化患病率,男性均高于女性,差异有统计学意义(P <0.05)。结论 新生儿接种乙肝疫苗对慢性HBV感染的保护作用可延长至婚配年龄后,而不同性别人群慢性乙肝与肝硬化现患保护作用的差异值得进一步研究。     

Non-responders to hepatitis B vaccination: a review

Hepatitis B virus (HBV) infection is a major public health issue throughout the world and vaccination of those at risk is the main method of containment. Of healthy vaccinees, 5-10% fail to mount an adequate antibody response. The antibody levels of an unknown further fraction of vaccinees fall considerably over time rendering them at a potential risk of infection. The scope of this article is to review the factors that might influence the immune response to HBV vaccination, to review the methods used to overcome the problem of poor response and to discuss what possible guidelines are available or needed in treating these vaccinees.     

Dengue in the Middle East: a neglected, emerging disease of importance

Dengue transmission has increased worldwide, particularly in Asia and Latin America since the 1970s, but limited information on the disease is available from the Middle East. Saudi Arabia and Yemen have reported a few epidemics of dengue. Three of the four dengue virus serotypes (DENV-1-3) have been reported in the region. Climate conditions in the Middle East are not favourable for the disease vector, but all other risk factors for dengue are potentially increasing. The existence of a large immigrant work force from dengue-endemic countries, increased travel from and to dengue-endemic countries and increased urbanization are expected to increase the likelihood of the emergence of dengue in the Middle East.     

基于慢性乙型病毒性肝炎诊断路径的实验诊断学教学模式初探

探讨建立涵盖慢性乙型病毒性肝炎(CHB)诊断与鉴别诊断、治疗、药物选择及毒副作用预测、疗效监测、预后评估等全过程的疾病临床检验诊断路径的教学模式。根据CHB临床诊疗指南, 制订与疾病不同阶段相关的实验室检查检测策略, 建立CHB临床检验诊断路径, 以武汉大学第一临床学院2016级和2017级八年制本科生为研究对象, 通过随堂问卷比较其课堂教学效果。本研究首先建立了获得临床医生认可的CHB临床检验诊断路径, 其涵盖CHB疾病的诊断与鉴别诊断、治疗、药物选择及毒副作用预测、疗效监测、预后评估等全过程。该路径应用于2017级临床医学本科生课堂教学后, 教学质量评估指标均有较大程度的提升。此外, 随堂测验得分也有显著提高。综上, 基于CHB临床检验诊断路径的实验诊断学教学模式, 实现了实验诊断学与临床医学的融合, 提升了学生对CHB诊疗中各种实验室检查检测的整体认识, 教学质量得到了提高。     

深圳市脑卒中发病与气温关系

脑卒中在许多研究中被证实与空气污染相关。作为脑卒中发生发展过程中重要的危险因子,按照暴露时间不同,空气污染可分为长期与短期两种。空气污染的短期和长期暴露对于脑卒中住院人数和死亡率的影响是目前研究的热点,但目前国内尚缺乏这一类综合性论述。本文总结和分析了空气污染暴露与脑卒中的相关性及两者之间潜在的机制,以期更加明确空气污染对脑卒中住院人数和死亡率的影响,减少脑卒中的住院人数和死亡率。     

Health literature: a neglected resource

The health and medical sciences can enjoy outstanding information support through a vast literature made accessible by secondary services such as abstracting journals and data bases. Yet, for various reasons, few national health plans make use of bibliographic services, libraries, or documentation services. In many developing countries health science libraries are institution-based, and their services limited to research personnel, medical school staff, and postgraduate students. Even among these access to library resources may be severely restricted. Thus, collections are underutilized, and whole segments of the health community are denied access to the literature. A 2nd need is for the coordination of health literature at a national level, in activities such as inter-library lending, photocopy provision, and centralized cataloguing. In countries where there is more than 1 sizeable medical library, users would benefit by gaining access to a much wider range of resources than would otherwise be available. 3rd is a need for the extension of facilities to underserved groups such as health administrators and health care personnel, ministry of health staff, and hospital physicians. While these personnel may have access to statistics generated in national health systems, new ideas, views, criticisms, theories, and other nonnumerical data is needed outside literature. The literature needs of these health personnel is obviously different than those of medical research and teaching staff, and a bibliographic service must be developed to reflect these needs. The final improvement needed is the integration of health literature services into national health systems. Steps necessary for government to initiate integration are: 1) formulation of national policy for health literature services, 2) inclusion of health literature services in national health plans, 3) allocation of funds to health literature services in national budgets, and 4) bibliographic control of national health literature. For progress to occur, action must come from 3 groups: national health and education authorities, with their administrative and financial control; information mediators librarians, documentalists, bibliographers); and the users themselves.     

Infectious disease notification--a neglected legal requirement

The Acheson Report expressed concern about doctors' knowledge of the infectious disease notification system. This study was undertaken in order to quantify doctors' knowledge of the system, and guide action to improve its efficiency. A survey of 176 hospital doctors in one large Health District showed that, although 82% knew of the legal obligation to notify, 70% did not know where to obtain a notification form, and 40% did not know whom to notify. Over a third of those surveyed did not know that food poisoning and tuberculosis are notifiable diseases. Proposed changes in the law relating to infectious disease control will not compensate for such lack of knowledge. Consultants in Communicable Disease Control should take the lead in improving this vital information system.     

Hepatitis E: a neglected threat

Hepatitis E, responsible for explosive waterborne outbreaks and sporadic cases of acute hepatitis in developing countries, affects predominantly young adults and has a fatality rate as high as 25% in pregnant women. No effective treatment exists for hepatitis E; however, a vaccine using a baculovirus-expressed recombinant hepatitis E capsid protein was recently studied in Nepal. In this review, the progress made in hepatitis E research and the recently concluded vaccine trial of the recombinant protein vaccine are briefly discussed.     

乙型肝炎病毒感染与心血管疾病的相关性

HBV感染可引起许多肝外疾病,如皮肤疾病和关节炎等,但对心血管病变的影响关注和研究较少,且有些研究结果存在矛盾.此文总结HBV感染对心肌疾病、心衰、冠状动脉性疾病和心脏移植等心血管疾病的影响,以及HBV感染与代谢综合征之间的关系.     

Exploring hepatitis B vaccination acceptance among young men who have sex with men: facilitators and barriers

BACKGROUND: Studies continue to show that the majority of men who have sex with men in the United States remain unvaccinated against hepatitis B despite the licensure of an efficacious vaccine in 1982. METHODS: A theory-based, qualitative approach is used to explore acceptance of hepatitis B vaccination among men who have sex with men residing in Birmingham, Alabama. RESULTS: A total of 62 self-identified men who have sex with men (mean age = 25 +/- 2.3; range: 18-36 years) participated in one of eight focus groups. Among the findings of this study, participants reported low levels of perceived susceptibility to infection; lacked basic information about hepatitis B and hepatitis B vaccination; did not perceive their providers to be comfortable with discussing their same-sex sexual behavior; did not identify tangible or intangible benefits to vaccination; had limited access to health care and had little continuity of care; did not trust federally supported vaccination efforts; and reported the inundation of HIV prevention messages hampered their receptivity to health messages in general. CONCLUSIONS: There is an urgent need to enhance awareness and facilitate hepatitis B vaccination among men who have sex with men. While further research is necessary, our findings indicate that numerous barriers to hepatitis B vaccination exist that may result in low vaccination rates. Prevention efforts would benefit from addressing these barriers.