戊型肝炎病毒与甲乙丙型肝炎病毒重叠感染的研究

本文对419例病毒性肝炎患者进行抗-HEV-IgM/IgG及其它病毒标志物检测。结果:HEV感染者112例(26.2％);其中单纯HEV感染者30例,两种以上肝炎病毒重叠感染占73.2％;43.75％为HBV和HEV重叠感染,HAV和HEV合并感染占急性肝炎的40.58％。在重型肝炎中HEV感染率占57.89％,均为HBV和HEV重叠感染,病死率达72.73％。16.67％的单纯HEV感染者为慢性肝炎和肝硬变。结果表明,本地区戊型肝炎以散发为主,重叠感染多见。HBV与HEV重叠感染和HAV与HEV重叠感染是较常见的感染模式。在HBV感染的基础上重叠HEV感染是肝炎重症化的重要原因。HEV感染有导致慢性化的可能性。     

丙型肝炎病毒与甲乙型肝炎病毒重叠感染的研究

对485例病毒性肝炎患者进行了抗HCV、抗HAV-IgM、HBV-M检测.各型病毒性肝炎患者中抗HCV阳性率15.05％,慢性肝炎、肝硬变和重型肝炎阳性率高于急性肝炎;抗HCV阳性者中,27.40％有输血或血浆史;57.53％HBV-M阳性,其中HBsAg阳性占54.76％,抗HBc阳性达88.10％;既往有HBV感染者占33.33％.HBV与HCV重叠感染中慢性肝炎占58.06％,IAV与HCV重叠感染以急性肝炎多见(94.44％),HCV与甲乙型肝炎病毒三重感染可加速肝炎重症化的进程。     

重型病毒性肝炎432例病原学分析

目的 探讨病毒性肝炎病原学与慢性肝炎重症化及其预后的关系。方法 对432例重型病毒性肝炎的病原学资料进行回顾性分析。结果 在引起重肝的肝炎病毒中以HBV单一或重叠感染率最高(414/432,95.8％),未发现单一HAV、HDV和HGV感染引起者。10例(2.31％)未能确定病原。乙型慢性重型肝炎的HBV前C区变异率为59.8％(55/92),显著高于乙型急性或亚急性重型肝炎0％(P<0.05和P<0.01)。HBV重叠HEV感染者病死率为73.4％(69/94),HEV重叠其他肝炎病毒感染者的病死率为68.6％(72/105),均比单一HBV或单一HEV感染者高(P<0.01和P<0.05)。结论 HBV感染仍是广东地区重型肝炎的主要病因。乙型慢性重型肝炎多由HBV前C区变异所致。HBV与HEV重叠感染可加重病情,病死率高。     

349例重型病毒性肝炎的临床特点及病毒标志物检测结果分析

目的了解重型病毒性肝炎住院病例的临床及病原学特点,探讨慢性肝炎重症化及其预后的关系。方法采用回顾性调查方法,对349例重型病毒性肝炎的临床特点及病毒标志物检测结果进行分析。结果349例重型病毒性肝炎患者中,发生于急性肝炎的28例,发生于慢性肝炎有明确肝病史和无明确肝病史的分别为245例和76例;引起重型肝炎的病毒中以HBV单一或重叠感染率最高,占82.2%(287/349),6例(1.72%)未能确定病原,未发现单一HAV、HDV和HGV感染者,HBV重叠HEV感染者病死率为65.2%(15/23),HEV重叠其他肝炎病毒感染者的病死率为60%(18/30),均比单一HBV或单一HEV感染者高(P<0.01和P<0.05)。结论重型肝炎仍以HBV感染为主,HBV和HEV重叠感染可以加重病情、病死率高。     

北京地区慢性重型肝炎的病原学特点

目的 了解北京地区慢性重型肝炎（下称慢重肝）的病原学特点。方法 11例患者的选择均符合2000年9月西安“病毒性肝炎防治方案”慢性重型肝炎诊断标准。所有病人均抽血做甲、乙、丙、丁、戊型肝炎病原学检查。结果 111例慢重肝患者中,HBV感染者108例（97．30％）,HEV感染者22例（19．82％）,HAV感染者4例（3．60％）,甲－戊型肝炎病毒血清标志物均阴性者3例（2．7％）。单纯乙肝病毒感染者83例（74．77％）,其中HBV DNA阳性率18．07％（15／83）,HBeAg阳性率57．83％（48／83）。乙、戊重叠感染者21例（18．92％）,乙、甲重叠感染者3例（2．70％）,乙、甲、戊三重感染者1例（0．90％）。结论 （1）HBV感染是慢重肝最多见原因。其中乙肝病毒复制指标HBV DNA、HBeAg的阳性率均不很高,二者同时阳性者更少,说明其在慢重肝的发生中不起决定性作用。（2）HBV与其它肝炎病毒的重叠感染在慢重肝中占一定比例。尤其是乙、戊重叠最多。单纯HEV感染诱发重型肝炎者不多见,而在中、重度慢性乙肝或肝硬化基础上再感染HEV,易发展为慢重肝。HBV与HAV重叠较少见,本组与HCV或HDV重叠发生慢重肝者未见。（3）还有3例慢重肝甲－戊肝病原学指标均阴性（可除外药物、酒精、中毒等原因所致慢重肝）,提示仍有一部分慢重肝病因未明,有待进一步研究。     

各型肝炎病毒单纯及重叠感染的研究

目的 探讨病毒性肝炎患者甲～戊，庚型肝炎病毒(HAV-HEV，HGV)单纯感染及重叠感染情况。方法 采用EIA法检测病毒性肝炎患者血清抗-HAV IgM，HBV标志物、抗-HCV IgM、抗-HDV IgM、抗-HEV IgM、抗-HGV IgM。结果 共检测210例病毒性肝炎患者HAV-HEV、HGV血清标志物，20例未检出(9．5％)，190例患者检出标志物阳性(90．5％)。HBV感染率89，5％(188／210，其中有34例为既往感染，占16．2％，现症感染154例，占73．3％)；HAV感染率29．0％(61／210)，HCV、HDV感染率均为8．1％(17／210)、HEV、HGV感染率依次为10．0％(21／210)、7．1％(15／210)。各临床类型中单纯感染占61．4％(129／210)，二重感染占32．4％(68／210)，以HAV HBV、HBV HDV、HBV HEV感染模式最常见，三重感染占6．2％(13／210)，以HAV HBV HDV感染模式最常见；临床上以肝炎肝硬化、重型肝炎重叠感染常见，急性肝炎最少见。结论 病毒性肝炎中HBV感染最常见，其次为HAV感染；单纯感染、二重感染多见，三重感染少见；重叠感染发生率随病情加重而增加。     

亚太地区10届胃肠病及7届消化内镜会议纪要（关于肝炎及肝、胃、肠、胰腺癌部分）

目前认为HBV、HCV是慢性肝病的主要病因之一。而HAV、HEV是急性、亚急性肝炎的主要病原。印度的Tonden报告10-28％的成人急性肝炎因HAV所致，HAV很少引起暴发性肝炎(1．7％)，也不引起亚急性肝炎，除非超感染或并有其它肝炎病毒的感染。而HEV是暴发性肝炎最常见的病因(36．4％)，也是亚急性肝炎的常见病原(50％)，20-25％的急性     

17例庚型肝炎临床病理分析

对17例经逆转录聚合酶链反应(RT-PCR)法检测HGV RNA阳性的庚型肝炎患者进行临床和/或肝脏组织分析。结果发现经输血感染者8例(47.1％),散发性病例9例(52.9％)。单纯HGV感染者8例(47.1％),HGV和HBV或HCV二重、三重感染者9例(52.9％)。临床病理分型发现急性肝炎2例,慢性肝炎12例,重型肝炎2例和肝硬变1例。单纯HGV感染多呈隐匿发病,症状轻,,无黄疸,ALT轻度升高,但慢性化程度高。本文结果提示HGV感染易致病程慢性化,病理损伤轻,HGV与HBV重叠感染时,HGV有可能干扰HBV的复制。     

血清HGVRNA阳性病毒性肝炎94例研究

目的分析血清HGVRNA阳性病毒性肝炎的临床特点。方法全部病例入院后即检测血清AB，C，D，E型肝炎病毒标志及肝功能试验，抗-HGV采用ELISA法，HGVRNA采用RT-PCR法，均由302医院免疫室统一检测．结果在94例血清HGVRNA阳性患者中，单纯HGV感染（单纯感染组）18例，HGV合并其他肝炎病毒感染（合并感染组）76例，单纯感染组中以急性肝炎为主（61．1％），合并感染组以HBV＋HGV感染最多，占引例（5．3％）．51例中，以慢性肝炎（41．2％）及肝硬变（37．2％）为主，单纯HGV感染临床可表现为急、慢性肝炎及重型肝炎，其中，急性肝炎临床特点为：消化道症状较轻：半数以上有轻-中度黄疸，也可有重度黄疸者；ALT轻度增高；全部病例恢复顺利，合并感染组病情恢复也较顺利．11例重型肝炎，生存率45．4％．HGV与HBV合并感染者中，住院期间，HBsAg阴转率24．0％，HBeAg阴转率62．5％，HBVDNA阴转率55．6％结论单纯HGV感染以急性肝炎为主，亦可见于慢性肝炎及重型肝炎，合并感染级以慢性肝炎及肝硬变为主，并分析各自临床特点HGV与HBV合并感染时，对HBV可能有抑制作用.     

343例老年病毒性肝炎病原学分析

目的：探讨老年患者甲～戊型肝炎病毒感染、HBVDNA阳性相应乙型肝炎病毒标志物（HBV-M）表现形式和重型肝炎病原学。方法：检测我院2001年1月至2005年12月住院343例老年病毒性肝炎患者血清肝炎病原学指标。结果：甲、乙、丙、丁、戊型肝炎病毒感染分别为3例（0．87％）、115例（33．53％）、35例（10．20％）、1例（O．29％）、91例（26．53％）；乙和／或戊丙甲丁重叠感染59例（17．21％），其中乙戊重叠40例（11．67％），未定型41例（11．95％）。HBVDNA阳性但HBeAg（-）占80．48％（33／41）。重型肝炎中以HBV感染为主，占72．41％（21／29）。结论：近5年老年病毒性肝炎住院率7．51％，依次为HBV、HEV、HCV、HAV、HDV感染，HEV感染显著上升，尤其是HBV和HEV重叠感染，应引起高度重视。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.