Detection of core antibody in hepatitis B infection.

Hepatitis B core antigen (HBcAg) is found on the decoated Dane particle and on a morphologically similar particle detected mainly in the nucleus of hepatocytes of patients with hepatitis B. HBcAg prepared from the liver of a chimpanzee infected with hepatitis B virus was used to test human serum for core antibody (anti-HBc) by complement fixation. Anti-HBc was found in serum collected from patients with hepatitis B in both the acute and convalescent stages, from carriers of hepatitis B surface antigen (HBsAg) and from patients with chronic liver or renal disease who were carriers of HBsAg. It was not found in patients with hepatitis A or infectious mononucleosis, or in healthy persons who were not carriers of HBsAg.     

Hepatitis delta virus infection in Northern Ireland 1970-1989.

The incidence of hepatitis delta virus (HDV) infection in Northern Ireland (1970-1989) was tested by enzyme linked immunosorbent assay in 401 hepatitis B surface antigen (HBsAg) positive sera. Hepatitis delta antigen (HDAg) was tested in 388 patients and antibody to delta antigen (anti-HD) in 401 patients. Four patients (1.03%) were HDAg positive. Nine patients (2.24%) were positive for anti-HD and after acid pre-treatment of sera from eight of these patients, five were positive for HDAg. The overall incidence of HDV markers was 3.27%, which reflects the low incidence in HBsAg carriers in Northern Ireland (who were in high risk groups for delta hepatitis). The use of acid treatment of the sera to break up antigen/antibody complexes has been a useful technological improvement in the identification of this virus.     

DIAGNOSTIC SIGNIFICANCE OF IgM ANTI-HBc DETECTION BY ELISA IN HBV INFECTION

This paper deals with an enzyme linked immuno- sorbent assay for the detection of IgM antibody to hepatitis B core antigen. The test was shown to be highly specific and sensitive. 109 hepatitis cases and HBsAg carriers were examined. Fifteen of 57 acute hepatitis cases, 16 0f 24 chronic persistent hepatitis cases, 8 0f 14 chronic active hepatitis cases, and 7 0f 14 carriers were positive. GMT of IgM anti-HBc in early acute hepatitis cases (>10-5) was significantly higher than that in chronic hepatitis cases(10_3.1) and carriers (10-2.45). The IgM anti-HBc could be classified into three types according to their serum reactions. IgM anti-HBc in high titer was of signifi- cant value. The dynamics of IgM anti-HBc and the comprehensive analysis of the HBV marker were emphasized. The use of IgM anti-HBc in diagnosis of hepatitis B is discussed.     

慢性乙肝患者HDV二重感染的定位研究

采用免疫荧光与免疫酶标方法对145饲慢性肝病患者肝内丁型肝炎抗原(HDAg)定位研究。在95例HBsAg阳性慢性肝病患者中发现6例HDAg阳性(6.3％),在79例HBsAg阳性慢性肝炎中检出率为7.6％。在HBsAg阳性肝硬化、慢性活动性肝炎和慢性迁延性肝炎中,HD-Ag检出率分别为14.3％、7.1％和5.9％。结果提示,我国一部分慢性乙肝患者也是HDV携带者。这是我国肝炎防治研究中的新课题。     

各种HBsAg阳性人群中抗D型肝炎病毒抗体的研究

采用Abbott EIA法对各种HBsAg阳性人群血清抗HDV抗体进行了调查,结果在1004份血清标本中检出有18份标本抗HDV抗体阳性,阳性率为1.8%。抗HDV抗体检出率与年龄、性别无关。但在无症状HBsAg携带者、急性乙型肝炎、慢性乙型肝炎(包括慢性活动性肝炎、慢性迁延性肝炎、肝硬化)、肝癌患者血清中,抗HDV抗体检出率有显著性差别,分别为0.6%、0%、1.7%、和12.1%。这些阳性血清中抗HDV抗体滴度<1:10,间隔2～6个月后对部份患者重新采血复查时,抗HDV抗体转为阴性。研究结果提示了低感染率的D型肝炎在我国的存在。     

Increased severity and morbidity of acute hepatitis in drug abusers with simultaneously acquired hepatitis B and hepatitis D virus infections

Hepatitis D virus (delta agent) markers were present in 111 (36%) of 308 intravenous drug abusers who were positive for hepatitis B surface antigen (HBsAg), 52 of these having hepatitis D virus antigenaemia. IgM antibody to hepatitis B core antigen (anti-HBc IgM) was present in 92 out of 95 subjects tested, indicating that hepatitis D virus and hepatitis B virus infections had been acquired simultaneously. Hepatitis D virus markers were present in three out of four patients with fulminant hepatitis, and in 80 of 223 (36%) with mild or moderate hepatitis compared with four of 29 (14%) of those who were asymptomatic. These proportional differences were significant (p less than 0.001). Hepatitis D virus markers were present in twice as many patients positive for anti-HBc IgM requiring admission to hospital with acute hepatitis compared with outpatients attending a drug treatment centre. Tests on one patient showed complete disappearance of HBsAg, but hepatitis D antigen (HDAg or delta antigen) and hepatitis B e antigen (HBeAg) were still present in serum samples. All five patients with chronic active hepatitis had hepatitis D antibody (anti-HD) compared with seven of 24 (29%) with chronic persistent hepatitis (p = 0.008). Blocking anti-HD persisted for long periods after simultaneous infections with hepatitis B virus and hepatitis D virus but at lower titres than in patients with chronic liver disease.     

IgM乙肝核心抗体:反映对病毒复制的肝内炎症应答的标志

CORAB-M(Abbott,USA)是经特殊标定的试剂盒,只能检出很高滴度的IgM抗HBc.在46例临床诊断为急性黄疸型乙型肝炎中,24例IgM抗HBc阴性,随访表明为慢性无症状乙肝病毒携带者的急性症状发作.用未经特殊处理自行组成的试剂盒检测处于病毒复制时相的慢性乙肝病毒感染者,IgM抗HBc的检出率与肝组织病变的活动性相平行.上述结果表明:IgM抗HBc能较好反映对病毒复制的组织免疫应答,即病变活动性.     

Epidemiology of hepatitis D virus (delta) infection in Melbourne over a 15-year period

The prevalence of delta infection was studied in 3986 individuals seropositive for hepatitis B surface antigen (HBsAg), who were seen in Melbourne between 1971 and 1985. The group comprised 2004 patients with acute hepatitis B, 1820 asymptomatic HBsAg carriers, 139 HBsAg carriers with evidence of chronic liver disease, and 23 carriers who had suffered more than two separate attacks of acute hepatitis. Markers of delta infection were found almost exclusively among intravenous drug abusers and their close contacts. Studies of stored sera suggest that delta infection was introduced into this group about 1970. In carriers with no evidence of chronic liver disease, the prevalence of delta infection was highest among intravenous drug abusers (19.2%). In carriers with evidence of chronic liver disease, delta markers were present in 20.1% and all 23 carriers with recurrent acute hepatitis had evidence of infection with the delta virus.     

Lack of evidence of hepatitis D (delta) infection in Newfoundland and Labrador.

Epidemiologic knowledge of hepatitis D virus (HDV) infection is limited. A seroepidemiologic study was undertaken to determine the prevalence of the infection in Newfoundland and Labrador. Between October 1983 and October 1985 over 200 people were recognized through routine serodiagnosis and screening as having hepatitis B seromarkers. A total of 223 serum samples from 186 of these people were tested for anti-HDV. The subjects were mainly asymptomatic carriers of hepatitis B surface antigen or patients with acute or chronic hepatitis B from the native Indian and Inuit and the non-native populations. None of the serum samples were positive for anti-HDV. The absence of anti-HDV in a substantial number of people in the province who are infected with hepatitis B virus is strong evidence that HDV infection is not prevalent in the local population, including native people.     

Importance of markers of hepatitis B virus in alcoholic liver disease

To determine the importance of the presence of serological markers of hepatitis B virus infection in patients with alcohol related liver disease we compared cumulative alcohol intake and clinical and histological features in patients with markers of hepatitis B virus infection and in those without. Hepatitis B surface antigen (HBsAg) was detected in five (2%) out of 285 patients studied and antibody to HBsAg (anti-HBs) in 41 (14%); one patient had antibody to hepatitis B core antigen alone. The combined prevalence of markers of hepatitis B virus infection was similar in patients with alcoholic cirrhosis (18%) and precirrhotic liver disease (13%). Two patients positive for HBsAg had histological features of both alcoholic liver disease and chronic active hepatitis, with stainable HBsAg. Patients with anti-HBs were, however, histologically indistinguishable from patients without markers, and the mean cumulative alcohol intake of patients with anti-HBs was similar to or even higher than that of patients with liver disease of comparable severity who had no evidence of previous infection. The presence of markers of hepatitis B virus infection was related to former residence in countries with a high prevalence of the infection and to previous parenteral treatment and blood transfusions. Infection with hepatitis B virus does not enhance the development of chronic liver disease in heavy drinkers, except in the small number who remain positive for HBsAg.     

急性起病的非甲非乙型病毒性肝炎的病原分析

对HBsAg(一)、IgM抗HAV(一)临床诊断为急性非甲非乙肝炎63例,进行了病原学鉴定。以聚合酶链反应(PCR)检测HBV DNA,HCV RNA,并检测了IgM抗HBc和抗HCV血清抗体。诊断为急性丙型肝炎15例(23.8％),急性乙型肝炎20例(31.7％),慢性HBV携带者急性活动19例(30.2％),乙、丙型混合肝炎2例(3.2％),病原不明7例(11.1％)。结果表明在临床所谓的急性非甲非乙肝炎中,急性和慢性乙型肝炎仍占多数。     

Perinatal hepatitis B virus transmission in the United States. Prevention by passive-active immunization

Among infants born to women in whom sera are positive for both the hepatitis B surface antigen and the e antigen, 85% to 90% are infected with hepatitis B virus and become chronic hepatitis B surface antigen carriers. In a study to assess the effectiveness of passive-active prophylaxis (hepatitis B immune globulin and hepatitis B vaccine) of such infants, we screened 18,842 pregnant Asian-American women: 8.7% were positive for hepatitis B surface antigen and 3.0% were also positive for hepatitis B e antigen. Thus far, 113 infants have received hepatitis B immune globulin (0.5 mL at birth) and hepatitis B vaccine (three 20-micrograms doses beginning at birth or at 1 month) and have been followed up for nine to 18 months. Among these infants, 16 have become chronic carriers, an incidence of only 14.2%. All of the uninfected infants have retained high levels of antibody to surface antigen, suggesting that they have had an active immune response to the vaccine and should have long-term protection against hepatitis B virus.     

Perspectives on hepatitis B infections and the efficacy of vaccination (hepatitis B and pneumococci) in dialysis patients

Hepatitis B is a well known problem in dialysis units. We therefore examined the historical frequency of hepatitis B carriers in our unit, our vaccination program to hepatitis B virus (HBV), the response to hepatitis B vaccine, the IgG subclass response of anti-HBs and the response and IgG subclass response to pneumococcal vaccination (another vaccine) in dialysis patients. From 1970 and onwards 23 HBV carriers were found, but no new cases of hepatitis B occurred during the study period, i.e. from 1980 and onwards. Only one of the carriers was alive by the end of 2001. In four patients liver disease (in one of them liver cirrhosis) may have been a concomitant cause of death. The antibody response to hepatitis B vaccine was significantly lower in patients than in staff. In four patients a fourth injection was cancelled due to transplantation and bad health, while such data were lacking in 8 cases. In anti-HBs positive patients and controls a significant difference in the response of healthy adults was observed in anti-HBs IgG1 (p < 0.001) vs all other IgG subclasses. Dialysis patients had low levels, or negative findings, in all cases, with IgG1 as the highest proportion found (3/11 patients). An antibody response to pneumococcal vaccination was registered in 25 out of 29 dialysis patients (in all 86%). The IgG-subclass vaccination response to pneumococci in 28 dialysis patients was mainly IgG2 and IgG1 but also occurred in IgG3 and IgG4. Prevaccination antibody levels of the controls were higher in IgG1 and IgG2 (p < 0.01) (n = 21) than in dialysis patients (n = 28). Hepatitis B is nowadays a rare, but still dangerous disease in nephrology units. Dialysis patients have a reduced response to hepatitis B vaccine and vaccination schedules should be started early as some patients otherwise may not receive a fourth injection. The adequate antibody response to pneumococcal vaccination mainly due to IgG2 and IgG1 antibodies indicates that the antigen involved is important in vaccination responses in dialysis patients.     

乙型重症肝炎HDV重叠感染的临床意义

对８５例乙型重症肝炎患者血清进行了丁型肝炎病毒标志物（ＨＤＶＭ）及肝功能检测。结果ＨＤＶＭ阳性率为２９．４１％，表明桂林地区乙型重症肝炎患者中ＨＤＶ感染率较高；乙型重症肝炎ＨＤＶ重叠感染后肝功能损害程度明显加重，重症肝炎主要并发症发生率及死亡率明显增高，提示ＨＤＶ感染可导致乙型重症肝炎临床病情加重。同时发现乙型重症肝炎ＨＤＶ重叠感染后乙型肝炎病毒复制标志阳性率低。     

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)     

乙型肝炎患者丁、戊、庚型肝炎病毒混合感染的临床探讨

目的 探讨乙型肝炎患者丁、戊１庚型肝炎病毒感染情况及其混合感染对发病的影响。方法 采用ＥＩＡ法检测乙型肝炎患者血清中抗－ＨＤＶ ＩｇＭ、和抗－ＨＧＶ ＩｇＧ并比较与临床间关系。结果 各型乙肝患者中单纯ＨＢＶ感染占６９．９％（１００／１４３）,混合感染占３０．１％（４３／１４３）;混合感染病例中,二重感染达９５．３％（４１／４３）,三重感染占４．６％（２／４３）;古１戊、庚肝抗体阳性率分别为１０．５     

丁型肝炎病人肝组织HDAg与HBsAg/HBcAg和HBV DNA表达及关系

目的：探讨丁型肝炎病人肝组织中ＨＤＡｇ与ＨＢｓＡｇ／ＨＢｃＡｇ和ＨＢＶＤＮＡ表达及关系。方法：应用免疫组化双重染色和原位杂交,检测７９例丁型肝炎病人肝组织ＨＤＡｇ、ＨＢｓＡｇ、ＨＢｃＡｇ和ＨＢＶＤＮＡ表达,以５２例乙型肝炎作对照。结果：丁型肝炎ＨＢｓＡｇ、ＨＢｃＡｇ检出率（８１％、７１％）较乙型肝炎（９４％、９２％）低（Ｐ〈０．０５或０．０１）。ＨＤＡｇ以肝细胞核表达为主,ＨＢｓＡｇ以肝细胞浆表达     

Metabolic,endocrine and mood responses to nocturnal eating in men are affected by sources of dietary energy

Hepatitis B is a well known problem in dialysis units. We therefore examined the historical frequency of hepatitis B carriers in our unit, our vaccination program to hepatitis B virus (HBV), the response to hepatitis B vaccine, the IgG subclass response of anti-HBs and the response and IgG subclass response to pneumococcal vaccination (another vaccine) in dialysis patients. From 1970 and onwards 23 HBV carriers were found, but no new cases of hepatitis B occurred during the study period, i.e. from 1980 and onwards.Only one of the carriers was alive by the end of 2001. In four patients liver disease (in one of them liver cirrhosis) may have been a concomitant cause of death. The antibody response to hepatitis B vaccine was significantly lower in patients than in staff. In four patients a fourth injection was cancelled due to transplantation and bad health, while such data were lacking in 8 cases. In anti-HBs positive patients and controls a significant difference in the response of healthy adults was observed in anti-HBs IgG1 (p &lt; 0.001) vs all other IgG subclasses. Dialysis patients had low levels, or negative findings, in all cases, with IgG1 as the highest proportion found (3/11 patients). An antibody response to pneumococcal vaccination was registered in 25 out of 29 dialysis patients (in all 86%). The IgG-subclass vaccination response to pneumococci in 28 dialysis patients was mainly IgG2 and IgG1 but also occurred in IgG3 and IgG4. Prevaccination antibody levels of the controls were higher in IgG1 and IgG2 (p &lt; 0.01) (n = 21) than in dialysis patients (n = 28).

Hepatitis B is nowadays a rare, but still dangerous disease in nephrology units. Dialysis patients have a reduced response to hepatitis B vaccine and vaccination schedules should be started early as some patients otherwise may not receive a fourth injection. The adequate antibody response to pneumococcal vaccination mainly due to IgG2 and IgG1 antibodies indicates that the antigen involved is important in vaccination responses in dialysis patients.     

乙肝疫苗在肝移植后长期生存患者中的应用

目的为了评估乙肝疫苗预防乙肝相关疾病肝移植后乙肝复发的效果.方法肝移植后病人在拉米夫定和乙肝免疫球蛋白治疗24个月后,停用乙肝免疫球蛋白2个月,分别在第0,1,2,6个月时肌接种基因重组疫苗,每次20μg.接种第2,6个月时检测血清抗-HBs水平.如不能达到10 IU/L,再行一轮接种.结果接种后患者反应率为56%(5/9).结论结果表明乙肝预苗可以有效地诱导机体产生乙肝抗体,但其确切效果尚需进一步研究证实.