乙、丙型肝炎病毒及幽门螺杆菌在慢性肝炎、肝硬化患者胃黏膜的表达

目的 探讨乙、丙型肝炎病毒(HBV、HCV)的泛嗜性及幽门螺杆菌(Helicobacter pylori)感染的关系。方法 选择慢性乙型肝炎(慢肝)28例、乙型肝炎后肝硬化(肝硬化)44例,共72例作为观察组,无肝病的胃病患者30例作为对照组。受检者常规胃镜检查,取胃窦幽门周围3cm以内活体组织3块,除普通病理检查外,分别做乙型肝炎病毒表面抗原(HBsAg)、乙型肝炎病毒核心抗原(HBcAg)、丙型肝炎病毒抗原(HCVAg)检测及快速尿素酶、品红染色和免疫组化法检测H.pylori抗原(HPAg)。结果 慢肝组有不同程度的胃黏膜慢性炎症者达92.9％(26/28)、肝硬化组为95.5％(42/44)。排除年龄影响因素外,慢肝组以单纯慢性炎症为多,而肝硬化组以伴萎缩和肠化者多。72例慢性肝病者中有51例胃黏膜HBVAg阳性,其中HBsAg、HBcAg双阳性31例。肝硬化组HBsAg或HBcAg表达及HBsAg、HBcAg双阳性者均高于慢肝组(P均<0.05)。51例慢性肝病胃黏膜中有33例占64.7％有HCVAg表达;其中22例占52.4％与HBsAg或(和)HBcAg同时表达。在慢肝和肝硬化组有炎症的胃黏膜中H.pylori阳性率分别为67.9％(20/26)、69.0％(29/42),与对照组相比无显著差别。慢性肝病H.Pylori阳性、阴性者胃黏膜HBV抗原表达率分别为69.8％(37/53)、73.7％(14/19),亦无统计学差异(P>0.05)。结论 (1)HBV、H     

肝组织中丙型肝炎病毒抗原的表达及其临床意义

目的研究肝炎患者肝组织中丙型肝炎病毒抗原的表达及其临床意义。     

乙肝患者胃黏膜HBsAg、HBcAg的表达及意义

应用免疫组织化学PV二步法检测乙肝患者胃黏膜HBsAg、HBcAg的表达,结果HBsAg颗粒主要存在于胃黏膜上皮腺细胞的胞质中,HBcAg在胃黏膜上皮腺细胞的胞质及胞核、部分胃小凹、间质及毛细血管内皮细胞中可见。提示乙肝病毒直接感染及免疫复合物所致的炎症反应可能是乙肝患者胃黏膜损害的原因。     

乙、丙型肝炎病毒的分子机制

(一)乙型肝炎病毒基因组由一个不完全的双链 DNA 组成,分子量约1.6×10~6。HBV DNA可分为:①双链松弛状 DNA(RC),有4000个核苷酸;②双链线状 DNA(Linear),有3200个核苷酸;③超螺旋 DNA(SC),含2000个核苷酸;④单链 DNA(SS),含140个核苷酸。其中双链线状 DNA 又分为长链 L(又名负链)和短链 S(又     

合并乙型肝炎病毒感染对丙型肝炎病毒核心抗原检测的影响

目的 探讨合并HBV感染对慢性HCV感染者血清丙型肝炎病毒核心抗原(HCVcAg)检出情况的影响. 方法 收集2005年12月-2009年10月慢性丙型肝炎患者和HBV/HCV合并感染者资料,检测血清HCVcAg和HCV RNA,对后者血清进行HBV DNA、HBeAg检测,分析HCVcAg检出率与HBeAg、HBV DNA定量检测的关系.用独立两组多分类的X2检验方法进行统计学分析. 结果 共收集88例慢性丙型肝炎患者和62例HBV/HCV合并感染者资料,血清HCVcAg的检出率分别为72.7％(64/88)和38.7％ (24/62),两者比较,x2= 17.358,P＜0.01,差异有统计学意义.HCV RNA检出率分别为81.8％ (72/88)和53.2％ (33/62),两者比较,x2=20.110,P＜0.01,差异有统计学意义.62例HBV/HCV合并感染者血清中,HBeAg阳性和HBeAg阴性感染者HCVcAg检出率分别为28.6％ (12/42)和60.0％ (12/20),两者比较,x2=5.641,P=0.011,差异有统计学意义.HCV RNA阳性率分别为42.9％ (18/42)和80.0％ (16/20),两者比较,X2=7.547,P＜ 0.01,差异有统计学意义.HBV DNA阳性和阴性时HCVcAg检出率分别为39.1％ (18/46)和37.5％ (6/16),两者比较,P＞0.05,差异无统计学意义.与单纯HCV感染者血清HCVcAg检出率72.7％ (64/88)比较,HBeAg阴性合并感染者为60.0％ (12/20),x2=1.266,P=0.261,差异无统计学意义;HBV DNA阴性合并感染者为37.5％ (6/16),x2=7.635,P＜0.01,差异有统计学意义.结论 HBV/HCV合并感染时HCVcAg检出率较低,可能是由于HBeAg抑制HCV的复制,从而减少HCVcAg的表达所致.     

经血和经性传播的人类免疫缺陷病毒感染者乙、丙型肝炎病毒重叠感染比较

我国目前传播人类免疫缺陷病毒(HIV)主要途径为经血传播,如静脉吸毒,输血等,我们曾报道了经血传播HIV和HBV/HCV重叠感染的特征[1,2 ] 。而国外报道HIV传播的主要途径为性途径,在经性途径传播的HIV感染者中HBV/HCV重叠感染状况和感染特征不甚明确,我们以HIV感染的德国男性同性恋者为研究对象,首先对其HBV/HCV重叠感染状况进行调查,并总结了经性和经血传播HIV感染者HBV/HCV重叠感染特点及差异。对象和方法一、研究对象1992年1月～2 0 0 0年12月HIV感染的德国男性同性恋者4 9例,我国经血传播HIV感染者6 2例,取静脉血3ml,- …     

乙型、丙型肝炎病毒的病毒学及抗病毒靶位

乙型肝炎病毒(HBV)与丙型肝炎病毒(HCV)属于两种截然不同的病毒家族,分别是嗜肝DNA病毒科与黄病毒科,因此有不同的病毒学特征。对HBV和HCV生活周期及变异性的深入了解,为发展新的治疗方法及药物的分类提供可能性。然而,乙型肝炎的治疗尚遗留超螺旋共价闭和环状DNA(cccDNA)的清除问题,而HCV感染是可以治愈的。HBV与HCV除了它们均在肝脏中复制外,没有任何相同点。它们属于两种完全不同的病毒家族,且有不同的病毒学特征。HBV感染的治疗是以应用α-干扰素(α-IFN)或针对HBV多聚酶、逆转录酶功能的特异性抑制剂为基础的。慢性丙…     

EBV转化B淋巴细胞中丙型肝炎病毒抗原表达的免疫组化研究

观察丙型肝炎患者外周血单个核细胞（PBMC）体外转化培养后其中是否仍有丙型肝炎病毒（HVC）存在。用EB病毒感染患者HCV阳性PBMC7并使其转化,获得永生化B细胞（EBVTB）。而后,用套式RT-PCR检测培养细胞和上清中的HCV RNA,用免疫组化SP法观察HCV抗原在细胞中的表达,HCV在传代细胞中持续存在,而培养细胞中的HCVRNA负链和培养上清中的HCV间断阳性,免疫组化发现HCVNS3、NS5和C抗原分布于胞细胞膜和核膜周围也可见阳性着色,细胞核阴性。HCV可以在体外EB病毒转化B细胞系中较长时间存在和复制。     

乙型肝炎病毒和丙型肝炎病毒不同模式重叠感染患者临床特征分析

目的 了解HBV和HCV不同模式重叠感染患者临床特征的差异.方法 回顾分析中山大学附属第三医院1999年5月至2010年5月HCV和HBV重叠感染患者186例.统计分析不同病毒学模式重叠感染患者的人口学、流行病学、实验室检查和病理学表现,数据处理采用t检验和x2检验等.结果 186例HBV和HCV重叠感染患者中,HBV...     

肝细胞癌中丙型肝炎病毒的原位检测

目的了解丙型肝炎病毒在本地区肝细胞癌中存在的频度.方法66例首次住院手术肝癌标本(含癌及癌旁组织),其固定、包埋、切片均经无RNase处理.应用地高辛标记HCVcDNA重组基因探针进行原位杂交,检测HCV病毒核酸.免疫组化SABC法检测HCV不同基因区抗原,HCV-CP10,HCV-NS3,HCV-NS5在HCC中的表达.结果66例HCC中HCVRNA阳性50例,阳性率为75.8%,阳性信号大部分存在于胞质中,偶有核阳性,或核浆混合型.HCVCP10阳性42例,阳性率63.6%.HCVCP10的阳性表达定位于胞质,少数病例有明显的围核分布现象,未见明确的核阳性.HCVNS3阳性33例,阳性率50%.HCVNS3阳性信号以胞质型为主,少数为核、浆混合型.HCVNS5阳性48例,阳性率72.8%.HCVNS5阳性信号以胞质型为主,部分呈膜型,少数为核、浆混合型.HCVRNA及三种抗原在癌周组织中的表达明显强于癌组织者.阳性细胞在癌组织呈散在分布,少数呈灶性分布,偶尔呈弥漫分布.在癌周组织大部分呈灶性、弥漫性分布,也可呈散在分布.经x2检验原位杂交检测HCVRNA一般比免疫组化检测HCV不同基因区抗原阳性率高,敏感(HCVRNA与HCVCP10相比,x2=4.083,P<0.05;与HCVNS3相比,x2=13.479,P<0.005;与HCVNS5相比,x2=0.1,P>0.5).两种检测方法的结果又有联系(HCVRNA与HCVCP10之间,x2=21.038,P<0.005;与HCVNS3之间,x2=13.942,P<0.005;与HCVNS5之间,x2=29.838,P<0.005).结论原位杂交结合免疫组化更能准确反映HCC中HCV的感染情况.     

Clinical Significance of Hepatitis GB Virus C Infection in Alcoholic Liver Disease

Recently, hepatitis GB virus C (HGBV-C) has been recovered from patients with non-A-E hepatitis. However, it has been unclear whether HGBV-C may be related to the development of alcoholic liver disease (ALD) or not. In this study, we determined HGBV-C RNA in sera from alcoholic patients without markers for hepatitis C and B viruses to evaluate the role of HGBV-C in ALD. Serum samples were obtained from 68 patients with ALD and 40 nonalcoholic patients with chronic type C liver disease. HGBV-C RNA was detected in only 3 of 68 (4.4%) patients with ALD, in 2 of 27 patients with hepatic fibrosis, and in 1 of 5 patients with chronic hepatitis. There was no HGBV-C RNA in sera from patients with fatty liver, alcoholic hepatitis, or cirrhosis. Serum levels of AST, ALT, and γ-glutamyltranspeptidase in alcoholic patients with, as well as without, HGBV-C RNA decreased to normal levels after abstinence. In addition, an inflammatory change was not observed in liver biopsy specimens obtained from two HGBV-C-positive patients with alcoholic hepatic fibrosis. Our results clearly suggest that the prevalence of HGBV-C infection in patients with ALD is rare and that HGBV-C may not play an important role in the development of liver disease in alcoholics.     

Occult Hepatitis B Virus Infection in Patients With Chronic Hepatitis C Treated With Antiviral Therapy

Background

Occult hepatitis B virus infection (OBI) is defined as the presence of hepatitis B virus (HBV) DNA in the liver and/or in the serum of patients with negative results of hepatitis B s antigen (HBsAg) test with or without serological markers of previous viral exposure. The impact of OBI in patients with chronic hepatitis C (CHC) is still unclear.

Objectives

The Aim of this study was to assess OBI prevalence and its potential implications on treatment outcome in a cohort of patients with CHC underwent standard antiviral therapy.

Patients and Methods

Baseline serum samples from 137 HBsAg-negative CHC patients treated with pegylated-interferon and ribavirin (73 Responders/74 Non Responders),were retrospectively analyzed for HBV status.

Results

Seventy-three patients (53.3%) showed markers of previous exposure to HBV. HBV DNA was detected in 2 of 137 serum samples (1.5%), both carrying HBV antibodies. Liver biopsies and post-therapy sera were available for 35 patients (12 Responders/23 Non Responders). HBV DNA sequences were found in 13 of 35 specimens (37.1%), all of patients with HBV DNA negativity in basal and post-therapy serum samples. Among OBI-positive patients, 5 (38.5%) carried serological markers of HBV infection. Regarding therapy outcome, in the OBI-positive group there were 5 of 13 (38.5%) sustained virological responders (SVR) compared to 7 of 22 (31.8%) in the OBI-negative one.

Conclusions

Despite the high prevalence rate of liver HBV DNA in patients with CHC, SVR was not affected by occult HBV infection.     

抗纤散在慢性乙型肝炎抗纤维化治疗中的作用研究

目的:研究抗纤散(KXS)在慢性乙型肝炎(CHB,慢乙肝)抗纤维化治疗中的作用.方法:将40例慢性乙型肝炎患者随机分为两组,治疗组及对照组各20例.对照组给予保肝、退黄、降酶药物治疗,治疗组每日给予抗纤散汤剂200ml,分两次口服,其他治疗方案同对照组.治疗两个疗程后,分别检测两组患者血清乙肝标志物及丙氨酸转氨酶(ALT)、天门冬氨酸转氨酶(AST)、总胆红素(TBil)、Ⅲ型前胶原PCⅢ、层粘连蛋白(LN)、透明质酸(HA)的含量.结果:治疗组13例HBeAg( )阴转7例,对照组11例HBeAg( )只有1例转阴,治疗组患者血清ALT、AT、TBil、PCⅢ、LN、HA含量检测提示均显著低于对照组(P＜0.05).结论:抗纤散在慢性乙型肝炎抗纤维化治疗中有确切疗效.     

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。     

丙型肝炎患者IFN治疗前后肝内HCV-Ag表达状况的研究

应用抗HCV NS4 McAb以酶标链霉亲和素生物素化二抗方法(LAB法),对IFN_2治疗前后肝组织进行免疫组化研究。结果显示HCV-Ag位于肝细胞浆中,治疗前后肝内HCV-Ag定位相似。但是治疗后HCV-Ag阳性肝细胞数量有明显变化,IFN有效者HCV-Ag阳性肝细胞数量明显减少或消失,且与血清HCV-RNA的变化基本一致。治疗前后肝HCV-Ag染色的变化与肝HAI计分变化的符合程度优于血清ALT和HCV-RNA。提示肝内HCV-Ag的检测可能有助于IFN疗效的预测和评价。     

康氏乙肝合剂联合干扰素治疗慢性乙型肝炎41例

目的：研究康氏乙肝合剂联合干扰素治疗慢性乙型肝炎的临床疗效。方法：选择慢性乙型肝炎的病例，应用康氏乙肝合剂联合干扰素进行治疗，以单独应用康氏乙肝合剂和单独应用干扰素治疗的患者进行对比观察，疗程均为6个月。观察患者治疗前后肝功能、乙肝病毒标志物的变化情况。结果：在肝功能复常方面，治疗组优于两对照组，但无统计学差异，P＞0．05：在HBeAg、HBVDNA阴转方面，治疗组明显优于对照组，统计学处理差异有显著性意义，P＜0．01或0．05。结论：康氏乙肝合剂联合干扰素治疗慢性乙型肝炎具有较好疗效，康氏乙肝合剂能明显提高干扰素的抗乙肝病毒效果。     

Prevalence of Occult Hepatitis B Virus in Plasma and Peripheral Blood Mononuclear Cell Compartments of Patients With Chronic Hepatitis C Infection in Tehran-Iran

Background

Occult hepatitis B virus (HBV) infection (OBI) is frequently reported in patients with chronic hepatitis C virus (HCV) infection. An association between OBI and more liver damage, cirrhosis, hepatocellular carcinoma, and reduced response to interferon therapy in patients with HCV infection is suggested.

Objectives

The aim of this study was to determine the prevalence of occult HBV, and evaluate its clinical influence on patients with chronic HCV.

Patients and Methods

A cohort study including50 patients with positive results for HCV, and negative results for HBsAg tests was performed. The patients were divided into two groups: one group had positive results for both HCV and occult HBV tests (n = 18), and the other had positive results for HCV, but negative findings for occult HBV (n = 32). All were treated with PEG-IFN alpha-2a and Ribavirin. Presence of HCV RNA was followed in these patients.

Results

HBV-DNA was detected using nested-PCR in 20% of plasma and 32.6% of peripheral blood mononuclear cell (PBMC) compartments. No significant differences were observed between patients with and without occult HBV for sex, age, duration of HCV infection, histological markers, presence of anti-HBc, HCV viral load, and HCV genotype. The response rate was significantly higher in patients with positive results for HBV-DNA test compared to those with negative findings (100% vs. 71.9 %, P < 0.05).

Conclusions

In conclusion, occult HBV was found in 36% of patients with negative results for HBsAg, but positive results for HCV. Detection of HBV-DNA in both PBMCs and plasma together in comparison with plasma alone provided more true identification of OBI.The SVR rate was significantly higher in coinfected patients than mono-infected ones.     

拉米夫定治疗重型乙型病毒性肝炎的临床研究

目的 :探讨拉米夫定治疗慢性乙型重型病毒性肝炎的疗效和安全性。方法 :86例慢性乙型重型病毒性肝炎分为两组。对照组 3 8例 ,给予常规内科综合治疗 ;拉米夫定组 48例 ,在综合治疗的基础上 ,加用拉米夫定。统计两组的病死率、存活者肝功能恢复情况及平均住院时间。结果 :治疗组患者病死率为 41 7% ,对照组为 68 4% ,两组患者病死率经统计学处理差异有显著性意义 (P <0 0 5 ) ;治疗组存活者达到显效出院平均住院时间为 (74 6±2 2 7)天 ,明显短于对照组的 (114 3± 2 6 2 )天 (P <0 0 5 )。拉米夫定治疗期间未见明显副反应 ,显示良好的安全性。结论 :拉米夫定治疗慢性乙型重型病毒性肝炎是有效和安全的 ,可作为抢救重型乙型肝炎的治疗药物之一。     

Fas Antigen Expression on Hepatocytes Predicts the Short- and Long-term Response to Interferon Therapy in Patients with Chronic Hepatitis C

Background: Interaction between Fas antigen on hepatocytes and Fas ligand on cytotoxic T cells induces apoptosis, a major mechanism of hepatitis C virus (HCV)-induced hepatocyte injury. We investigated the usefulness of Fas expression on hepatocytes as a predictor of short- and long-term response to interferon (IFN) therapy in 72 patients with chronic hepatitis C. Methods:     

HBsAg阳性慢性肝病患者肝组织HBV DNA分子状态与血清HBV标志物关系的研究

采用分子杂交技术对28例慢性肝病患者进行肝组织和血清HBV对比研究,结果表明:①肝组织HBV DNA阳性率显著高于血清HBV DNA阳性率,②血清DNA-P反映乙肝病毒的早期复制;③血清HBeAg阴性、Anti-HBe阳性时肝组织内可发现游离型HBV DNA及小片段DNA,表明肝内HBV正处于活跃复制状态,从分子水平证实了Anti-HBe阳性时部分患者可有传染性,需积极有效治疗:④慢迁肝和慢活肝中发现整合型HBV DNA较少,提示慢活肝经治疗后有希望达到从肝内清除乙肝病毒的目的。另外,也提示乙肝病毒在肝内的复制状态与病理损伤无直接关系。