Vitamins B status and antioxidative defense in patients with chronic hepatitis B or hepatitis C virus infection

Background & Aims  

The impact of hepatitis B virus (HBV) or hepatitis C virus (HCV) infection upon B vitamins status and antioxidative defense in infected patients was examined.     

慢性乙型肝炎的治愈现状

慢性乙型肝炎（chronic hepatitis B, CHB）是一种广泛的全球感染性疾病,是肝细胞癌和肝衰竭的主要原因。目前可以通过接种乙型肝炎疫苗降低CHB的新发感染率,主要的治疗方法是通过聚乙二醇化干扰素α和核苷（酸）类似物抑制病毒,延缓CHB患者的疾病进展,但不能治愈CHB。如何清除稳定的DNA中间体共价闭合环状DNA,以及如何恢复肝脏微环境中疲惫的免疫系统是目前面临的挑战。为此肝病学者们不断探索新的靶标和药物,研究通过针对HBV生活周期不同阶段的药物联合疗法实现持久功能性治愈。本文将对目前CHB的多种治疗策略以及正在研发的新靶标和新药物进行回顾。     

云南省婴幼儿乙型肝炎病毒感染现状及乙肝疫苗接种状况分析

目的 分析2019年云南省婴幼儿乙型肝炎病毒感染现状及乙肝疫苗接种状况.方法 按照分层抽样方法在云南省16个州(市)129个县(市、区)抽取了387个乡镇的1149个调查点,再采用简单随机抽样方法,共调查8～23月龄婴幼儿7500名.婴幼儿分为8个年龄组,即:8月龄、9月龄、10月龄、11月龄、12月龄～、15月龄～、18月龄～、21～23月龄.现场通过问卷调查收集婴幼儿的乙肝疫苗接种情况及个人基本信息,采集血样,采用酶联免疫吸附试验检测HBsAg、Anti-HBs及Anti-HBc,并将结果录入数据库进行统计分析.结果 7500名婴幼儿乙肝疫苗首次及时接种率为80.99％,全程接种三针剂占96.73％,接种两针剂占2.51％,接种一针剂占0.29％,免疫史不详占0.47％;城镇与乡村接种率差异均无统计学意义(P>0.05).保护性抗体阳性率为88.33％,各年龄组间保护性抗体阳性率差异有统计学意义(χ2=98.78,P<0.05),随着年龄逐渐增长,到11月龄达高峰,之后逐渐下降.HBV血清标志物组合模式中,既无抗体也未感染模式(三项全阴)占10.28％;通过接种疫苗产生抗体模式(Anti-HBs单项阳性)占78.40％;感染乙型肝炎病毒模式占0.28％,各年龄组间差异无统计学意义(χ2=7.86,P>0.05).结论 2019年云南省8～23月龄婴幼儿乙肝疫苗全程接种率较高,城市与乡村疫苗接种率差异无统计学意义;保护性抗体阳性率各年龄组间差异显著,11月龄组最高,之后逐渐降低.乙型肝炎病毒感染状况城市与乡村差异不大.     

拉米夫定经治慢性乙型肝炎患者治疗现状调查分析

目的了解我国拉米夫定(LAM)经治慢性乙型肝炎(慢性乙肝)患者的治疗情况,为进一步优化慢性乙肝患者的治疗方案提供依据。方法采用问卷调查形式,调查全国110个城市741家医院的684名医师及其LAM经治慢性乙肝患者情况。结果 684名医师中,采取LAM经治患者占39.62%(271人);65.50%(448人)医师认为患者可承担抗病毒药物的费用为每月500～1000元。LAM经治慢性乙肝2 396例HBeAg阳性患者中,自行停药、疗效不佳停药和达到停药标准停药者分别占46.74%、23.04%和30.22%;LAM经治慢性乙肝1 046例HBeAg阴性患者中,自行停药、疗效不佳停药和达到停药标准停药者分别占48.95%,22.47%和28.59%,两者差异无统计学意义(P>0.05)。在1 632例自行停药者中,1年、2年、3年累计停药率分别为24.27%、58.77%、80.58%;在787例疗效不佳停药者中,1年、2年、3年累计停药率分别为18.93%、55.14%、78.53%;在1 023例达到停药标准停药者中,治疗2～3年者占46.53%,3年以上者占53.47%。在1年内停药545例LAM经治慢性乙肝者中,72.66%为自行停药,27.34%为疗效不佳停药;1 393例2年内停药者中,68.84%为自行停药,31.16%为疗效不佳停药;3年内停药者中,54.59%(1 315/2 409)为自行停药,25.65%(618/2 409)为疗效不佳停药,19.76%(476/2 409)为达到停药标准停药;3年以上停药者中,30.69%(317/1 033)为自行停药,16.36%(169/1 033)为疗效不佳停药,52.95%(547/1 033)为达到停药标准停药。结论我国LAM经治患者所占比例较高,其经济承受力有限,依从性差,因此,优化拉米夫定经治慢性乙肝患者的治疗和提高其依从性十分重要。     

Prevalence of chronic hepatitis B virus infection before and after implementation of a hepatitis B vaccination program among children in Nepal

Background

In Nepal, an estimated 2–4% of the population has chronic hepatitis B virus (HBV) infection. To combat this problem, from 2002 to 2004, a national three dose hepatitis B vaccination program was implemented to decrease infection rates among children. The program does not currently include a birth dose to prevent perinatal HBV transmission. In 2012, to assess the impact of the program, we conducted a serosurvey among children born before and after vaccine introduction.

Methods

In 2012, a cross-sectional nationally representative stratified cluster survey was conducted to estimate hepatitis B surface antigen (HBsAg) prevalence among children born from 2006 to 2007 (post-vaccine cohort) and among children born from 2000 to 2002 (pre-vaccine cohort). Demographic data, as well as written and oral vaccination history were collected. All children were tested for HBsAg; mothers of HBsAg positive children were also tested. Furthermore, we evaluated the field sensitivity and specificity of the SD Bioline HBsAg rapid diagnostic test by comparing results with an enzyme immunoassay.

Results

Among 2181 post-vaccination cohort children with vaccination data by either card or recall, 86% (95% confidence interval [CI] 77–95%) received ≥3 hepatitis B vaccine doses. Of 1200 children born in the pre-vaccination cohort, 0.28% (95% CI 0.09–0.85%) were positive for HBsAg; of 2187 children born in the post-vaccination cohort, 0.13% (95% CI 0.04–0.39%) were positive for HBsAg (p = 0.39). Of the six children who tested positive for HBsAg, two had mothers who were positive for HBsAg. Finally, we found the SD Bioline HBsAg rapid diagnostic test to have a sensitivity of 100% and a specificity of 100%.

Conclusions

This is the first nationally representative hepatitis B serosurvey conducted in Nepal. Overall, a low burden of chronic HBV infection was found in children born in both the pre and post-vaccination cohorts. Current vaccination strategies should be continued.     

Treatment of chronic hepatitis B virus infection

The treatment of the patient with chronic hepatitis B virus infection (HBV) must be carried out with the knowledge that the percentage of patients infected with the B virus that develop chronic hepatitis remains between 5-10%. Of these, 10-30% will present chronic infection with active viral replication, necroinflammatory hepatic lesion, evolution to hepatic cirrhosis and the risk of developing hepatocarcinoma. For this reason, the aim of treatment is to achieve negativisation of the HBeAg, seroconversion to anti-HBe and a reduction of viral replication to undetectable values (estimated by level of DNA-HBV), for protracted periods of time. When a sustained loss of HBeAg and a reduction of viral replication are obtained, a biochemical, clinical and histological remission is achieved. Up until now the therapeutic alternatives in chronic infection by the B virus have been immunomodulation with Interferon alpha and the blocking of viral replication with lamivudine or adefovir dipivoxil. A difference must be drawn between the biochemical response, defined as a fall in the transaminases to normal values, and the virological response, which refers to a fall in the levels of DNA-HBV below 10(5) copies/ml. Finally, the complete response is defined as the virological and biochemical response with negativisation of the HBsAg. If a sustained response is obtained for several months, a histological response can be predicted with reduction in the intensity of the hepatic lesion and an absence or stabilisation in the process of fibrosis. The sustained response should last for no less than 6 to 12 months following the end of treatment.     

Endogenous serum interferon-alpha in patients with chronic hepatitis B virus infection

Serum endogenous interferon-alpha was determined in 42 patients with chronic hepatitis B virus infection by radioimmunoassay using an Abbott kit (USA). The study sample included 26 males and 16 females, aged 3 to 59 years (mean, 30.1). Ten of these patients had a history of acute viral hepatitis B carrying HBsAg for more than 6 months. Thirty two patients were accidentally found to be virus carriers for 8 months to 15 years. Six of these were treated with interferon-alpha and one with Ursofalk. Forty one patients (97.62% +/- 2.38) were anti-HBcIgG positive which confirmed former hepatitis B virus infection. Only one patient who was anti-HBcIgG positive was found to be also anti-HBcIgG positive, anti-HBcIgM positive, HBeAg negative, and anti-HBe positive later biophysically verified as exacerbated chronic active hepatitis. Serum HBeAg was detected in 13 of the whole sample (30.95% +/- 7.13); 8 patients (32% +/- 9.33) were HBV-DNA positive, i.e., a third of the cases presented with active replication of the hepatitis B virus. In all 42 patients with chronic hepatitis B virus infection (convalescence and health HBsAg carriers) serum interferon-alpha levels were nil or close to nil. Only in the patient with chronic active hepatitis the serum interferon level was 3.83 IU/ml. These data support the observations that interferon-alpha production is reduced in chronic hepatitis B virus infection and are consistent with the view that treatment with exogenous interferon-alpha stimulates the clearance of the virus.     

慢性乙型肝炎患者免疫状态变化规律研究

目的 探讨慢性乙型肝炎患者免疫状态变化的规律.方法 回顾性分析医院2007年1月-2008年3月收治的84例慢性乙型肝炎患者诊治资料,33例患者经干扰素治疗后HBV-BNA转阴设为观察组;51例患者经治疗后HBV-BNA未转阴设为对照组;比较两组患者治疗前后、同期正常人的CD3+T、CD4+T、CD8+T、HLA-DR、CD18、CD83、CD86水平,总结慢性乙型肝炎患者的免疫状态变化规律.结果 两组患者在治疗前,CD4+T浓度较正常人显著偏低,CD8+T却较正常人显著增高,HLA-DR、CD18、CD83、CD86水平明显低于正常人,差异均有统计学意义(均P＜0.05);观察组患者经过治疗后,外周血CD4+T、CD8+T、HLA-DR、CD18、CD83、CD86恢复至正常值,而对照组仍然未恢复.结论 T细胞、树突细胞DC在慢性乙型肝炎患者的转归过程中起着重要作用.     

HBeAg阳性儿童慢性乙型肝炎的临床治疗

目的 评价拉米夫定联合左旋咪唑涂布剂治疗HBeAg阳性儿童慢性乙型肝炎的近、远期疗效,以探讨治疗儿童慢性乙型肝炎的有效方法.方法 采用统一检测方法和评价标准,分析拉米夫定联合左旋咪唑涂布剂治疗HBeAg阳性的儿童慢性乙型肝炎(儿童组)的近期疗效、HBV YMDO发生率及停药后的远期疗效,并与同期治疗的HBeAg阳性成人慢性乙型肝炎(A组:拉米夫定+左旋咪唑涂布剂与B组:单用拉米夫定)的相关指标比较,进行X2检测.结果 儿童组与成人A组及成人B组治疗结束时,血清学、病毒学、生化学单项应答率分别为52.4%:34.0%:28.5%;90.5%:74.9%:62.8%;85.7%:82.9%:75.9%;完全应答率分别为52.4%、32.0%、25.5%;HBV YMDD变异率分别为14.3%、18.0%、32.1%;停药后1年持久应答率分别为90.9%、75.0%、51.4%.儿童组与成人A组各项疗效差异均无统计学意义,疗效基本相同,完全应答率虽优于成人A组,但差异无统计学意义.儿童组与成人B组相比,血清学、病毒学应答率、联合应答完全应答率及1年持久应答率均显著优于成人B组(P<0.05),而其他各项疗效差异均无统计学意义(P>0.05).结论 对ALT≥正常上限2倍的儿童慢性乙型肝炎,拉米夫定联合左旋咪唑涂布剂治疗的近远期疗效均明显优于单用拉米夫定者.     

慢性乙型肝炎患者血清表面抗原与抗体同时阳性结果分析

目的:探讨乙型肝炎患者HBsAg和抗HBs共存模式及与HBV DNA的关系。方法:采用增强化学发光法检测血清乙肝标志物,并采用荧光定量PCR法检测HBV DNA。结果:5717例慢性乙肝患者检测出HBsAg和抗HBs双阳性248例,占4.34%,其中多数与HBV DNA同时出现。结论:HBsAg和抗HBs同时阳性并不少见,慢性乙肝患者出现抗HBs,不完全代表病毒复制终止,需结合HBV DNA定量综合分析。     

慢性乙型肝炎患者配偶乙型肝炎病毒感染状况调查和分析

目的 通过对慢性HBV感染者及其配偶HBV感染状况的调查和分析,评价婚后生活接触与慢性HBV感染之间的关系.方法 选择婚前即为慢性HBV感染者、且婚后血清HBV DNA阳性的慢性HBV感染者,调查其配偶人群的家族史、献血史、输血史、吸毒史、健康体检史、婚检史、婚外性接触史及乙型肝炎疫苗接种史等,排除婚前已感染HBV或接...     

慢性乙型肝炎患者配偶乙型肝炎病毒感染状况调查和分析

Objective To evaluate the influence of daily contact on HBV infection between hepatitis B virus carriers and their spouses by investigating the infection situation after marriage. Methods Premarital HBV carriers of serum HBV DNA positive were enrolled, family history, the histoty of blood donation, blood transfusion, drug abuse,physical examination, premarriage medical check, extramarital sex and hepatitis B vaccine were investigated in their spouses. Couples who were infected before marriage or vaccined with HBV vaccine were excluded. 68 couples were enrolled with an average marriage time of 12.5 years (0.5-35 years), their HBV serum markers and quantitative were performed. Results In the 68 couples, 54(79.4%) spouses were serum HBV marker positive, of the 54 spouses, 4 were HBV DNA positive. The chronic rate of HBV infection in the spouses was 7.4%, and was similar to the rate in general population(5%-10%). 48(88.9%) spouses were anti-HBs positive, the positive rate was similar to the rate in vaccinated population (85%-90%). Male spouses with at least one HBV marker positive were 22 cases (22/24), occupied 91.7% , female spouses were 32(32/44), occupied 72.7%, there was no difference between the male and female spouses(χ2 = 2.681, P > 0.05). Conclusions Whether HBV carriers' spouse infected with HBV is not correlated with marriage time, gender and HBV DNA level of carriers. HBV infection rate of the healthy people increases after marriage with HBV carriers, but the rate of chronic HBV infection is not increased obviouly.     

Preventing transmission of hepatitis B virus from people with chronic infection

BACKGROUND: People with chronic hepatitis B virus (HBV) infection are the major source of HBV transmission in the United States. The Public Health Service recommends prevention counseling for HBV-infected people and vaccination of their household contacts and sexual partners. OBJECTIVES: To describe the implementation of these recommendations by community physicians. METHODS: Telephone survey of 69 people with chronic HBV infection and their healthcare providers, October 1997 through November 1997, in San Diego, California. MAIN OUTCOME MEASURES: Counseling of people with chronic HBV infection and vaccination of their household contacts and sexual partners. RESULTS: Forty-three percent of providers reported providing prevention counseling to their HBV-infected patients to reduce transmission; 16% of patients reported receiving counseling. For the 32 pairs for which both the patient and provider could be reached and the patients were aware of their HBV infection, 20 (63%) providers reported counseling patients, and 10 (50%) of these providers' patients reported receiving counseling. Fifty-five percent of providers recommended vaccination of contacts; 13% of eligible adult household contacts and sexual partners and 20% of eligible child household contacts had begun hepatitis B vaccination. CONCLUSIONS: Prevention counseling of people with chronic HBV infection and vaccination of their contacts occur infrequently despite guidelines and an effective vaccine. Collaborative efforts between providers and people involved in public health are needed to improve delivery of these preventive health services.     

Mental and physical health status among chronic hepatitis B patients

Quality of Life Research - Little is known about health-related quality of life (HRQoL) in patients with chronic hepatitis B virus (CHB) infection in the United States. Our goal is to understand...     

医学生慢性乙型肝炎患者心理健康状况调查

目的调查慢性乙型肝炎感染患者的心理健康状况,为做好该类患者的心理护理提供依据。方法应用症状自评量表(SCL-90)对医学生及其慢性乙肝感染患者进行独立测试,并与全国常模及医学生健康组进行比较。结果慢性乙肝感染患者在躯体化、人际关系敏感、精神病性、焦虑、恐怖因子分上与国内常模比较,差异有统计学意义(P<0.05)。医学生健康组与国内常模比较在躯体化、强迫、人际关系敏感、焦虑、偏执上差异有统计学意义(P<0.05)。乙型肝炎感染患者与医学生健康组进行多因素logistic回归分析发现,在躯体化、人际关系敏感、焦虑、恐怖上,差异有统计学意义(P<0.05)。结论医学生及其慢性乙型肝炎患者心理健康状况较差,应根据患者的心理特点,加强心理健康教育,以促进其身心健康。     

Predictors of hepatitis B immunization status in Korean American children

This study assesses the predictive factors of social context and ethnicity on childhood hepatitis B immunization status among Korean American children living in an urban area. Logistic regression analysis revealed that maternal perceptions of benefits (OR = 3.24, 95% CI = 1.23–9.63) and barriers (OR = 0.4, 95% CI = 0.25–0.89) were important predictors of hepatitis B immunization status. Among children ages 2–5 years in this study, children born prior to the adoption of new immunization guidelines in 1994 were less likely to have received all three doses of hepatitis B vaccine (adjusted OR = 0.69, 95% CI = 0.43–0.80). An informal social support network providing information concerning parenting and health care of children was also associated with an increased probability of obtaining the immunization (adjusted OR = 2.76, 95% CI = 1.25–7.66). Mother's history of adequate prenatal care (² = 3.98, p < 0.05) was significantly related to immunization status. Major perceived barriers in accessing preventive health care include burden of cost, language barrier, and difficulty remembering the immunization schedule.     

慢性乙肝患者乙肝血清学标志物及生化学指标的检测及意义

目的探讨慢性病毒性乙型肝炎(简称"乙肝")患者乙肝血清标志物(HBVM)不同感染模式对血清生化指标的影响,了解肝功能损害情况,为临床治疗及预后判定提供依据。方法依据乙肝标志物HBsAg(+)、HBeAg(+)、HBcAb(+)和HBsAg(+)、HBeAb(+)、HBcAb(+)分为HBeAg阳性组和HBeAg阴性组,以研究对象中的内对照作为参照,进行丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、白蛋白(ALB)、总胆红素(TBIL)等指标检测。结果 207例慢性乙肝患者中HBeAg阳性者74例(35.75%),HBeAg阴性者73例(35.27%);ALB和TBIL的含量在正常范围内,ALT和AST在两组的含量均高于正常值,与对照组间比较差异无统计学意义(P>0.05)。结论乙肝标志物的持续存在,会引起肝脏的慢性炎症反应,临床上在治疗慢性乙肝患者及预后判断时,应结合血清生化指标与乙肝标志物,以获得较好的诊疗效果。     

乙型肝炎母婴传播阻断成功儿童乙型肝炎病毒突破性感染的特征

目的了解乙型肝炎(乙肝)母婴传播阻断成功儿童乙肝病毒(HBV)突破性感染及其影响因素。方法选取江苏省淮安市淮安区2009年9月-2011年1月乙肝表面抗原(HBsAg)阳性母亲所生儿童,且乙肝母婴传播阻断成功。阻断成功定义为儿童按国家免疫程序在完成出生时乙肝疫苗(HepB)和乙肝免疫球蛋白以及1、6月龄HepB接种后7-12月龄HBsAg阴性,HBV突破性感染定义为阻断成功儿童在12月龄后HBsAg阳性或24月龄后乙肝核心抗体(HBcAb)阳性。至2019年9月进行5次随访并检测HBV血清标志物,分析HBV突破性感染及其影响因素。结果本研究共纳入儿童390名,其中12名29-117月龄儿童发生HBV突破性感染,发生率为3.08%(12/390),均为乙肝核心抗体(HBcAb)阳性和HBsAg阴性。乙肝疫苗(HepB)初次免疫无、低、正常、高应答儿童HBV突破性感染率分别为25.00%、6.67%、2.61%、0.95%;母亲HBeAg阳性、阴性的儿童分别为9.76%、0.00%;母亲高、低HBV病毒载量的儿童分别为11.96%、0.34%。儿童HBV突破性感染发生密度为0.36/100人年;多因素Cox回归分析显示,HepB初次免疫低或无应答、母亲高病毒载量是儿童HBV突破性感染的危险因素(HR=5.91,95%CI:1.87-18.71;HR=45.81,95%CI:5.88-356.96)。结论乙肝母婴传播阻断成功儿童的HBV突破性感染发生率较低;母亲HBeAg阳性、母亲高HBV病毒载量、HepB初次免疫低或无应答的儿童更易发生突破性感染。