丁型肝炎病人肝组织HDVRNA与 HBVDNA的表达及关系

目的 探讨丁型肝炎病人肝组织中ＨＤＡｇ、ＨＤＶＲＮＡ与ＨＢＶＤＮＡＧ表达及关系。方法 应用免疫组化和原位杂交技术检测了７９全丁型肝炎病人肝组织ＨＤＡｇ、ＨＤＶＲＡＮ～ＨＢＶＤＮＡ表达,以５２例型肝炎病人肝组织作对照。结果 丁型肝炎ＨＢＶＤＮＡ检出率（２７％）低于乙型肝炎（４４％）（Ｐ〈０．０５）。在坏死灶边缘肝细胞和气球样变肝细胞浆内有大量的ＨＤＶＲＮＡ蓄积或ＨＤＡｇ呈强型强表达,ＨＤＶＲＮＡ表达     

HBV感染与IgA肾病肾小管间质病变的关系

目的探讨ＩｇＡ肾病ＨＢＶ感染与肾小管间质病变的关系。方法利用原位分子杂交（ＨＢＶＤＮＡ）、免疫组化（ＨＢＡｇ、ＣＤ３、ＣＤ８）以及ＨＢＶＤＮＡＨＢＡｇ和ＨＢＡｇＣＤ４３双标记技术，对９１例ＩｇＡ肾病肾穿刺标本进行研究。结果肾组织内ＨＢＡｇ阳性率为６９．２％。ＨＢＶＤＮＡ原位杂交阳性率为４２９％。ＨＢＶＤＮＡ阳性的病例，双重标记染色发现ＨＢＶＤＮＡ阳性的肾小管上皮细胞可表达ＨＢｃＡｇ或／和ＨＢｓＡｇ。ＨＢＶ感染标记（ＨＢＶＤＮＡ、ＨＢｃＡｇ、ＨＢｓＡｇ）阳性组ＣＤ３阳性细胞和ＣＤ８阳性细胞数明显高于阴性组（Ｐ＜００１），并可见数量不等的Ｔ淋巴细胞入侵ＨＢｃＡｇ及ＨＢｓＡｇ阳性肾小管管壁或围绕其周围。结论感染ＨＢＶ的肾组织细胞能够表达ＨＢＡｇ，并诱导ＣＤ３阳性细胞和ＣＤ８阳性细胞浸润，从而加重肾小管、间质损害。ＨＢＶ感染对ＩｇＡ肾病的发生发展可能起着重要作用     

用聚合酶链反应检测人肝细胞癌乙型肝炎病毒DNA和丙型肝炎病毒RNA

为研究乙型肝炎病毒ＤＮＡ（ＨＢＶＤＮＡ）和丙型肝炎病毒ＲＮＡ（ＨＣＶＤＮＡ）与肝细胞癌的关系，用聚合酶链反应（ＰＣＲ）和巢式ＰＣＲ（ｎｅｓｔｅｄ－ＰＣＲ）分别检测４２例肝肿瘤组织中ＨＢＶＤＮＡ和ＨＣＶＲＮＡ。结果：１例胆管细胞癌组织ＨＢＶＤＮＡ和ＨＣＶＲＮＡ均阳性，１例胆管囊腺瘤ＨＢＶＤＮＡ阳性。４０例肝细胞癌组织中，单纯ＨＢＶＤＮＡ阳性１９例，单纯ＨＣＶＲＮＡ阳性３例，二者均阳性１０例。ＨＢＶＤＮＡ阳性率７２．５％，ＨＣＶＲＮＡ阳性率３２．５％。ＨＢＶＤＮＡ和ＨＣＶＲＮＡ感染与肝癌组织学分型无关；且肝细胞癌中ＨＣＶ感染与ＨＢＶ未见相关。结果提示，我国ＨＢＶ感染仍是引起肝细胞癌的主要原因。但由于肝细胞癌患者中ＨＣＶ的感染率也较高，且有上升趋势，因此ＨＣＶ可能也是肝细胞癌发生的重要原因之一。     

丁型病毒性肝炎的原位分子杂交及免疫组化研究

利用原位分子杂交和免疫组化方法对１４２例乙型肝炎活检肝组织进行丁型肝炎病毒ＲＮＡ及其抗原的定位研究。２８／１４２例丁型肝炎病毒标记阳性。其中慢性重症型６例；慢性活动性１７例；慢性持续性５例。慢性活动性乙肝重叠丁型肝炎病毒感染组发生早期肝硬变的比例明显高于无重叠感染组（Ｐ＜０．０５）。２８例丁型肝炎病毒感染肝组织１９例ＨＢｃＡｇ阳性，并以核浆型为主，提示活动性ＨＢＶ复制与ＨＤＶ感染的正相关性，两者相加作用导致肝损害加重并加速发展为肝纤维化。ＨＤＶＲＮＡ在肝细胞内大量蓄积，ＨＤＡｇ在碎屑状坏死边缘肝细胞或气球样变肝细胞内呈浆膜型分布，提示ＨＤＶ直接细胞毒在丁型肝炎发病学中的作用。     

成年树鼩实验感染丁型肝炎病毒的初步研究

在证实成年树可感染人乙型肝炎病毒（ＨＢＶ）的基础上，进行了丁型肝炎病毒－乙型肝炎病毒（ＨＤＶ／ＨＢＶ）实验感染的探索。ＨＤＶ／ＨＢＶ阳性人血清经同时和重叠感染方式接种于成年树后，定期留取感染树血清及肝组织，检测血清中ＨＢｓＡｇ、ＨＤＡｇ、抗－ＨＤ、ＨＢＶＤＮＡ及ＨＤＶＲＮＡ，初步探讨成年树实验感染ＨＤＶ的可能性。研究发现：①成年树对人ＨＢＶ易感，ＨＢｓＡｇ阳性率为７５％，其血清学反应及肝组织病理改变与文献报道一致；②ＨＤＶ可通过同时和重叠两种方式感染成年树，感染树血清中可出现ＨＤＡｇ及抗－ＨＤ，经分子杂交证实其血清及肝内均有ＨＤＶＲＮＡ和ＨＢＶＤＮＡ存在，且可导致明显的肝细胞损伤。结果提示：成年树既可感染人ＨＢＶ也可感染ＨＤＶ，可作为研究ＨＤＶ人工感染的实验动物；成年树感染ＨＤＶ后的特点与人及黑猩猩感染时十分相似，能较好地反映人丁型肝炎的真实情况。     

52 例病毒性肝炎患者肝组织中丙型肝炎病毒 RNA 和 HCAg-NS3 的测定

应用地高辛标记探针原位杂交法和单克隆抗ＨＣＶ－ＮＳ３－ＨＲＰ建立直接酶标免疫组化法分别测定５２例肝炎患者肝组织ＨＣＶＲＮＡ和ＨＣＡｇ－ＮＳ３。结果抗ＨＣＶ阳性组ＨＣＶＲＮＡ检出率５７．１％（１６／２８），ＨＣＡｇ－ＮＳ３检出率５３．６％（１５／２８）；抗ＨＣＶ阴性组其两项检出率均为１２．５％（３／２４）。肝组织中ＨＣＶＲＮＡ阳性物呈蓝紫色细小颗粒存在于肝细胞核或胞浆内，其在肝小叶中的分布可分为３型，即弥漫型、局灶型、散在型。肝组织中ＨＣＡｇ－ＮＳ３阳性物呈棕黄色细小颗粒分布于肝细胞核或胞浆内，以单个或数个阳性细胞散布于肝小叶中。２３例ＨＣＶＲＮＡ或／和ＨＣＡｇ－ＮＳ３阳性病例以肝炎后肝硬化（ＬＣ）病例占多数（１４／２３），其次为慢性重型肝炎（ＣＳＨ）和中度慢性肝炎（ＣＡＨ）。此两种检测方法具有较高符合率（９０．４％，４７／５２），表明病毒核酸及其表达产物均存在于肝细胞内，与ＨＣＶ感染密切相关。这为ＨＣＶ感染诊断提供了直接依据，有利于研究ＨＣＶ感染中病毒复制、慢性化进程、抗病毒治疗监测及重叠感染时病毒相互关系。     

应用聚合酶链反应技术检测肝组织中的HBV－DNA

采用聚合酶链反应（ＰＣＲ）技术，对４２例肝活切组织石蜡切片中乙型肝炎病毒（ＨＢＶ）ＤＮＡ进行检测，并与乙肝表面抗原（ＨＢｓＡｇ）的免疫组织化学及血清学检测进行比较，ＨＢＶ－ＰＣＲ阳性率为７３．８％，高于组织及血清ＨＢｓＡｇ阳性率（分别为５９．５％和５０．０％）。３例病理形态呈肝炎改变，而血清ＨＢｓＡｇ（─）的肝组织中有２例检出ＨＢＶ－ＤＮＡ，提示ＰＣＲ的高度敏感性和准确性。８３．３％的门脉性肝硬变和８７．５％的肝细胞癌组织中ＨＢＶ－ＰＣＲ呈阳性，进一步证实了上述两病与ＨＢＶ的关系密切。我们还发现肝细胞淤胆患者ＨＢＶ感染率较高，ＨＢＶ－ＤＮＡ及组织ＨＢｓＡｇ阳性比例各为６／９和４／８。     

慢性乙型肝炎肝内HBVDNA和HBsAg的双标记定位研究

应用原位杂交和免疫组化ＰＡＰ法双标记技术，结合病人乙型肝炎（乙肝）病毒血清学标志物检测结果，研究了３１例慢性乙肝病人肝穿刺组织中乙型肝炎病毒ＤＡＮ和ＨＢｓＡｇ的分布及意义。结果显示，肝辔内检ＨＶＤＮＡ２３例，ＨＢｓＡｇ２６例，二者同时检出者２１例。从同组病人肝组织的ＨＢＶＤＮＡ和ＨＢｓＡｇ双标检测结果与其乙肝病毒血清学标志物检测结果的比较来看，肝组织内ＨＢＶＤＮＡ和ＨＢｓＡｇ同时很可能表明ＨＢＶ正     

HBV感染与IgA肾病肾小管-间质病变的关系

目的 探讨ＩｇＡ肾病ＨＢＶ感染与肾小管间质病变的关系。方法 利用原位分子杂交（ＧＨＢＶ ＤＮＡ）、免疫组化（ＨＢＡｇ、ＣＤ３、ＣＤ８）以及ＨＢＶ ＤＮＡ－ＨＢＡｇ和ＨＢＡｇ－ＣＤ４３双标记技术,对９１例ＩｇＡ肾病肾穿刺标本进行研究。结果 肾组织内ＨＢＡｇ阳性率为６９．２％。ＨＢＶ ＤＮＡ原位杂交阳性率为４２．９％。ＨＢＶ ＤＮＡ阳性的病例,双重标记染色发现ＨＢＶ ＤＮＡ阳性肾小管上皮细胞可表达ＨＢ     

重型病毒性肝炎中丁型肝炎病毒的检测

为了探讨丁型肝炎病毒（ＨＤＶ）感染在重型病毒性肝炎中的作用，对北京佑安医院１９８０年至１９８９年收治的５４例急性和亚急性重型肝炎和３８例急性乙肝患者血清，应用国产ＨＤＶＥＬＩＳＡ试剂测定抗－ＨＤ、抗－ＨＤＩｇＭ和ＨＤＡｇ，应用斑点杂交技术测定ＨＤＶＲＮＡ。结果发现重型肝炎组ＨＯＶ－Ｍ检出率明显高于急性乙肝组（２７．８％比５．３％．Ｐ＜０．０５）。单独ＨＢＶ感染和ＨＤＶ／ＨＢＶ混合感染的重型肝炎患者均有较高的病死率。提示ＨＤＶ感染是重型肝炎中重要的病原学因素之一，ＨＤＶ与ＨＢＶ具有协同作用加重肝损害，导致肝衰竭。     

乙型肝炎病毒感染者血清中丁型肝炎病毒标志物检测分析

目的 了解丁型肝炎病毒(hepatitis delta virus,HDV)感染标志物在乙型肝炎病毒(hepatitis B virus,HBV)感染者中的分布状况并分析其临床意义.方法 收集HBV感染者的临床资料和血清样本,通过酶联免疫分析法检测其血清HBV感染五项指标、HDVAg和Anti-HDV,结合临床诊断和生化指标进行分析.结果 收集HBV感染者样本462例,其中无症状携带者210例,慢性肝炎175例,急性乙肝35例,肝纤维化42例,检出HDV感染率为4.8％,男性显著高于女性,肝纤维化组的HDV感染率最高,为9.5％,其次为慢性肝炎的6.9％,45～60岁人群的HDV感染率为7.8％,显著高于其他年龄段.结论 慢性乙肝和肝纤维化病例的HDV感染显著增高,提示HDV感染与肝病的严重程度相关,建议对肝病患者开展血清HDV感染标志物检查,鉴别是否存在HDV重叠感染.     

分子杂交法研究肝炎病人血清和肝组织中输血传播病毒

目的 对各型肝炎病人血清和肝组织中输血传播病毒（TTV）核酸检测分析,探讨病毒的致病性。方法 以地高辛为标记物制备TTV DNA探针,斑点杂交法、原位杂交法分别检测血清中及肝组织中TTV DNA。结果 检测103例血清,TTV总阳性率为25．24％（26／103）;甲－戊型肝炎组检出率21．81％（12／55）、非甲－非庚型患者检出率47．37％（9／19）,显著高于正常对照组15％（3／20）。临床可见TTV的单独感染和重叠感染;出现急性、慢性甚至重度肝损伤。12 肝组织可见TTV阳性,阳性颗粒主要见于肝细胞核内。结论 从血清和肝组织证实了TTV的存在,提示这种病毒可能是导致肝脏炎症的一种新病原。     

地高辛标记探针原位杂交检测肝内HDV RNA

本研究采用随机引物法用地高辛标记ＨＤＶ　ｃＤＮＡ全基因片段作为探针，通过原位杂交方法检测了５８例慢性乙型肝炎患者的肝组织石蜡切片中的ＨＤＶ　ＲＮＡ，发现ＨＤＶ　ＲＮＡ阳性者９例，检出率为１５．５％。ＨＤＶ　ＲＮＡ阳性物质在肝细胞内的分布方式有胞浆型、核膜型、核仁型、核膜核仁型和全核型等。ＨＤＶ　ＲＮＡ阳性肝细胞在显微镜下多数正常或只显示轻微病变。本文结果提示ＨＤＶ的致病性并非由于ＨＤＶ的直接细胞毒作用，而是宿主细胞和病毒共同作用结果，但其确切生物学意义还有待进一步探索。     

Hepatitis B virus concentrations in serum determined by sensitive quantitative assays in patients with established chronic hepatitis delta virus infection.

To clarify the correlation between hepatitis B virus (HBV) DNA levels and serum alanine aminotransferase (ALT) levels in patients with established chronic hepatitis delta virus (HDV) infection, sensitive HBV quantitative assays were used for the study. Thirty-four consecutive patients with chronic liver disease who were positive for both hepatitis B surface antigen (HBsAg) and antibody to HDV (anti-HDV), including 19 patients with chronic hepatitis, 8 patients with liver cirrhosis and 7 patients with hepatocellular carcinoma. All were negative for hepatitis Be antigen (HBeAg) and positive for antibody to HBeAg. HBV DNA was detected in 25 (73.5%) of the 34 patients using real-time detection PCR, and the HBV DNA levels of these patients were significantly lower compared with HBeAg status and ALT level-matched patients with chronic liver disease positive for HBsAg but negative for anti-HDV. There was no correlation between serum HBV DNA and ALT levels among the 34 patients with chronic liver disease positive for anti-HDV. Whereas serum ALT levels in anti-HDV-positive HBsAg carriers with HDV RNA were significantly higher than those without HDV RNA. Liver damage in patients with established chronic HDV infection may be caused mainly by ongoing HDV infection not by HBV replication.     

慢性乙型肝炎患者血清和肝组织中HBV DNA含量与庚型肝炎病毒感染的关系

目的：观察慢性乙型肝炎（CH－B）患者血清、肝组织中HBV DNA含量与庚型肝炎病毒（HGV）感染的关系，探讨HGV感染对CH－B患者乙型肝炎病毒（HBV）复制的影响。方法：应用逆转录－聚合酶链反应（RT－PCR）、免疫组织化学法、荧光定量PCR（FQ－PCR）技术方法对56份CH－B患者血清HGV RNA、肝组织HGV Ag、血清及肝组织中HBV DNA含量分别进行了检测，并将血清HGV RNA与肝组织HGV Ag的表达、HGV RNA、HGV Ag阳性与阴性患者HBV DNA含量分别进行了对比研究。结果：血清HGV RNA、肝组织HGV Ag阳性分别为10份（17．9％）、8份（14．3％）。血清HGV RNA阳性与肝组织HGV Ag表达显著相关（P＜0．01），但部分肝组织HGV Ag阴性患者亦有血清HGV RNA表达。血清HGV RNA、肝组织HGV Ag阳性与阴性患者血清及肝组织中HBV DNA含量差异无显著性（P＞0．05）。结论：HGV感染对CH－B患者HBV复制无影响。HGV可在肝脏中复制，但致病性可能较微弱。     

Investigating the prevalence and clinical effects of hepatitis delta viral infection in Taiwan

PurposeTo clarify and investigate the prevalence and clinical impact of hepatitis D virus (HDV) infection in Taiwan's communities.MethodsHDV infection in patients with chronic hepatitis B viral (HBV) infection was examined using an anti-HDV antibody in Yonghe Cardinal Tien Hospital (YCTH), a district hospital in Taiwan. Clinical characteristics of anti-HDV-positive and anti-HDV-negative patients were collected and compared. These characteristics were also compared with the data collected from a medical center. Continuous variables and confounding factor adjustments were compared using the analysis of covariance method, whereas categorical variables were compared using the logistic regression method.ResultsA total of 346 patients with chronic HBV infection were assessed from 2018 to 2019. Among them, 4 (1.15%) were positive for anti-HDV. The clinical, virological, and biochemical characteristics were similar between anti-HDV-positive and anti-HDV-negative groups. None of the four patients was positive for serum HDV RNA. Another 18 anti-HDV-positive patients were identified from National Taiwan University Hospital (NTUH). The clinical, virological, and biochemical characteristics of anti-HDV-positive patients from YCTH and NTUH were also similar.ConclusionThe prevalence of HDV and the serum HDV RNA-positive rate were low in district hospitals in Taiwan. Coexisting HDV infection did not influence the clinical manifestation of patients with chronic HBV infection in Taiwan. However, because the number of HDV RNA cases was very small, our findings may not be conclusive. Besides, since the sensitivity of current anti-HDV kit is not 100%, more sensitive methods are needed to achieve reliable prevalence data.     

Molecular and clinical aspects of hepatitis D virus infections

Hepatitis D virus (HDV) is a defective virus with circular, single-stranded genomic RNA which needs hepatitis B virus (HBV) as a helper virus for virion assembly and infectivity. HDV virions are composed of a circular shape HDV RNA and two types of viral proteins, small and large HDAgs, surrounded by HBV surface antigen (HBsAg). The RNA polymerase II from infected hepatocytes is responsible for synthesizing RNAs with positive and negative polarities for HDV, as the virus does not code any enzyme to replicate its genome. HDV occurs as co-infection or super-infection in up to 5% of HBsAg carriers. A recent multi-center study highlighted that pegylated interferon α-2a (PEG-IFN) is currently the only treatment option for delta hepatitis. Nucleotide/nucleoside analogues, which are effective against HBV, have no relevant effects on HDV. However, additional clinical trials combining PEG-IFN and tenofovir are currently ongoing. The molecular interactions between HDV and HBV are incompletely understood. Despite fluctuating patterns of HBV viral load in the presence of HDV in patients, several observations indicate that HDV has suppressive effects on HBV replication, and even in triple infections with HDV, HBV and HCV, replication of both concomitant viruses can be reduced. Additional molecular virology studies are warranted to clarify how HDV interacts with the helper virus and which key cellular pathways are used by both viruses. Further clinical trials are underway to optimize treatment strategies for delta hepatitis.     

双标记法检测乙型和丙型肝炎病毒双重感染的肝组织 …

目的 研究乙型肝炎病毒（ＨＢＶ）与丙型肝炎病毒（ＨＣＶ）双重感染者肝组织内两种病毒的分在体内的分布特点和相互关系。方法 用免疫组化和原位杂交法分别检测了ＨＢＶ的核酸及抗原和ＨＣＶ的核酸及抗原,对其中乙型肝炎核心抗原,对其中乙型肝炎核心抗原与ＨＣＶ ＲＮＡ同时阳性的组织进一步做了同一切片的双标记染色。