丙氨酸氨基转移酶持续正常的慢性丙型肝炎病毒感染的研究进展

丙型肝炎病毒(HCV)感染极易慢性化,研究表明,约有20％~30％的HCV慢性感染患者丙氨酸氨基转移酶(ALT)持续正常,临床症状缺失或非常轻微。所谓ALT持续性正常,即为在6个月内间断1个月以上复查3次,ALT均在正常范围以内。对于此类患者是否进行抗病毒治疗一直存在争议。现就ALT持续性正常HCV感染的自然病史、肝脏病理变化、病毒载量、     

筛查献血者丙型肝炎病毒感染研究进展

丙型肝炎病毒(HCV)是一种单股正链RNA病毒,全长约9.6 kb,开放读框区编码结构蛋白和非结构蛋白。全球HCV感染率约为3%,是一种严重威胁人类健康的传染病,在献血者中进行HCV筛查是防控丙型肝炎病毒传播的最有效手段。目前,检测HCV感染的方法主要包括抗HCV抗体检测、HCV抗原检测、HCV抗原-抗体联合检测、胶体金法快速检测、HCV分子核酸检测等。抗体检测应用最早,但窗口期较长;抗原检测能缩短窗口期,敏感性高,但易受到体内因素的干扰而影响检测结果。一些快速检测方法不需要任何设备,且简便易行,但其敏感性较差。分子检测使用的HCV RNA扩增技术(NAT)是目前最敏感的检测技术,能大大缩短窗口期,但其检测成本较为昂贵。各检测方法各有其优缺点。目前,血液中心采用至少两种不同试剂检测抗HCV以进行血液的安全筛查。     

丙型肝炎病毒感染与500例肝炎临床类型的关系

应用抗-HCV与HCV-RNA(RT-PCR法)检测了低温保存的500例各型肝炎的血清标本,结果抗-HCV与HCVRNA阳性率以CAH及Lc-D为高;而ASC两项指标阳性率较低;余均无显著性意义,     

隐匿性乙型肝炎病毒感染

大量研究通过对肝组织和血清乙型肝炎病毒（HBV）DNA或转录体的检测，证实隐匿性HBV感染是所谓“隐源性肝炎”及其它慢性肝病的常见病因。现就其发生率、形成机制、临床意义、诊断、治疗等方面作一综述。     

隐匿性丙型肝炎的临床与病理学特征研究

目的研究隐匿性丙型肝炎（OHC）的诊断及其临床表现和病理学特征。方法对11例肝功能异常的患者进行肝活检,采用免疫组化法检测HCV抗原;将组织裂解后提取核酸,采用套式RT-PCR法检测HCV RNA。结果11例患者血清ALT为87±9．6U／L,AST为68±7．4U／L;血清抗-HCV和HCV RNA阴性;肝组织病理学分级为G0S03例,G1S04例,GoSll例,G1S13例;免疫组化检测HCVAg（＋＋）3例,（＋＋＋）8例,而HBsAg和HBcAg阴性;5例肝组织HCVRNA阳性者,HCV RNA〉1.0×10^3 copies／ml 2例,〉1．0×10^4copies／ml 3例;基因分型1b型3例,2a型2例。结论我国存在OHC患者,以1b和2a基因型为主。     

恶性肿瘤患者丙型肝炎病毒感染的分析

自1989年国外建立了血清丙型肝炎病毒抗体(抗HCV)检测方法以来,文献中报道大部分慢性肝炎、肝硬化及肝癌患者血清中可检出抗HCV。但对常见恶性肿瘤中丙型肝炎病毒(HCV)感染的情况报道甚少。本文对401例确诊为恶性肿瘤的住院患者进行了抗HCV检测,希图了解HCV感染与常见恶性肿瘤的关系,并对试验结果及实验过程中的有关问题进行分析。 材料与方法 一、检测对象 1991年12月以来确诊为恶性肿瘤的住院患者401例,其中男255例,女146例,年龄最小12岁,最大70岁,平均年龄34.14±10.32。401例患者中肝癌67例,乳腺癌59例,肺癌54例,结肠癌46例,恶性淋巴瘤32例,宫颈癌32例,胃癌     

丙型肝炎病毒感染与治疗药物

丙型肝炎病毒（HCV）通过在宿主细胞内持续复制,导致慢性感染。目前用于治疗慢性丙型肝炎（CHC）的药物主要是聚乙二醇干扰素（PEG-IFN）和利巴韦林的联合用药。本文将就HCV的细胞入侵、复制、逃避宿主的固有和获得性免疫,以及抗HCV临床试验药物的最新进展做一综述。     

丙型肝炎病毒感染的检测

丙型肝炎病毒（HCV）感染的检测包括血清学检测和核酸检测（NAT）,前者包括HCV抗体（抗-HCV）、核心抗原检测,后者包括定性/定量RNA检测和基因型/亚型检测。抗-HCV检测是应用最广的HCV感染筛查试验,操作简便、耗时短、成本低,但其缺点是窗口期较长,不能判别是活动性感染还是病毒已被清除,不适用于免疫缺陷人群。HCV RNA是病毒感染的直接证据,既往定性RNA检测灵敏度较高,但随着实时定量PCR技术的成熟,定量检测灵敏度不断提高,线性范围不断拓宽,适用于临床抗病毒治疗应答的监测,也正逐步取代定性检测用于血液制品的筛查。近年HCV抗原检测和抗原抗体联合检测试剂盒已用于HCV感染的筛查及治疗监测,但其灵敏度尚不及NAT。目前主流的HCV基因分型试剂检测基因型有较高的符合率,而检测亚型的结果存在较大差异,需要方法学上的改进。     

丙型肝炎病毒感染与肝癌

丙型肝炎病毒感染与肝癌余竹元，郑宁（上海医科大学肝癌研究所上海２０００３２）肝癌（ｈｅｐａｔｏｃｅｌｌｕｌａｒｃａｒｃｉｎｏｍａ，ＨＣＣ）居我国癌症死亡的第三位，除已知的乙肝病毒（ＨＢＶ），黄曲霉毒素及饮水污染为重要的致癌因素外，近年来丙型肝炎病毒（...     

乙型和丙型肝炎病毒感染与慢性肝病

检测天津地区１１９例慢性肝病毒者ＨＢＶ、ＨＣＶ标志，并对其中２８例ＨＣＶＲＮＡ阳性血清进行基因分型。结果，ＨＢＶ感染率明显高于ＨＣＶ感染率（Ｐ〈０．０５），肝癌患者中ＨＢＶ、ＨＣＶ重叠感染率明显高于慢性肝炎（Ｐ〈０．０５）；各组均以ＨＣＶⅡ型为主。提示天津地区慢性肝病上前仍以ＨＢＶ感染为主；ＨＢＶ、ＨＣＶ重叠感染对肝癌的发生似有相加作用；ＨＣＶⅡ型感染在天津地区ＨＣＶ相关性曙性肝病中可以起主要作用     

Comparative study between occult hepatitis C virus infection and chronic hepatitis C

We have recently described the presence of occult hepatitis C virus (HCV) infection (HCV-RNA in liver in the absence of anti-HCV and serum HCV-RNA) in patients with persistently abnormal liver function tests of unknown aetiology. The aim of this study was to compare the characteristics of patients with occult HCV infection vs those of patients with chronic hepatitis C. We compared clinical features of 68 patients with occult HCV infection and 69 untreated chronic HCV patients (anti-HCV and serum HCV-RNA positive), matched for age, gender, duration of abnormal liver function tests and body mass index. Aspartate aminotransferase and alanine aminotransferase were higher (P < 0.001) in chronic HCV, but cholesterol and triglycerides were significantly higher in patients with occult HCV infection (P < 0.001 and P = 0.002). Chronic HCV patients had higher gamma-globulin (P = 0.005), alpha-foetoprotein (P < 0.001) and iron (P < 0.001) levels. Percentage of patients with necroinflammatory activity and fibrosis was higher (P < 0.001) in chronic HCV than in occult HCV infection. Mean percentage of infected hepatocytes was higher (P = 0.001) in chronic HCV (10.1%) than in occult HCV infection (5.3%). This occult HCV infection is a milder disease than chronic HCV, and this could be related to the significantly lower number of infected hepatocytes observed in occult HCV.     

Role of occult hepatitis B virus infection in chronic hepatitis C

The development of sensitive assays to detect small amounts of hepatitis B virus(HBV) DNA has favored the identification of occult hepatitis B infection(OBI), a virological condition characterized by a low level of HBV replication with detectable levels of HBV DNA in liver tissue but an absence of detectable surface antigen of HBV(HBs Ag) in serum. The gold standard to diagnose OBI is the detection of HBV DNA in the hepatocytes by highly sensitive and specific techniques, a diagnostic procedure requiring liver tissue to be tested and the use of non-standardized non-commercially available techniques. Consequently, in everyday clinical practice, the detection of anti-hepatitis B core antibody(antiHBc) in serum of HBs Ag-negative subjects is used as a surrogate marker to identify patients with OBI. In patients with chronic hepatitis C(CHC), OBI has been identified in nearly one-third of these cases. Considerable data suggest that OBI favors the increase of liver damage and the development of hepatocellular carcinoma(HCC) in patients with CHC. The data from other studies, however, indicate no influence of OBI on the natural history of CHC, particularly regarding the risk of developing HCC.     

Influence of occult hepatitis B virus infection in chronic hepatitis C outcomes

Persistence of hepatitis B virus-DNA in the sera,peripheral blood mononuclear cells or in the liver of hepatitis B surface antigen(HBsAg) -negative patients with or without serological markers of previous exposure(antibodies to HBsAg and/or to HB-core antigen) defines the entity called occult hepatitis B infection(OBI).Co-infection with hepatitis B and hepatitis C viruses is frequent in highly endemic areas.While this co-infection increases the risk of liver disease progression,development of cirrhosis and ...     

Pathogenesis of occult chronic hepatitis B virus infection

Occult hepatitis B infection(OBI) is characterized by hepatitis B virus(HBV) DNA in serum in the absence of hepatitis B surface antigen(HBsAg) presenting HBsAg-negative and anti-HBc positive serological patterns.Occult HBV status is associated in some cases with mutant viruses undetectable by HBsAg assays;but more frequently it is due to a strong suppression of viral replication and gene expression.OBI is an entity with world-wide diffusion.The failure to detect HBsAg,despite the persistence of the viral DN...     

New perspectives in occult hepatitis C virus infection

Occult hepatitis C virus (HCV) infection, defined as the presence of HCV RNA in liver and in peripheral blood mononuclear cells (PBMCs) in the absence of detectable viral RNA in serum by standard assays, can be found in anti-HCV positive patients with normal serum levels of liver enzymes and in anti-HCV negative patients with persistently elevated liver enzymes of unknown etiology. Occult HCV infection is distributed worldwide and all HCV genotypes seem to be involved in this infection. Occult hepatitis C has been found not only in anti-HCV positive subjects with normal values of liver enzymes or in chronic hepatitis of unknown origin but also in several groups at risk for HCV infection such as hemodialysis patients or family members of patients with occult HCV. This occult infection has been reported also in healthy populations without evidence of liver disease. Occult HCV infection seems to be less aggressive than chronic hepatitis C although patients affected by occult HCV may develop liver cirrhosis and even hepatocellular carcinoma. Thus, anti-HCV negative patients with occult HCV may benefit from antiviral therapy with pegylated-interferon plus ribavirin. The persistence of very low levels of HCV RNA in serum and in PBMCs, along with the maintenance of specific T-cell responses against HCV-antigens observed during a long-term follow-up of patients with occult hepatitis C, indicate that occult HCV is a persistent infection that is not spontaneously eradicated. This is an updated report on diagnosis, epidemiology and clinical implications of occult HCV with special emphasis on anti-HCV negative cases.     

隐匿性丙型肝炎病毒感染研究进展

丙型肝炎病毒(HCV)感染是慢性肝炎和肝纤维化的主要病因之一,约70%急性HCV感染者可发展为慢性感染[1],其中约20%和2.5%将发展为肝硬化或肝细胞癌(HCC)[2]。因此,HCV感染是全球性的公共卫生问题。一直以来,HCV感染的诊断主要是根据血清中     

Dual chronic hepatitis B virus and hepatitis C virus infection

Dual hepatitis B virus (HBV) and hepatitis C virus (HCV) infection are common in HBV or HCV endemic areas. However, several clinical and pathogenetic issues remain unresolved. First, clinical and in vitro studies suggest the interactions between two viruses. The dynamics of the interaction in untreated setting versus treated setting and its influence on the long-term outcomes await further studies. A key issue regarding viral interactions is whether modulation of infection occurs in the same dually infected individual hepatocyte of the liver. Clarifying this issue may help to understand the reciprocal interference between HCV and HBV and provide clues for future immunopathogenetic studies. Second, the prevalence and clinical significance of coexisting occult HBV infection in patients with chronic HCV infection need further investigations. Third, combination therapy of peginterferon alfa-2a and ribavirin appears to be just as effective and safe for the treatment of hepatitis B surface antigen (HBsAg)-positive patients chronically infected with active chronic hepatitis C as it is in patients with HCV monoinfection. Nevertheless, one-third of dually infected patients with nondetectable serum HBV DNA-level pretreatment developed HBV reactivation posttreatment. How to prevent and treat this reactivation should be clarified. Furthermore, about 10% of the dually infected patients lost HBsAg. Underlying mechanisms await further investigations. Finally, the optimal treatment strategies for dually infected patients with hepatitis B e antigen-positive chronic hepatitis B should be identified in future clinical trials.