Chronic hepatitis B infection in Singapore.

Four hundred and four patients (273 men, 131 women) aged 3 to 85 years with chronic Hepatitis B virus (HBV) infection seen during a five year period were analysed. At presentation, 177 patients (44%) were Hepatitis B e Antigen (HBeAg) positive (mean age 32 years) and 217 patients (54%) were anti-HBe-positive (mean age 40 years). Ten patients (2%) were negative for HBeAg and anti-HBe. Serum HBV-DNA was detected in 169 patients (42%). 85% of the HBeAg-positive patients had detectable serum HBV-DNA and 9% of the HBeAg-negative patients were positive for serum HBV-DNA. The mean serum Alanine amino-transferase (ALT) and Aspartate amino-transferase (AST) levels were higher in HBeAg-positive patients (75 and 52 iu/l) than in HBeAg negative patients (46 and 37 iu/l) (P less than 0.001). Liver biopsies were performed in 135 patients. Fifty-three (39%) had minimal changes, 61 (45%) chronic hepatitis (CPH, CLH & CAH) and 21 (16%) cirrhosis. There was no significant difference in the histologic distribution between HBeAg-positive and HBeAg-negative groups. Two hundred and fifty eight patients were followed up for a mean duration of 2 years (range 3 to 108 months). The cumulative probability of clearing HBeAg at the end of the first, second and third year were 14%, 16% and 18% respectively. Of these, the cumulative probability of developing anti-HBe over one, two and three years were 8%, 9% and 11% respectively. Reversion to HBeAg occurred in 1.5% of patients who were HBeAg-negative at presentation and 11% of HBeAg-positive patients who cleared HBeAg.(ABSTRACT TRUNCATED AT 250 WORDS)     

HDV (delta factor) infection complicated with subacute fulminant hepatitis B. A morphological and immunohistochemical observation.

In 75 patients with subacute fulminant hepatitis B (SAFH), HDAg positive liver cells were observed in 14 cases (18.67%) by direct enzyme labelled method. It was found further that HDV (delta factor) infection was an important cause in producing massive necrosis of liver cells and superinfection of HDV with hepatitis B was identified as one of the causes of SAFH. This experiment also showed that the number of HDAg positive cells was in direct proportion to the area of liver necrosis. No obvious lymphocytic infiltrations and cytotoxic phenomena around the necrotic foci and HDAg positive cells could be found, while the cytoplasmic type HDAg positive cells showed distinct degeneration or even atrophy. Hence it was suggested that HDV could be a direct pathogenesis. No obvious characteristic changes in morphology of HDV infection could be found.

     

慢性肝病与乙、丙型肝炎病毒感染关系的探讨

目的　探讨慢性肝病与乙、丙型肝炎病毒感染的关系。方法　EIA法检测HBV感染指标 (两对半系统 )及抗HCV ;PCR法检测HBVDNA ,反转PCR法检测HCVRNA。结果　 32 8例慢性肝病患者中 ,HBV感染率明显高于HCV感染率 (P <0 .0 5 ) ,肝癌患者中HBV、HCV重叠感染率明显高于慢性肝炎组 (P <0 .0 5 )。结论　本地区慢性肝病仍以HBV感染为主 ;HBV、HCV重叠感染对肝癌的发生似有相加作用。     

乙型病毒性肝炎感染率调查

<正>慢性乙型肝炎我国是常见的慢性传染病之一,严重危害人民的健康。我国是乙型病毒性肝炎的高发区域,全国大约有1.2亿以上的人群为乙型肝炎病毒携带者。     

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.     

慢性乙型肝炎病毒感染者血清乙型肝炎病毒核酸相关抗原检测的应用价值

目的探讨慢性乙型肝炎病毒(HBV)感染者血清乙型肝炎病毒核酸相关抗原(HBV NR Ag)检测的临床应用价值。方法选择慢性HBV感染者292例,男性158例,女性134例,空腹采集静脉血。采用酶联免疫吸附试验(ELISA)检测受试者血清HBV NR Ag及前S1抗原(PreS1Ag);化学发光法检测乙型肝炎标志物[HBV表面抗原(HBsAg)、HBV表面抗体(HBsAb)、HBVe抗原(HBeAg)、HBVe抗体(HBeAb)、HBV核心抗体(HBcAb)]含量;实时荧光定量聚合酶链反应(PCR)技术检测HBV-DNA含量;检测患者肝功能指标[丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)、总蛋白(TP)、白蛋白(Alb)]。结果 292例慢性HBV感染者中,HBV-DNA阳性患者181例。HBV-DNA阳性患者中HBV NR Ag、HBeAg、PreS1Ag阳性率分别为96.7%、45.3%、73.5%。无论HBeAg和HBeAb是否阳性,HBV DNA与HBV NR Ag阳性率差异均无统计学意义(P均>0.05)。HBV NR Ag的表达与HBV-DNA拷贝数呈正相关(r=0.915 5,P<0.05)。HBV NR Ag阳性患者的ALT、AST水平明显高于HBV NR Ag阴性患者(P<0.05)。结论HBV NR Ag与病毒复制有关,与HBV-DNA水平高度相关,并参与对肝细胞的损伤,是监测HBV复制和抗病毒疗效的一种新指标。     

Chronic hepatitis B in hepatocarcinogenesis

Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world, and has a wide geographical variation. Eighty per cent of HCC is attributed to hepatitis B virus (HBV). The predominant carcinogenic mechanism of HBV associated HCC is through the process of liver cirrhosis, but direct oncogenic effects of HBV may also contribute. Prevention of HBV infections as well as effective treatment of chronic hepatitis B is still needed for the global control of HBV associated HCC. Continued investigation of the mechanisms of hepatocarcinogenesis will refine our current understanding of the molecular and cellular basis for neoplastic transformation in the liver.     

Prevalence of hepatitis delta virus infection in Malaysia

The prevalence of coinfection, superinfection and chronic infection with the hepatitis delta virus (HDV) was studied in 324 hepatitis B surface antigen (HBsAg)-positive Malaysians. Of these, 10.0% (5/50) had coinfection, 5.7% (11/194) had superinfection, but none of the 80 patients with chronic liver disease (CLD) or primary hepatocellular carcinoma (PHC) had chronic infection with HDV. The overall HDV infection was 4.9% (16/324). One of the coinfection cases acquired the HDV infection as early as 1982. HDV superinfection was detected mainly among IV drug abusers (20% or 7/35) and promiscuous males and females (13.6% or 3/22). They were all asymptomatic. Only 0.8% (1/125) apparently healthy blood donors was infected with HDV. None of the 12 multi-transfused patients examined were positive. Malaysia is the only Southeast Asian country examined so far in which HDV infection was detected. The reason could be that the IV drug abusers and the sexually promiscuous groups missed being examined in the other countries. Comparing the HDV infection rates in 4 categories of infected Malaysians (viz. acute hepatitis B patients, IV drug abusers, blood donors and CLD patients) with those of other countries, it was noted that the Malaysian rates were similar to the lowest in the range of prevalence rates of each category in the latter group. The rate of coinfection in a preliminary study in 1982-84 (9.0% or 1/11) was not very different from that obtained to date (10.0% or 5/50).(ABSTRACT TRUNCATED AT 250 WORDS)     

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。     

人抗乙肝特异转移因子治疗慢性乙肝27例临床观察

目的：探索慢性乙型肝炎（简称慢乙肝）的免疫调节治疗。方法：用乙型肝炎病毒（HBV）疫苗多次免疫健康的供血员，使之产生强的免疫应答，然后分离白细胞，从中提取转移因子（暂称“人抗乙肝特异转移因子”或“乙型肝炎高度特异转移因子”，HSTF）。先后二次进行临床观察，治疗组27例慢性乙肝患才HSTF治疗，对照组15例慢性乙肝患才乙肝胎盘肽（PSTF）治疗，结果：HBeAg阴转治疗组为14／27例，对照组为2／15例（P＜0．05);HBsAg阴转治疗组为4／27，对照组为0／15例，两次应用HSTF过程中，未发现不良反应。结论：初步的临床研究表明，HSTF不仅能改善慢乙肝患的临床症状，还能改善患体内的乙肝病毒标记物（HBVM），其疗效高于PSTF，能达到与单独应用干扰能（rIFN α2b）类似的疗效；本疗法疗程短，费用低，未见不良反应，在目前对HBV缺乏特效抗病毒药的情况下，HSTF有临床应用价值，值得进一步研究。     

维持性血液透析患者乙肝病毒感染及乙肝疫苗接种现状分析

目的调查维持性血液透析患者乙型病毒性肝炎的感染现状以及乙肝疫苗的接种情况。方法纳入2009年1月~2013年5月间河北省秦皇岛市北京军区北戴河二八一医院维持性血液透析患者601例(血透组),同时选取健康体检者938人作为对照组。采用酶联免疫吸附法(ELISA)检测乙肝表面抗原(HBsAg)、乙肝表面抗体(HBsAb)、乙肝e抗原(HBeAg)、乙肝e抗体(HBeAb)、乙肝核心抗体(HBcAb),并问卷调查乙肝疫苗接种情况。结果血透组和对照组五项指标的阳性率除HBeAg外差异均有统计学意义(P<0.05)。乙肝病毒感染率(HBsAb单独阳性除外)血透组和对照组分别为5.16%和1.81%,二组间差异有统计学意义(P<0.05)。血透组接种过乙肝疫苗的有174人(29.0%),其中101人(58.0%)HBsAb阳性,其余阴性。对照组接种过乙肝疫苗的有287人(30.6%),其中206人(71.8%)HBsAb阳性。未接种的原因主要是认为注意卫生就没必要接种或怀疑免疫效果。结论应加强医源性感染的控制以及积极推广乙肝疫苗接种,以减少维持性血液透析患者的乙肝病毒感染率。     

不明原因肝炎患者隐匿性乙型肝炎病毒感染检测分析

目的探讨不明原因肝炎患者隐匿性乙型肝炎病毒（HBV）感染情况及隐匿性感染的机制。方法采用巢式聚合酶链反应（PCR）检测103例不明原因肝炎患者血清HBVDNA。用电化学发光免疫技术对检测出的隐匿性HBV感染者血清HBsAg进行定量测定。结果隐匿性乙型肝炎病毒感染率为17．5％。电化学发光免疫技术检测隐匿匿性HBV感染者血清HBsAg,未检出有3例,在0．05～0．1ng／ml有8例,0．1～0．5ng／ml有6例,3．5ng／ml有1例。隐匿性HBV感染者血清HBVDNA水平为10^3～10^6copies／ml。结论隐匿性HBV感染是不明原因肝炎的病因之一。隐匿性HBV感染者血清HBsAg阴性的机制主要是HBV复制和基因表达的严重抑制,以及HBV基因突变。