The association of syphilis with cirrhosis: the role of alcohol and serum hepatitis

The role of syphilis and alcohol was investigated in a prospective study of patients with cirrhosis of liver in Uganda, and results were correlated with the histological type of cirrhosis, and serological tests for hepatitis B antigen (HB Ag). Eighteen out of eighty (22·5%) patients with histologically-proven cirrhosis had positive serology for syphilis (VDRL and TPI). A high incidence of alcoholism (80%) and syphilis (60%) was found in patients with micronodular cirrhosis who were all negative for HB Ag. By contrast, HB Ag was detected in 37% of patients with macronodular cirrhosis who had a much smaller incidence of syphilis and alcoholism. Although chronic infection with hepatitis B virus related to HB Ag appears to be an important factor in the pathogenesis of cirrhosis in at least 30% of cases, infection acquired during past treatment for syphilis is not an important cause of the association of syphilis with cirrhosis in this population. Subdivision of patients with cirrhosis into those with and those without a history of severe alcohol abuse showed that the difference between the incidence of syphilis in the two groups is significant statistically. However, evidence of syphilis in association with non-alcoholic as well as alcoholic cirrhosis in this and other previously reported series suggests that the association between the two diseases cannot be entirely explained through the common factor of alcoholism, and other factors may also be responsible.     

The role of immunological mechanisms in acute and chronic hepatitis

Studies of asymptomatic carriers of hepatitis B antigen (HB Ag) have suggested that the hepatitis B virus may not be directly damaging to liver cells and it is possible that the hepatocellular necrosis which accompanies acute hepatitis may be induced by immunological reactions directed at viral antigenic determinants on the surface of infected cells.     

Recent advances in the identification of hepatitis viruses.

Resulting directly from the discovery of virus-related antigens, rapid progress has marked the last decade of viral hepatitis research. The hepatitis B virion has been tentatively identified as a DNA virus with an endogenous DNA polymerase, and new serological markers for type B hepatitis have been discovered. Hepatitis A antigen has been identified on a virus-like particle thought to be the hepatitis A virion. Progressively more sophisticated assays for hepatitis antigens and antibodies have been applied to the study of viral hepatitis epidemiology and biochemical-biophysical characterization of the agents. Most recently, knowledge learned from such studies has been exploited to develop a prototype non-infectious but immunogenic hepatitis B vaccine using hepatitis B surface antigen (HBsAg) purified in large quantities from chronic HBsAg carriers. Especially exciting is the prospect, suggested by serological studies of viral hepatitis, that hepatitis viruses besides hepatitis A and B viruses will be identified.     

心脏手术对乙肝及乙肝病毒携带者肝功能的影响

目的观察体外循环心脏手术对乙肝（HB）及乙肝病毒（HBV）携带者肝功能的影响。方法对心脏病手术患者于手术前后进行了肝功能测定，其中肝功能正常组45例、HBV携带组42例，HB组18例。结果体外循环对HBV携带者的肝功能无显著影响（P〈0．05），对其术后出血也无明显影响。HB患者体外循环术后谷丙转氨酶（ALT）及谷草转氨酶（AST）显著升高，且其术后出血量较肝功正常者明显增加（P〈0．05）。结论术前肝功能正常的乙肝病毒携带者接受心脏手术是安全的．HB患者心脏手术中肝功能损害是可逆性的，只要采取必要的保护措施也可以接受手术治疗．     

Treatment of viral hepatitis in children

Hepatitis B and hepatitis C are important causes of chronic liver disease in children and adolescents, and later on for potential cirrhosis and primary hepatocellular carcinoma. The risk of developing chronic hepatitis B (HB) infection ranges from 90% in neonates to <5% in adults. Hepatitis C induces chronic infection in at least 85% of affected persons. HBV and HCV associated liver damage appears to be less severe in children than in adults. At the present time, lamivudine and a combination of interferon and lamivudine seem to be the best options for HB infection treatment in the pediatric population, even though they induce the presence of drug-resistant mutations, and new therapies have to be developed to improve reduction and cessation of viral replication and decrease the emergence of mutations. Therapy with interferon and ribavirin seems to offer the best results for children and adolescents. Results from a study on pegylated interferon in a pediatric population might lead to better therapeutic responses. Cost of treatment for chronic viral hepatitis is very high and efforts have to continue to extend hepatitis B vaccination to the general population worldwide to reduce vertical and horizontal transmission of hepatitis C.     

Prospective evaluation of seropositive occult hepatitis B viral infection in lymphoma patients receiving chemotherapy

OBJECTIVE. To serially evaluate the viral kinetics of occult hepatitis B virus infection in lymphoma patients and perform a correlation with clinical outcomes. DESIGN. Case series with 1-year follow-up. SETTING. Regional hospital, Hong Kong. PATIENTS. Consecutive patients who were newly diagnosed to have lymphoma in the hospital between 1 April 2007 and 31 March 2008 were tested for hepatitis B (HB) surface (s) antigen (Ag), anti-HBs antibody (Ab) and anti-HB core (c) Ab. Seropositive occult hepatitis B patients as defined by being negative for HBsAg but positive anti-HBsAb and/or anti-HBcAb without a hepatitis B vaccination history were recruited. Serum HBsAg, anti-HBsAb, anti-HBcAb, hepatitis B virus deoxyribonucleic acid (DNA) level, and liver biochemistry were checked at baseline and every 4 weeks during and after chemotherapy until 12 months after the completion of chemotherapy or death. Entecavir was started if patients developed biochemical flare-up of hepatitis B associated with virological rebound. The prevalence and course of hepatitis B virus-related hepatitis, as well as any temporal relationship to viral kinetics and clinical hepatitis, were assessed. RESULTS. Of 47 patients tested, 10 (21%) with lymphoma were seropositive occult hepatitis carriers. Their median baseline hepatitis B virus DNA level was 89 IU/mL (range, <34-807 IU/mL). Virological rebound (as defined by a 10-fold increase in serum hepatitis B virus DNA level from pre-chemotherapy level persisted for 4 weeks) occurred in one of the 10 patients, followed by biochemical reactivation. Whereupon entecavir treatment was started and no liver failure ensued. Regarding the other seropositive occult patients, their serum hepatitis B virus DNA levels fluctuated, but there was no associated biochemical reactivation. CONCLUSION. Detectable baseline serum hepatitis B virus DNA is not uncommon in patients with occult hepatitis B who receive chemotherapy. Transient elevation in serum hepatitis B virus DNA levels does not predict biochemical reactivation, but antiviral treatment might be considered if virological rebound persists.     

Treatment of chronic active hepatitis in children

Thirty-eight children with chronic active hepatitis are reported. Their mode of presentation was usually indistinguishable from acute viral hepatitis (63%). Extra hepatic manifestations were more common in those patients with an insidious onset. The twenty-eight patients tested for hepatitis B antigen (HB Ag) were all negative and SGOT values were higher (mean 1000 i.u./l) than those reported in adult patients with chronic active hepatitis. Thirty-three patients had marked elevation of serum gammaglobulin (mean 3·78 g/100 ml) and 34% had positive LE cells. All patients had histologic features of ‘aggressive’ hepatitis; in addition five biopsies also showed areas of submassive hepatic necrosis. The initial response to corticosteroid was excellent in all but three patients. To date drug therapy has been suspended in fifteen patients for periods of 3 months to 4 years and 7 months. There have been eight deaths. Three with hepatic insufficiency and two with sepsis. Three others have subsequently died following orthotopic liver transplantation.     

Prevention and treatment of hepatitis B relapse after liver transplantation

Ｏｒｔｈｏｔｏｐｉｃｌｉｖｅｒｔｒａｎｓｐｌａｎｔａｔｉｏｎ (ＯＬＴ)ｈａｓｂｅｅｎｔｈｅｍｏｓｔｅｆｆｅｃｔｉｖｅｍｅｔｈｏｄｆｏｒｅｎｄｓｔａｇｅｈｅｐａｔｉｃｄｉｓｅａｓｅ ＨｅｐａｔｉｔｉｓＢ(ＨＢ)ｒｅｌａｔｅｄｌｉｖｅｒｄｉｓｅａｓｅｓｈａｖｅｂｅｅｎｔｈｅｍａｉｎｉｎｄｉｃａｔｉｏｎｏｆＯＬＴｂｕｔｔｈｅＨＢｒｅｃｕｒｒｅｎｃｅｒａｔｅａｆｔｅｒＯＬＴｒｅａｃｈｅｓ 80 %ｏｒｍｏｒｅ,ｌｅａｄｉｎｇｔｏｈｅｐａｔｉｃｆａｉｌｕｒｅ ,ｒｅｔｒａｎｓｐｌａｎｔａｔｉｏｎｏｒｅｖｅｎｄｅａｔｈ…     

肝移植后乙肝复发的预防和治疗

目的　探讨原位肝移植治疗乙型肝炎相关疾病的效果及Lamivudine在防治肝移植后乙肝复发中的作用。方法　 10例患者接受了原位肝移植 ,其中 9例男性为乙肝患者 ,1例女性为肝癌患者 ,术前无乙肝感染。 9例乙肝患者中 ,6例并有不同程度的肝性脑病 ,1例并肝肾综合征 ,1例并上消化道大出血。 9例乙肝中 ,7例服用Lamivudine预防术后乙肝复发。结果　 8例存活 2 - 12个月 ,2例死亡。存活的 8例中 ,7例为乙肝患者 ,仅 1例术后 6个月出现HBsAg( ) ,但全部均肝功能良好 ;另 1例为肝癌患者 ,术后 6个月出现乙肝。死亡的 2例中 ,1例为术后乙肝复发暴发性肝功能衰竭所致 ,另 1例死于术后多器官功能衰竭。结论　原位肝移植加Lamivudine是治疗乙肝和肝细胞癌病例的有效方法。Lamivudine在观察期内可预防乙肝移植后乙肝复发。     

Prevention of intrauterine infection by hepatitis B virus with hepatitis B immune globulin: efficacy and mechanism

Objective　To evaluate the efficacy of hepatitis B immune globulin (HBIG) in preventing intrauterine infection by hepatitis B virus (HBV) and to investigate its mechanism. Methods　Forty-eight pregnant women positive for hepatitis B surface antigen (HBsAg) were randomly divided into 2 groups. The 34 women in the study group were injected with HBIG during pregnancy; the other 14 women were controls. Maternal blood samples were taken before HBIG injection and at delivery. Neonatal blood samples were taken within 24 hours after birth before HBIG and hepatitis B vaccine were given. HBsAg and antibody to HBsAg (anti-HBs) were tested by radioimmunoassay. Results　None of the 35 newborns (including 2 twins) in the study group was positive for HBsAg, but 3 (21%) in the control group were positive (P=0.02). The HBsAg titers in the women in the study group decreased after HBIG injection. Of the 35 newborns in the study group, 32 (91%) were positive for anti-HBs. Conclusion　Systematic injections of HBIG during pregnancy may prevent intrauterine HBV infection, the mechanism of which may be reduction of maternal HBV viremia and production of fetal passive immunity.     

乙型肝炎患者血清甲状腺激素水平变化及其临床意义

目的探讨乙型肝炎患者血清甲状腺激素水平的变化及临床意义。方法将45例乙型肝炎患者分为慢性轻度组21例,慢性中度组19例和慢性重度组5例;同时选择15例健康人群为对照组,测定各组血清甲状腺激素水平。结果与对照组比较,乙型肝炎患者血清总三碘甲状腺原氨酸(TT3)、总甲状腺素(TT4)、游离三碘甲状腺原氨酸(FT3)水平降低(P<0.05),而反三碘甲状腺原氨酸(rT3)和甲状腺素结合球蛋白(TBG)水平升高(P<0.05)。慢性轻度组、慢性中度组和慢性重度组3组间各指标两两比较差异均有统计学意义(P<0.05);随着患者病情的加重,患者血清TT3、TT4、FT3水平逐渐降低,而rT3、TBG水平逐渐升高。结论血清甲状腺激素水平可以反映乙型肝炎患者的病情严重程度;动态监测乙型肝炎患者血清甲状腺激素水平具有重要的临床价值。     

乙型肝炎三个抗原抗体系统的联合检测及HBsAg动态观察

<正> 乙型病毒性肝炎流行广泛,发病率高,目前各地关于乙肝的研究,报告甚多。本文仅就乙肝的三个抗原抗体系统的检测及HBsAg的动态改变,综合报告如下。 资料来源 本文病例均系1982～1983年传染病院收治的肝炎病人,均按1978年杭州全国肝炎会议所制定的病毒性肝炎诊断标准进行确诊。     

CD4+CD25+FoxP3+免疫调节细胞在不同免疫应答状态乙型肝炎疫苗接种者中的表达

目的:通过对乙型肝炎病毒疫苗接种后不同免疫应答人群CD4+ CD25+T调节细胞(T regulatory cells,Tregs)及FoxP3 mRNA的表达及细胞因子分泌的检测,探讨乙型肝炎病毒疫苗接种后免疫应答与免疫调节细胞和细胞因子之间的内在联系.方法:采集不同反应人群(应答组18例,无应答组22例,对照组10...     

细胞趋化因子受体5在病毒性肝炎患者外周血单核细胞中的表达

目的研究细胞趋化因子受体5（CCR5）在乙型病毒性肝炎（HB）免疫发病机制中的作用。方法用流式细胞仪对20例正常人（NC）及20例HB患者外周血单核细胞（PBMC）水平进行检测，并比较其经植物凝血素（PHA）培养前后的变化。结果培养前NC与HB患者PBMC的CCR5的表达无明显差异（P〉0．05）；培养后HB患者CCR5表达水平高于NC（P〈0．05）；NC的CCR5表达均较培养前明显减少（P〈0．05），而HB患者的CCR5表达虽较培养前减少，但无统计学意义（P〉0．05）；急性乙型肝炎（AHB）、慢性乙型肝炎（CHB）、肝硬化（LC）患者的CCR5的表达有一定的差别：AHB〉CHB〉LC，但无统计学意义（P〉0．05）。病毒复制指标阳性组CCR5的表达明显低于阴性组（P〈0．05）。结论HB患者PBMC的CCR5的表达水平与HB的临床转归可能有一定的关系，高水平的CCR5患者预后较好；PMBC高水平CCR5的表达可能不利于乙型肝炎病毒（HBV）的复制。     

大学生乙型肝炎基因重组疫苗接种效果分析

目的 观察乙型肝炎基因重组疫苗的安全性和对大学生的免疫效果,为制定免疫策略提供依据。方法 应用乙肝酶母重组疫苗,按0,1和2月3针接种乙肝血清标志物全阴的156名大学生,并用定量族免法（PIA）对免疫后的抗体反应进行检测。结果 未发现接种对象出现严重副反应。成全程免疫后2个月时,抗体阳转率达81．41％,但大多数接种者体滴度（mean geometric titer,GMT）在（10－99）IU／L之间,为低应答水平,只有1．92％的人GMT在100IU／L以上,男、女生之间抗体阳转率及GMT构成分布差异多无显著性。12名既往疫苗接种抗体无应答者复种疫苗后,有7人抗体转阳。结论 乙肝重组疫苗安全性较,对大学生免疫后的抗体阳转率尚可,但抗体应答水平较低,性别差异不明显。免疫失败后可考虑复种,以增强抗体阳转机会。     

HBIG及乙肝疫苗联合应用阻断乙肝母婴传播效果分析

目的 :研究乙型肝炎免疫球蛋白 (HBIG)和乙型肝炎疫苗联合应用对乙型肝炎产后母婴传播阻断作用及对出生时已感染乙肝病毒新生儿乙型肝炎表面抗原阴转的效果。方法 :选择 6 8例乙型肝炎表面抗原 (HBsAg)及乙型肝炎e抗原 (HBeAg)双阳性母亲所产新生儿 ,于产后 4h～ 6h乙肝疫苗免疫接种前抽股静脉血检测HBsAg和HBeAg ,新生儿于 6h和 1月龄分别注射HBIG 10 0IU ,并按 0 ,1,6 (5 μg)方案注射乙型肝炎疫苗 ,于 1岁龄复查HB sAg和HBeAg。结果 :新生儿HBsAg和HBeAg双阳性 2 5例占 36 .76 % ,HBeAg单阳性 1例 1.4 7% ,HBsAg单阳性 18例占 2 6 .4 7% ,HBsAg和HBeAg双阴性 2 4例占 35 .2 9% ;1岁龄HBsAg转阴 19例占 4 3.18% ,其中HBsAg和HBeAg双阳性转阴性 4例 ,HBsAg单阳性转阴性 15例。HBsAg阴性转阳性 2例占 8.33%。结论 :人HBIG和乙型肝炎疫苗联合应用能有效阻断乙型肝炎因母婴接触、母乳喂养引起的传播 ,有效率为 91.6 7% ;并使已感染乙肝病毒新生儿的HBsAg转阴率达到 4 3.18%。     

HBsAg阳性者乙肝标志物及肝功检测结果分析2 562例

【目的】通过对正常体检者HBsAg阳性标本的不同乙肝标志物模式类型的统计,探讨HBsAg在乙肝病情及传染性方面的真正价值。【方法】检测34 532例健康体检标本中2 562例HBsAg阳性者的HBV血清学指标:表面抗原(HBsAg)、表面抗体(HBsAb)、e抗原(HBeAg)、e抗体(HBeAb)、核心抗体(HBsAb)、核心抗体IgM(HBcIgM)。以阳性项目出现的序号为该类型的代码,结合肝功能指标,分析临床意义。【结果】在每一阳性标本中,可能存在不止一种标志物,在2 562例标本中按每个阳性标本中的阳性标志物的分布可归纳成9种不同的乙肝标志物模式类型。【结论】在健康查体中的HBsAg阳性者中存在着很多特殊情况例如模式7、8、9这样的特殊类型,应做乙肝血清标志物并结合肝功能来判断其病情和传染性。     

西安市459例急性病毒性肝炎住院患者血清学及流行病学调查

目的：研究西安市急性散发性病毒性肝炎的发布情况。     

湖南郴州市1992～2006年乙肝流行特征分析

目的分析1992～2006年郴州市乙肝流行特征，为预防和控制乙肝提供科学依据。方法收集整理郴州市1992～2006年乙肝疫情资料，并对其进行描述性研究分析。结果郴州市1992—2006年乙肝年均发病率为21．00／10万，乙肝发病率从1992年的11．95／10万上升至2006年的40．72／10万，1992～1996、1997～2001和2002—2006年三个时段的年均发病率分别为15．40／10万、22．55／10万和24．83／10万，三时段发病率差异有统计学意义（Y0=509．35，P〈0．01）；各县（市、区）年均发病率差异有显著性（X^2=2968．94，P〈0．01）；发病主要集中在15～40岁年龄阶段，占总发病数的59．01％，男女发病比例为2．63：1；职业主要为农民、学生和工人，分别占总发病数的43．44％、15．38％和13．82％；发病季节性不明显。结论郴州市乙肝发病率仍较高，且有上升趋势，今后应加强乙肝监测，提高乙肝疫苗接种率，严格执行医院消毒制度，加强血液制品管理，开展健康教育，以有效控制乙肝的发病和流行。     

乙肝血清标志物-前S1抗原的临床意义

目的探讨乙肝病毒前-S1抗原与乙肝血清标记HBeAg、HBV-DNA的相互关系,了解乙肝病毒感染者血清前S1抗原的临床意义。方法双抗体夹心ELISA法测定血清前S1抗原,ELISA法测定乙肝病毒血清标记,荧光定量PCR检测血清乙肝病毒DNA。结果分析常规HBV血清标记物不同组合模式发现,HBeAg阳性模式中前S1抗原的检出率显著高于HBeAb阳性模式,其中S1抗原和HBeAg的符合率达80.88%;HBV-DNA阳性组前S1抗原的检出率明显高于HBV-DNA阴性组,两者的总体符合率达80.27%。结论血清前S1抗原与HBV-DNA、HBeAg相互关联,可以作为HBV存在和复制的标志。联合检测前S1抗原与HBV-DNA、HBeAg可相互补充、印证,对判断乙肝病毒的复制和存在更有价值。