丁型肝炎病毒感染的流行病学:近14年来的变化

本研究通过调查西班牙HBsAg阳性患者中HDV的感染情况,分析HDV重叠感染的流行病学特点。 研究对象为1979～1992年在某肝病中心确诊的696例HBV慢性携带者(HBsAg阳性超过6个月,同时存在IgG抗-HD为HDV重叠感染)。696例患者中,男482例(69.3％),女214例(30.7％),平均年龄34.8±14.4 岁。HBeAg阳性164例(23.6％),抗-HBe阳性519例(74.7％),HBeAg和抗-HBe均阴性13例(1.7％)。387例(55.6％)为无症状携带者,309例(44.4％)为有慢性肝病的携带者,其中221     

韶关市区不同类型乙肝患者HDV感染情况调查

作者对208例不同临床类型乙肝患者进行HDV感染指标的检测,结果表明HDV感染情况为:HBsAg携带者(6.67％),急性肝炎(8.33％),慢性迁延性肝炎 (13.64％),重症肝炎(16.67％),慢性活动性肝炎(21.95％),肝硬化(29.63％)。提示乙肝患者感染HDV后易发展成肝硬化及HDV感染与慢性肝病有关。     

急性δ感染时HDV RNA:血清学特征和其他HDV感染标记的相互关系

急性HDV感染的血清学诊断是基于HDAg和/或抗-HD的测定。在HDV和HBV联合感染时,HDV标记往往呈一过性,而慢性HBsAg携带者重叠HDV时,多呈慢性感染并伴血清总抗-HD和IgM抗-HD阳性以及肝内HDAg。最近,应用分子杂交技术测定HDV感染患者的血清HDV RNA,旨在明确其临床意义以及观察与急性或慢性HDV感染的其他标记(如肝内HDAg和血清IgM抗-HD)的相互关系。     

丁型肝炎

由δ因子(HDV)引起的丁型肝炎,常在HBsAg阳性的携带者中与乙型肝炎病毒(HBV)联合感染或重叠感染,由HDV引起的肝炎一般为暴发型或重型,它可诱发免疫系统产生抗—HD,但该抗体对机体无保护作用。鉴于HDV已呈世界性分布,但一般对其尚乏了解,故作简要介绍。     

HBV复制调节慢性丁型肝炎中HDV的致病作用

由于丁型肝炎病毒(HDV)引起的肝病包括无症状的携带者、轻型和重型肝炎患者,因而调查HDV和乙型肝炎病毒(HBV)复制与肝炎结局之间的关系很重要。为此,作者研究了一批慢性HBsAg和抗-HD携带者肝和血清中HDV RNA和HBV核酸的水平及其与肝病病程的关系。 85例慢性HBsag和抗-HD携带者,男     

HBsAg无症状携带者的抗丁型肝炎病毒抗体

以往研究表明西非洲的塞内加尔HBsAg阳性肝病患者中,包括原发性肝细胞癌的病,人,就有22.5％丁型肝炎病毒(HDV)抗体阳性,而无症状的HBsAg携带者则未有抗—HD的检出。为此,作者检测了塞内加尔422名健康孕妇的HBV/HDV感染标志,即包括HBsAg、HBeAg和抗—HD,HBV DNA用斑点杂交法检查。对象来自塞内加尔两个     

δ肝炎病毒感染对慢性乙型肝炎患者进展为肝硬变的影响

δ肝炎病毒(HDV)具有高度致病性,可引起急、慢性肝病。以往临床研究提示,HDV 感染与慢性乙型肝炎病毒(HBV)携带者的严重性肝病有关。作者在大量罹患慢性肝病的 HBsAg 持续阳性患者中研究了HDV 感染的发生率和临床意义。对这些患者平均随访了5年,报道了 HDV 阳性的慢性肝病的主要临床和实验室结果,并将HDV 阳性患者的特征与 HDV 阴性患者和慢性乙型肝炎患者作了比较。     

Delta肝炎的血清学调查分析

本文报告了湖北某些地区 HDV 感染调查结果,在108例 HBsAg 阳性者中,发现抗-HDV 阳性者27例,阳性率为25.0％。其中48例 HBsAg 阳性携带者和28例乙肝病人中,抗-HDV 阳性者分别为9例(18.8％)和14例(50.0％),后者明显高于前者。ALT 异常者的抗-HDV 阳性率(85.7％)     

我国部分地区δ型肝炎调查研究

本文应用酶联吸附(EIA)及固相放射免疫(RIA)法对我国11个省、市、自治区共1 027例,HBsAg阳性者检测了抗-δ抗体。发现北京、上海、广西、四川、黑龙江、福建、辽宁及河南八省,市634例中未检出阳性;内蒙、新疆及西藏自治区393例中17例阳性(4.3%)。这些地区慢性活动性肝炎和慢性迁延性肝炎中抗-δ阳性率明显高于慢性无症状HBsAg携带者。提示我国HDV感染呈现明显的地方性散发特征及HDV感染对慢性肝炎的形成具有重要意义。     

IgM抗-HD为慢性δ感染的标志

慢性δ肝炎的诊断依据通常是血清中存在高滴度抗δ总抗体(抗-HD)和/或肝细胞中存在δ抗原(HDAg)。IgM 抗-HD 可在部分急性δ病毒(HDV)感染期病人中短暂出现,并已成为慢性感染的一项敏感标志。作者测定了一组抗-HD 阳性慢性肝病病人的抗体和肝内 HDAg,并研究了这两项标志与肝损害的程度和严重性的关系。共观察36例 HBsAg 阳性及组织学证实为慢性肝病和高滴度抗-HD 抗体(>1∶     

重庆部分地区HDV感染的调查

本文收集了重庆部分地区乙肝患者ＨＢｓＡｇ无症状携带者血清标本２４２份，用ＥＬＩＳＡ法检测抗－ＨＤ，２４份阳性，阳性率为９．９１％，与其它地区比较重庆部分地区ＨＤＶ感染率较高，且郊区的阳性率明显高于市区，此结果符合以前曾报告的ＨＤＶ在我国呈地方性分布的论述。原发性肝癌病人，急、慢乙型肝炎病人和ＨＢｓＡｇ无症状携带者中，以原发性肝癌病人抗－ＨＤ阳性率较高，提示ＨＤＶ感染可能与原发性肝癌的致病有关。     

丁型肝炎病毒感染的血清流行病学观察

1987年4月至1988年10月间,本文应用酶联吸附法(EIA)对石家庄地区Ml例乙型肝炎病毒感染者进行了抗-HD的检测,共发现35例阳性,阳性率12.92%,其中男性阳性率14.06%(27/102),女性为10.13%(8/79),男女间差异无统计学意义(P>0.05),提示石家庄地区可能为丁型肝炎病毒感染的高发区.在这些人群中,慢性活动性肝炎、慢性迁延性肝炎和肝硬化的抗-HD阳性率明显高于HBsAg携带者,但三者相互间差异无统计学意义,表明合并或重香感染HDV对乙肝慢性化及肝硬化的形成具有重要的意义。本研究证明在乙型肝炎病毒感染人群中丁型肝炎病毐与年龄、性别、职业等因素关系不密切。     

丁型肝炎病毒抗原酶联免疫诊断试剂盒（HDAG—E）的制备和应用

为了建立丁型肝炎病毒抗原酶联免疫诊断试剂,选用慢性肝炎患者的高效价抗-HD阳性血清用亲和层析法进行纯化;选用吐温20为裂解液处理血清,以裸露HDV核心部位的HDAg。本试剂采用酶联夹心法。经与澳大利亚及荷兰HEPAnoST1KA试剂盒HDAg对比,结果完全一致。与甲、乙型肝炎病毒抗原无交叉反应。用抗-HD阳性血清作中和试验确认其特异性可靠。对本院各类HBsAg阳性的肝炎患者或携带者血清测定结果,其HDAg的检出率为2.29％(9/392);国内8省、市同类病例HDAg检出率为1.37％(10/729)。临床及流行病学调查表明,本试剂可靠、实用。     

丁型肝炎系列酶免诊断试剂的研制及应用

为解决丁型肝炎诊断试剂短缺的问题，本研究采用实验感染ＨＤＶ的土拨鼠肝脏和丁型肝炎病人血清，提取纯化丁型肝炎病毒抗原和抗体，制备了检测ＨＤＡｇ、抗－ＨＤ、ＩｇＭ抗－ＨＤ的系列酶免诊断试剂。该试剂与进口同类试剂相比较，符合率达１００％。其特异性好，灵敏度较高。对不同类型乙型肝炎病人血清检测，ＨＤＡｇ、抗－ＨＤ及ＩｇＭ抗－ＨＤ阳性率和总阳性率分别为２．９９％、３．３６％、３．７３％和７．２８％。该试剂的研制为丁型肝炎病毒感染的临床诊断及流行病学研究提供了可靠的实验手段。     

Unexpected low prevalence of delta antibodies in the east Amazon region and S?o Paulo: evidence for regional differences in the epidemiology of delta hepatitis virus within Brazil

Antibodies (anti-HD) to hepatitis delta virus (HDV) were tested by radioimmunoassay in 207 human serum samples from the eastern Amazon (states of Pará and Amapá) and S?o Paulo, Brazil. 42 Amazon HBsAg asymptomatic carriers were negative for anti-HD. 84 S?o Paulo HBsAg asymptomatic carriers were also negative. Among the 81 HBsAg patients from S?o Paulo with different liver diseases, only one had anti-HD. Liver biopsy of this chronic active hepatitis case was positive for HBsAg, HBcAg and HDAg in liver, by an immunoperoxidase technique. The low prevalence of HDV infections in S?o Paulo and eastern Amazon was unexpected and contrasts with the recent reports of high prevalence in the western Amazon region. Such regional differences emphasize the need for extensive and precise worldwide epidemiological studies of HDV.     

河南省人群丁型肝炎病毒感染的血清流行病学调查研究

为了了解河南省丁型肝炎病毒的人群感染情况，从１９９１－１９９３年对河南省十三个地区１１８２例ＨＢｓＡｇ阳性的各型乙肝病人及无症状ＨＢｓＡｇ携带者血清标本进行ＨＤＡｇ、抗ＨＤＶ和ＩｇＭ－抗－ＨＤＶ三项标志检测。结果表明，河南省人群ＨＤＡｇ、抗－ＨＤＶ、ＩｇＭ－抗－ＨＤＶ的总感染率分别为３．０％、３．５％、３．５％、８．１％。     

Epidemiology and clinical outcome of hepatitis D virus infection in Turkey

The prevalence, the epidemiology, the clinical and biochemical characteristics of hepatitis delta virus (HDV) infection were studied in patients with HBsAg-positive acute hepatitis, in those with chronic liver disease, and in apparently healthy carriers in Turkey.Fifty-eight of the 242 carriers of HBsAg (23.9%) and 31 of the 237 (13.1%) patients with acute HBsAg-positive hepatitis had serological evidence of HDV infection. Eleven of these individuals were HBsAg carriers with acute HDV superinfection. The prevalence of HDV infection was significantly (p < 0.001) higher in patients with chronic liver disease (54/165; 32.7%) than in asymptomatic carriers of HBsAg (4/77; 5.2%). The highest prevalence (26/57; 45.6%) of HDV infection was found in patients at high risk of acquiring hepatitis virus infection (health care workers, hemodialysis patients, polytransfused patients) with chronic liver disease.Whereas the frequency of severe or fulminant hepatitis was similar in HBV infected patients (7.8%) and in HBV/HDV coinfected individuals (10%), the frequency of biphasic hepatitis was significantly (p < 0.005) higher in the latter patients (30%) than in those with classical hepatitis B (7.8%). Chronic evolution of the disease was observed in 3.9% of the patients with classical hepatitis B and in 5% of those who had evidence of simultaneous HBV/HDV infection. The 10 carriers of HBsAg who survived the acute HDV superinfection developed chronic delta hepatitis.These findings indicate that HDV is endemic in Turkey and that its prevalence is highest among chronic HBsAg-positive hepatitis patients, implicating HDV as a major cause of liver disease among urban Turkis.Corresponding author.     

Sexual behaviour and multiple infections in drug abusers

We have studied the prevalence and the serological profile of HBV, HCV, HDV and HIV infections in 137 Italian subjects addicted to the intravenous use of heroine and correlated the virological findings with sexual behaviour. HBV and HCV viremia were also measured in 114 patients. Anti-HCV was detected in 81% of the addicts, and one or more markers of HBV infection were detected in 62.8% (4.4% were carriers of HBsAg, 58.4% had evidence of past HBV infection and 13.1% of the latter also had HDV markers). Anti-HIV was positive in 23.4%; 26% of those positive for anti-HCV and 4.6% of those positive for HBV markers had no other viral marker: none had only anti-HIV. HBV-DNA was negative in the carriers of HBsAg, and HCV-RNA was not detected in any of the HBsAg carriers who also had circulating anti-HCV Overall, 34% of the anti-HCV positive addicts had HCV-RNA in their blood. The prevalence of the virus infection correlated with the duration of drug addiction but not with sexual behaviour, and sexual behaviour did not influence the acquisition of any virus. HCV infection was most frequent and probably the first infection to occur, but exposure to HBV was also common despite a low rate of HBsAg carriage. The prevalence of HDV infection was high (50%) in the HBsAg carriers, while the overall prevalence of HIV was lower (23%) than expected. Lack of HBV-DNA and HCV-RNA in carriers of HBV with anti-HCV in serum may indicate that HBV and HCV mutually inhibit their own replication.     

Delta virus and hepatitis B surface antigen in chronic liver diseases.

This work was carried out on 45 patients with chronic liver diseases, including 24 cases of liver cirrhosis and 21 cases of chronic hepatitis. Their ages ranged from 2 to 15 years (median 5). All cases were examined clinically and assessed biochemically for liver function tests. Serological studies were performed to detect hepatitis B surface antigen (HBsAg) and delta IgG antibody (IgG anti-HD) using Enzyme Immunoassay (EIA) technique. The study showed that IgG anti-HD was detected in 8.9% of cases with chronic liver diseases (all positive cases were with liver cirrhosis). On the other hand, HBsAg was detected in 53.3% of cases (54.2% of them with cirrhosis and 45.8% with chronic hepatitis) with no significant association between HBsAg positivity and type of hepatic illness. Moreover, IgG anti-HD was positive in only 4.2% of HBsAg positive cases, while 14.3% of HBsAg negative cases were positive for IgG anti-HD. A significant association was also found between delta positivity and serum glutamic oxaloacetic transferase level (SGOT). We concluded that chronic delta hepatitis appeared to be more severe than other types of chronic viral hepatitis, as all delta positive cases were with liver cirrhosis and had elevated SGOT levels. Screening of delta markers in addition to hepatitis B viral markers could improve the understanding of a number of obscure cases of chronic hepatic illnesses and would help in the control of HBV and consequently HDV infection in the general population.     

Evidence of a 1985-1987 outbreak of acute and chronic hepatitis in Egypt caused by a mutant hepatitis-B virus detected by spot-DNA hybridization test.

Sera from 65 acute and 113 chronic sporadic hepatitis were screened for serological markers of hepatitis-B virus (HBV) and hepatitis delta virus (HDV) and for HBV-DNA. The enzyme linked immune sorbent assay (ELISA) and dot-DNA hybridization tests were used. Two HBV-DNA probes and their labelling systems (biotin, radiolabelling with 32P and digoxigenin) were compared for sensitivity and specificity. The 65 acute sera had serological parameters of HBV infection in 38 (58%) when all these sera were HBsAg, IgM anti HBcAg positive plus HBeAg presence in 11/38 sera. Some of the acute sera had markers of acute HBV and HDV coinfection in 14 and superinfection in 13. Thus HBV with HDV represented 27 (41.5%) of the acute hepatitis in this study. Correlation of these serological markers with dot-DNA hybridization results showed that serum HBV-DNA was present in 36/38 (94.7%) of the acute HBV infection. In the case of acute HBV+HDV positive antigenemia 4/6 had serum HBV-DNA while 10/21 of acute HBV with anti-deltaV. IgM had serum HBV-DNA. There were four cases that gave HBV-DNA positivity in sera without combination of HBV markers suggesting infection with "mutant" HBV. In the chronic hepatitis sera there were markers of HBV past infection (IgG anti HBc in 63/113 and IgG anti HBs in 36/113). Yet, among these sera there was HBV-DNA positive signals (20/63 and 17/36) respectively. Analysis of some of these HBV markers also suggested infection with "mutant" HBV.