散发性急性病毒性肝炎的血清学分型

本文报告９６例散发性急性病毒性肝炎的血清学分型，其中甲型２９例（３０．２１％），乙型４９例（５１．０４％），丙型４例（４．１７％），戊型３例（３．１３％），甲、乙型混合感染１例（１．０４％），另有１０例（１０．４１％）不能分型。甲型肝炎病人发烧、食欲不振、呕吐、腹泻、尿黄、巩膜黄、肝大的发生率高于乙型肝炎。戊型肝炎的临床表现类似甲肝、丙型肝炎类似乙型。     

大同市188例散发性急性病毒性肝炎的血清学分型

对山西省大同市１８８例散发性急性病毒性肝炎进行了血清学分型，其中甲型７８例（４１．４９％），乙型５５例（２９．２６％），丙型和戊型各１１例（５．８５％）；甲、乙型混合感染２例（１．０６％），余３１例（１６．４％）未能分型。甲型肝炎的平均发病年龄为１８．２０岁，明显小于乙型、丙型和戊型。各型肝炎均为男性多于女性，尤以乙型和戊型更为明显。６１．５３％甲型肝炎发生在秋冬季节，但乙型、丙型和戊型均无明显季节性。乙型和丙型肝炎病例中，有肠道外暴露史者较为常见（分别为６４．４５％和９０．９１％），而成型肝炎病例则多有肠道暴露史（８１．８１％）。     

不同人群TT病毒的检测及部分核苷酸序列分析

目的：了解不同人群TTV感染状况及基因型别。方法：采用TTV（N22）区核苷酸序列设计引物，建立半巢式（nPCR）方法，对健康人群、不同型别肝炎病人、非甲-非戊型肝炎、肝硬化患者等7组人群血清进行啊VDNA检测，并对部分阳性标本进行序列测定和分析。结果：TTV在非甲-非戊型肝炎、肝硬化患者、丙型肝炎、急性甲型肝炎、急性乙型肝炎、慢性乙型肝炎和健康人群中感染率分别为75．00％（15／20）、75．00％（27／36）、61．90％（13／21）、58．06％（18／31）、52．78％（38／72）、45．61％（26／57）和38．89％（28／72）。肝硬化患者及非甲-非戊型肝炎感染率明显高于健康人群（P〈0．01），也明显高于急、慢性乙型肝炎患者（P〈0．05）。5个阳性株序列分析结果显示：4株属于G1基因型，1株属于G2基因型。结论：TTV在河北地区肝病患者中有较高的感染率，TTV感染与不明原因ALT升高有一定的关系，基因型以G1型为主。     

急性散发性戊型肝炎的临床和流行病学特点分析

目的：探讨急性散发性戊型肝炎临床和流行病学特点。方法：收集我国6城市传染病院或综合医院传染科急性散发性肝炎729例，应用酶联免疫法（ELISA）检测抗－HAV IgM,HBsAg，抗－HBcIgM，抗－HCV和抗－HEV。结果：729例急性散发性肝炎中，12．3％（90／729）为戊型肝炎。93．3％（84／90）急性散发性戊型肝炎患的年龄为20－59岁。男性多于女性，男女之比为5：1。80％（72／90）病例发生在上年11月至次年5月。在发病前2月内，47．67％（40／84）患有在外就餐史，32．1％（27／84）有出差史，22．6％（19／84）有饮生水史。随访例患，2例（2．4％）死亡，82例（97．6％）康复，无一例发展为慢性。结论：在急性散发性肝炎中，戊型肝炎占12．3％，其主要临床和流行病学特点类似流行性戊型肝炎。     

柳州市急性散发性病毒性肝炎的病原学和流行病学研究

目的：探讨柳州市急性散发性病毒性肝炎的分型构成及危险因素。方法：用酶联免疫法（EIA）测柳州市121例急性散发性病毒性肝炎血清的各型肝炎病毒急性期感染指标,用逆转录套式聚合酶链反应（RT－nPCR)检测血清未能分型的18例血清的HEV RNA。结果：甲型、乙型、丙型分别占10．7％、58．6％、6．8％,丙型与乙型同时感染占0．8％,戊型分别与甲型、乙型、丙型、庚型同时感染各1例,共占3．3％,戊型7例,血清学未能分型者检HEV RNA阳性7例,则戊型肝炎共14例占11．65,未分型占9．1％,未检到单纯抗－HGV阳性者。解除因素分析表明甲型肝炎的血液暴露史（30．8％）于甲型肝炎（21．1％）。结论：该市急性散发性病毒性肝炎中乙型肝炎占比重最大（58．7％）;血清学未能分型者HEV－RNA阳性较率高（38．5％）;甲型肝炎经血传染、乙型肝炎经消化的方式有上升的趋势。     

南方某地区急性病毒性肝炎的分型与危险因素特点

目的：探讨部队与地方急性病毒性肝炎的型别与发病因素，为制定预防措施提供依据。方法：对驻广东、广西两所部队医院收治的急性病毒性肝炎101例进行了血清学分型与发病因素调查。结果：101例中部队病人42例，甲型肝炎（HA）52．38％，乙型肝炎（HB）40．48％，丙型肝炎（HC）7．14％。部队病人甲肝的发病因素主要为肝炎接触史（OR＝10．63），不洁饮食史（OR＝7．70），出差旅游史（OR＝5．71）。乙肝与丙肝主要与肝炎接触史（OR＝25．0，4．0）有关。地方病人59例，其中HA32．20％，HB40．68％，HC18．64％，混合感染8．47％。甲肝主要与肝炎接触史（OR＝5．95）、不洁饮食史（OR＝6．06）、出差旅游史（OR＝5．15）有关。乙肝主要与肝炎接触史（OR＝5．50），家庭成员既往肝炎史（OR＝4．20）有关。丙肝与肝炎接触史（OR＝8．33），输血史（OR＝3．75）有关。结论：病毒性肝炎的预防，部队人群应以甲肝为主，地方人群应以乙肝为主。     

河北地区TT病毒感染与不同型别病毒性肝病的关系

目的分析健康人群及肝病患者TTV感染状况。方法采用TTV（N22）区核苷酸序列设计引物，建立半巢式聚合酶链反应（Semi—nested PCR）方法，对309例7种不同人群血清检测TTV DNA。结果TTV在非甲一非戊型肝炎、肝硬化患者、丙型肝炎、急性甲型肝炎、急性乙型肝炎、慢性乙型肝炎和健康人群中感染率分别为75．00％（15／20）、75．00％（27／36）、61．90％（13/21）、58．06％（18／31）、52．78％（38／72）、45．61％（26／57）和38．89％（28／72）。肝硬化患者及非甲非戊型肝炎感染率明显高于健康人群（P〈0．01），也明显高于急、慢性乙型肝炎患者（P〈0．05）。21～30岁年龄组TTV感染率（39．06％）显著低于51～60岁年龄组感染率（68．75％）（P〈0．01），其他年龄间无差异。急性甲型肝炎、急性乙型肝炎和慢性乙型肝炎与丙型肝炎之间无统计学意义，性别之间亦无统计学意义。结论TTV在河北地区健康人群及肝病患者中有较高的感染率，TTV感染与不明原因ALT升高有一定的关系。     

病毒性肝炎检测血清G反应蛋白的临床意义

病毒性肝炎是常见病,临床上通过检测血清乙肝五项指标,肝功能及Ｇ反应蛋白（ＣＲＰ）,可了解肝炎的活动程度,其中,ＣＲＰ对患者的预后估计有一定的意义。本文共检测８０例各型病毒性肝炎ＣＲＰ,结果报告如下。１　资料与方法１－１　临床资料：８０例肝炎病例,３０例无症状ＨＢｓＡｇ携带者共１１０例中男６０例,女５０例,平均年龄３２－６岁;急性病毒性肝炎（急肝）３０例、慢性迁延肝炎（慢迁肝）２０例、慢性活动性肝炎（慢活肝）２０例、重症肝炎（重肝）１０例,均按１９９０年上海会议肝炎分型诊断标准,并排除其它急、慢性…     

宁波地区HGV RNA检测及分析

1995年，Simons等[1]率先报道了度型肝炎病毒（HepatitisGVirus，HGV）。目前国内有关庚型肝炎的报道尚不多。为了解宁波地区是否存在庚型肝炎病毒感染，我们对194例各型病毒性肝炎患者进行了庚型肝炎病毒基因组（HGV－RNA）检测，现将结果报告如下。1对象和方法1·1对象1996年6月～1997年3月分别收集我院住院和门诊病人的血清194份；其中男113例，女81例；年龄10～63岁，平均35．3岁；急性肝炎41例，慢性肝炎99例，（其中轻度40例、中度31例、重度28例），重症肝炎9例，肝炎后肝硬化45例；按肝炎病原学分型，计甲型22例．乙型96例，…     

浙东地区乙型肝炎病毒基因型分布及临床意义

目的：了解浙江东部地区乙型肝炎病毒（HBV）基因型的分布、优势型及其与临床的相关性。方法：选择浙江东部地区HBVDNA阳性的HBV感染者100例，应用基因芯片对其进行基因分型，其中对7例优势基因型进行S基因序列同源性测序复核。结果：100例HBV阳性的血清标本分型率为96．0％，其中B基因型36例（36．0％），C基因型47例（47．0％），BC混合基因型11例（11．0％）及BCD混合基因型2例（2．0％），未分出型的4例（4．0％）。基因芯片分型与S基因序列同源性测序分型结果一致，乙型肝炎感染者检出的基因型以C、B型为主；重型肝炎与肝癌组中c型检出率分别为60％和55％，明显高于其他基因型（P〈0．05），C、B基因型与HBVDNA拷贝数、丙氨酸氨基转移酶水平及总胆红素在统计学上无显著差异（P〉0．05）。结论：HBV的基因型存在地区性差异，浙江东部地区的优势基因型为c、B型，与以往报道的结论不太一致。不同临床肝炎型与基因型存在一定的相关性，主要表现为重型肝炎和肝癌患者检出的基因型多为C型，提示C基因型患者预后较差。基因芯片分型方法可应用于HBV基因的分型，方便、快速。     

Blood-lead levels in patients with chronic liver diseases

Blood-lead concentrations (Pb-B) were measured in 318 adult inpatients with chronic liver diseases. The Pb-B was highest (387 +/- 96 micrograms/l) in 102 patients with alcoholic liver disease without cirrhosis. The Pb-B was still high, but significantly lower in 60 patients with compensated alcoholic cirrhosis (342 +/- 100 micrograms/l) and in 72 patients with decompensated alcoholic cirrhosis (312 +/- 97 micrograms/l). This difference was in part due to a significant decrease of the hematocrit which fell from 44.4 +/- 4.9% to 42.4 +/- 27.2% and to 39.2 +/- 7.4% respectively. In patients with viral or cryptogenic liver diseases the Pb-B was 211 +/- 69 micrograms/l in 11 patients with chronic persistent hepatitis, 219 +/- 72 micrograms/l in 19 with chronic active hepatitis, 206 +/- 94 micrograms/l in 28 with compensated cirrhosis, and 226 +/- 98 micrograms/l in 26 with decompensated cirrhosis, without any significant difference. The Pb-B of the male patients showed no correlation to age, with the exception of 25 male patients with chronic persistent and active hepatitis (r = 0.626, P less than 0.001).     

血清IL-2、sIL-2R在病毒性肝炎中的意义

为评估血清白细胞介素-2（IL-2）及可溶性白细胞介素-2受体（sIL-2R）在病毒性肝炎中的意义．对39例急性肝炎（AH）,57例慢性乙型肝炎（CHB）受试对象和健康献血员对照组,分别采用放射免疫测定法和双抗体夹心ELISA法检测其血清IL-2和sIL-2R,结果显示AH和CH-B,患者血清中IL-2水平分别为7．2±4.0ng／ml和7．3±5．2ng／ml,均明显低于对照组（P＜0．01）,而sIL-2R水平分别为417．5±165.1u／ml和402．8±136．1u／ml,均明显高于对照组（P＜0．01）。因此,我们认为血清IL-2和sIL-2R水平与病毒性肝炎病人的免疫功能和临床经过相关。     

Endogenous serum interferon-alpha in patients with chronic hepatitis B virus infection

Serum endogenous interferon-alpha was determined in 42 patients with chronic hepatitis B virus infection by radioimmunoassay using an Abbott kit (USA). The study sample included 26 males and 16 females, aged 3 to 59 years (mean, 30.1). Ten of these patients had a history of acute viral hepatitis B carrying HBsAg for more than 6 months. Thirty two patients were accidentally found to be virus carriers for 8 months to 15 years. Six of these were treated with interferon-alpha and one with Ursofalk. Forty one patients (97.62% +/- 2.38) were anti-HBcIgG positive which confirmed former hepatitis B virus infection. Only one patient who was anti-HBcIgG positive was found to be also anti-HBcIgG positive, anti-HBcIgM positive, HBeAg negative, and anti-HBe positive later biophysically verified as exacerbated chronic active hepatitis. Serum HBeAg was detected in 13 of the whole sample (30.95% +/- 7.13); 8 patients (32% +/- 9.33) were HBV-DNA positive, i.e., a third of the cases presented with active replication of the hepatitis B virus. In all 42 patients with chronic hepatitis B virus infection (convalescence and health HBsAg carriers) serum interferon-alpha levels were nil or close to nil. Only in the patient with chronic active hepatitis the serum interferon level was 3.83 IU/ml. These data support the observations that interferon-alpha production is reduced in chronic hepatitis B virus infection and are consistent with the view that treatment with exogenous interferon-alpha stimulates the clearance of the virus.     

慢性病毒性肝炎临床病理研究(附81例报告)

目的 探讨研究慢性病毒性肝炎临床与病理诊断上的一些问题。方法 对1990年以来收治的8l例慢性病毒性肝炎患进行了较系统地回顾性分析、总结。结果 8l例病例中，我们发现大多数病例的临床与病理诊断相符，但在部分病例，临床与病理诊断出入较大。结论 在慢性肝炎的鉴别诊断上，尤其是临床较轻微的慢性活动性肝炎与慢性迁延性肝炎的鉴别，需要详尽地从临床、生化、病理等多方面综合分析，方能做出正确诊断。     

肝病患者血清HA、PⅢNP、LN、Ⅳ-Col水平与临床分型的关系

目的初步评价肝病患者血清4项指标透明质酸(HA)、层黏蛋白(LN)、Ⅲ型前胶原N端肽(PⅢNP)、ⅣC型前胶原含量(Ⅳ-Col)与慢性化及临床分型的关系。方法对145例肝病患者采用化学发光法测定血清中HA、PCⅢ、LN、Ⅳ-Col水平,比较这4项指标与临床分型的相关性。结果血清HA、PⅢNP、LN、Ⅳ-Col水平含量随着病程的进展有逐步升高的趋势,即急性肝炎慢肝轻度慢肝中度慢肝重度肝硬化。结论血清中HA、PⅢNP、LN、Ⅳ-Col水平可反映肝病慢性化趋势,与临床一致,是判断早期肝硬化的相对灵敏和可靠指标。     

温岭市病毒性肝炎的病原学与临床类型

了解温岭市散发性病毒性肝炎的病原和临床特征,为制定科学的预防措施提供依据。方法对2000年1月至2009年12月在温州医学院附属温岭医院住院的3317例病毒性肝炎患者资料进行回顾性分析。结果在3317例患者中,甲、乙、丙、丁、戊、庚型病毒性肝炎分别占1.63％、64.97％、0.66％、0.12％、9.52％、0.06...     

妊娠期肝病分布特征与产科结局

[目的]了解妊娠期肝病的病因、临床类型的分布特征和产科结局。[方法]对903例妊娠期肝病中属病毒性肝炎的病因构成及临床类型构成、妊娠期特有肝病类型构成、妊娠期肝病的产后结局进行统计分析。[结果]903病例中,妊娠期合并病毒性肝炎672例,占74.4%;妊娠期特有的肝病231例,占25.6%。妊娠期合并病毒性肝炎的病因以乙型肝炎最多见,占59.2%,乙型肝炎病毒携带状态占18.9%。妊娠期合并病毒性肝炎的临床类型以慢性肝炎最常见,占42.9%。妊娠期特有肝病的类型以妊娠期肝内胆汁淤积症(ICP)最多见。急性肝炎围生儿死亡率、新生儿窒息率和早产率分别为2.3%、29.3%和24.8%,慢性肝炎分别为3.1%、17.8%和19.9%。ICP围生儿死亡率、新生儿窒息率和早产率分别为0.00%、17.8%和20.0%,妊娠期合并重症肝病对产妇病死率的影响不大于非孕妇。[结论]妊娠期病毒性肝炎病因以乙型肝炎多见,临床类型以慢性肝炎多见;妊娠期特有肝病以ICP多见。妊娠期肝病对围生儿死亡率、新生儿窒息率和早产率有影响,但妊娠和分娩对妊娠期肝病无显著影响。     

Impact of HBV genotypes A and D genetic variability on infection evolution

HBV is characterized by a high genetic variability, which is the basis of its classification into eight genotypes (A–H). HBV infection is associated with different outcomes, from self-limiting acute hepatitis to active chronic hepatitis, asymptomatic carriage, and occult infection.The aim of this study was to analyze the genetic variability of HBV genotypes A and D isolates from 79 cases of self-limiting acute hepatitis and chronic hepatitis, in order to identify HBV variants associated with resolution or chronicity of acute HBV infection. The entire preS–S sequence and a fragment of 346 bp of the preC–C region, containing Enhancer II and Basal Core Promoter sequences, were analyzed. A phylogenetic analysis of preS/S region showed that the 45.45% (15/33) of isolates from acute hepatitis cases were genotype A compared to 8.69% (4/46) of chronic hepatitis cases. (p = 0.0002). Mutations associated with immune-escape (T131N, D144A/E, G145K), amino acid polymorphisms in “a determinant” domain of S protein and mutations/deletions in preC/C region were found in isolates from acute and chronic hepatitis B cases. In this study mutations/deletions in preS–S and preC–C regions, usually associated with fulminant acute hepatitis, advanced forms of liver disease and increased risk for HCC, were identified in HBV strains of genotype A and D obtained both from patients with self-limiting acute HBV infection and from persistent infected patients. This founding probably is due to the natural viral evolution under host immune response and to the circulation of a wide variety of HBV strains in our geographic area because of the ancient introduction of genotype D and the migrant fluxes from North Africa. Moreover, the analysis of circulation of new HBV antigenic variants is fundamental for the epidemiological surveys and for the evaluation of the impact of viral evolution on vaccine prophylaxis strategies.     

Viral hepatitis in the US Navy, 1975-1984

The epidemiology of viral hepatitis in US Navy enlisted personnel was reviewed for the years 1975-1984. Hospital discharge summaries of all active duty enlisted personnel admitted to a US Navy treatment facility were used for the study. From 1975 to 1984, total first hospitalizations for viral hepatitis declined from 128 per 100,000 personnel (95% confidence interval (Cl) 118-139) to 56 per 100,000 personnel (95% Cl 50-63). The highest incidence of acute viral hepatitis (115 per 100,000 personnel) was found in the youngest age groups aged 24 years and less. Risk factors for acute hepatitis included a previous hospitalization with either drug abuse (relative risk = 363) or a sexually transmitted disease (relative risk = 25) listed among the discharge diagnoses. Having a medical job classification was also associated with an increased risk of acute hepatitis. The steep decline in the incidence of viral hepatitis during this 10-year period may have been due to decreasing drug abuse in the US Navy. Immunization of high-risk groups in the US Navy with hepatitis B vaccine could be an effective policy for the prevention of acute viral hepatitis.     

Clinical significance of serum HBeAg and HBV-DNA-specific values of virus replication in chronic hepatitis-B virus infection.

The prevalence of serum HBV-DNA and that of HBeAg was evaluated in 44 subjects (27 males and 17 females) aged between 3 and 59 years. They were divided in two groups: (A) chronic asymptomatic HBsAg carriers; and (B) chronic HBsAg carriers with a history of HBV infection. The patients had been chronic HBV carriers between 8 months and 15 years. All underwent clinical and biochemical evaluation. The serological markers of HBV infection were tested using ABBOTT assay kits. The serum HBV-DNA was quantified using a hemiluminiscence molecular hybridization assay (Digene-Murex). HBV-DNA+ were 13 patients (29.55 +/- 6.88%). The highest level of viral replication (up to 50%) was measured in the patients aged from 3 to 29 years while in the others a 3 to 4-fold decrease of the viral replication was detected. HBV-DNA+ were 8 (23.53 +/- 6.39%) of the chronic asymptomatic hepatitis B carriers and 5 (50.00 +/- 7.5%) of the chronic HBV carriers with former acute hepatitis B infection. Similar results were obtained for the other index of viral replication--HBeAg/anti-HBe. Eight (23.53 +/- 6.39%) patients from group I and 4 (40.00 +/- 7.38%) patients from group II were HBeAg+ while anti-HBe+ were 26 (76.47 +/- 6.39%) and 6 (60.00 +/- 7.38%) patients from group I and II, respectively, i.e., about a quarter of the chronic asymptomatic HBsAg carriers and half of the chronic HBV carriers that had had an acute hepatitis B virus infection had HBV replication in their bodies. HBeAg+ patients had high levels of serum HBV-DNA (625.70-3328.00 pg/ml) which indicated extremely intensive viral replication. The presence of HBeAg and especially of HBV-DNA as markers of viral replication in chronic asymptomatic HBsAg carriers and chronic HBsAg carriers with a prior acute hepatitis B virus infection provide important information for the clinical decisions.