输血后丙型肝炎的临床观察

本文用前瞻性研究方法,观察了34例输血后丙型肝炎(PT-HC)的临床特点,现报告如下: 材料与方法1.病例的选择:因妇科病一次性受血,受血前ALT正常、HBsAg阴性,抗-HCV阴性,无肝炎症状与体征,受血后发生了     

献血员丙型肝炎病毒感染与输血后丙型肝炎的关系

自从美国Chiron公司推出丙型肝炎诊断试剂以来,国内外丙型肝炎诊断试剂的研究和生产已有很大进展。近年来又相继建立了多种检测HCV感染的方法。大大推动了丙型肝炎的病原学、流行病学及临床研究工作。笔者以此为基础,对某地献血员及受血者丙型肝炎的感染情况进行了研究,结果如下: 一、材料与方法 1.HBsAg阴性,ALT 25U/L以下,首     

不同方法治疗输血后丙型肝炎99例疗效随访

1989年以来,我们采用4种方法共治疗急性输血后丙型肝炎99例,并进行6个月以上的随访,报导如下。 1 资料与方法 1.1 一般资料 99例住院患者,男性61例,女性38例;年龄13～71岁,平均为36±10.8岁。全部病例均符合急性肝炎的诊断标准,且发病前20～150天有接受输血或血浆史,抗-HCV或/和HCV-RNA(PCR法)阳性,其中11例合并HBV-M阳性。     

输血后丙型肝炎的特点及防治对策

输血后丙型肝炎的特点及防治对策同济医科大学附属同济医院传染病教研室石淑仙，林建国输血后肝炎（ＰＴＨ）是输血常见并发症。在献血员进行乙肝病毒检测筛除之后，发现ＰＴＨ中９０％与丙肝病毒（ＨＣＶ）感染有关。国内外文献报道ＨＣＶ是ＰＴＨ最常见的病源［１］。１...     

输血后丙型肝炎病毒感染者10年随访观察

目的 :观察输血后丙型肝炎病毒 (HCV)感染者的远期预后 ,调查 HCV感染后慢性形成的危险因素。方法 :用贝克曼 CX5全自动生化分析仪 ,对 88例输血后丙型肝炎 (PT- HC)患者血清进行肝功能检测 ;以 EL ISA法检测抗 - HCV及 HBVM;以荧光定量 PCR诊断试剂盒检测 HCV- RNA。结果 :输血后 10年丙氨酸转氨酶 (AL T)异常率 4 2 .0 5 % ,抗 - HCV阳性率 94 .32 % ,HCV- RNA阳性率 6 3.6 3%。 5 6例 HCV - RNA阳性者中 ,2 6例 AL T正常、抗- HCV阳性。 88例 PT- HC中转为慢性肝炎者 5 4例 ,失代偿性肝硬化 2例 ,转慢率 6 3.6 3% ,男性与女性转慢率为75 .0 0 %及 5 2 .2 7% ,P <0 .0 5 ;饮酒者与无饮酒史者的转慢率为 90 .0 0 %及 5 5 .88% ,P <0 .0 1。结论 :AL T异常是慢性 HCV感染者的一个重要特征 ,抗 - HCV是反映慢性 HCV感染者的一个较稳定的指标 ,HCV - RNA阳性的AL T正常者 ,可以认为系病后病毒携带者 ,PT- HC易转为慢性 ,男性及饮酒者为慢性形成的高危因素     

输血后丙型肝炎的临床分析

输血后丙型肝炎的临床分析王守义，郎永秀我科自１９９１年１月至１９９６年５月共收治丙型肝炎、（丙肝）１３３例，其中输血引起者９９例，占７４．４％，现报道如下。临床资料一般资料本组９９例输血后丙型肝炎患者均为各科手术、外伤及胃、十二指肠溃疡出血等多种疾病...     

输血后丙型肝炎与血清γ—谷氨酰转肽酶测定

笔者随机抽取50例输血后丙型肝炎,对其急性期进行血清γ—谷氨酰转肽酶(γ—GT)检测,并与50例急性期乙型肝炎,50例散发的急性期非甲非乙型肝炎进行对比分析,报告如下。 1 材料与方法     

输血后丙型肝炎的前瞻性研究

为了解输血后丙型肝炎的发病情况，北京协和医院、华西医科大学、北京医科大学和上海医科大学４个单位共同协作，于１９９３年４月至１９９４年１１月进行了输血后丙型肝炎的前瞻性临床流行病学调查，并对健康献血员进行了丙型肝炎病毒抗体（抗－ＨＣＶ）的检测。北京协和医院的结果发现，献血员中抗－ＨＣＶ的阳性率以市区志愿献血员为低（０．４２％），其次为农村献血员（５．６０％），市区职业献血员最高（１４．４９％）。输血后丙型肝炎的发病率在随访３个月以上的受血者中，抗－ＨＣＶ阳性率分别为：北京协和医院１５．３４％（１４／９１），华西医科大学２４．５９％（１５／６１），上海医科大学１３．１８％（１２／９１）和北京医科大学１．５３％（１／６５），而同期输血后乙型肝炎的发病率和以往相比明显下降。表明现有献血员的各项筛选尚不能完全排除输血后丙型肝炎病毒的传播。     

重组α－2b干扰素治疗输血后丙型肝炎近期疗效观察

观察重组α－２ｂ干扰素治疗３０例输血后丙型肝炎的生化学和病毒学指标，疗程结束后３个月时ＡＬＴ正常率为７２％，ＨＣＶ－ＲＮＡ阴转率为５３．３％。疗效相关因素分析显示，患者的性别、年龄、输血量和临床病程等均非预测疗效的有意义指标，而治疗前血清ＨＣＶ－ＲＮＡ滴度和输血至临床发病时间均对疗效有显著影响。经ＨＣＶ基因亚型分析，本组３０例均为ＨＣＶ～Ⅱ型感染，提示在同一ＨＣＶ亚型感染中对干扰素疗法的反应亦不均一。同时发现干扰素治疗后可出现生化学疗效和病毒学疗效分离，以第二代抗一ＨＣＶ试剂盒检测抗，ＨＣＶ评价干扰素疗效，价值较小。     

Long-term follow-up of non-A, non-B (type C) post-transfusion hepatitis

One hundred and thirty-five patients who developed non-A, non-B post-transfusion hepatitis mostly after cardiac surgery, were followed for a mean (±S.D.) of 90±41 months (range: 13–180) to evaluate clinical and histological outcome.Thirty-one cases resolved within 12 months, while 104 (77%) progressed to chronicity. Twenty-one of 65 (32%) biopsied patients developed cirrhosis at the end of the follow-up, and one further progressed to hepatocellular carcinoma. One patient had a complete histological remission (1%). The remaining cases had chronic active (37%), chronic persistent (27%) or chronic lobular hepatitis (3%). About half of the cases with cirrhosis developed portal hypertension, and three of these died due to esophageal varices hemorrhage, one due to liver failure, and one due to hepatocellular carcinoma. Out of 26 patients with the initial histologic diagnosis of chronic hepatitis that were rebiopsied during follow-up, 13 (50%) progressed to cirrhosis. These patients were significantly older than patients who did not develop cirrhosis (mean age 57 and 45 years respectively; p<0.01).During acute hepatitis anti-HCV was positive in all but one of the 114 patients tested. Percentages were similar for patients who recovered (95%) and those who developed chronic hepatitis (100%). However, during follow-up, 71% of the 1st generation and 21% of the 2nd generation ELISA test patients with acute resolved hepatitis became anti-HCV negative, while the same figures in chronic cases were only 8.5% (p<0.0001) and 1.4% (p=0.012). This suggests a correlation between anti-HCV antibody activity, hepatitis C virus replication, and the development of chronic liver disease.     

Post-transfusional vs. sporadic non-A, non-B chronic hepatitis. A clinico-pathological and evolutive study

The clinical, morphological and evolutive features of 60 patients with chronic hepatitis, presumably caused by non-A, non-B virus infection, have been retrospectively analyzed. In all the cases the disease began as an acute episode of viral hepatitis that was followed by persistently abnormal liver function tests. No patient had evidence of current or past hepatitis B virus infection and other known causes of chronic liver disease were excluded. Thirty patients had received blood transfusions in the recent past, five were drug addicts and the source of the infection was not identified in the remaining 25, in whom the disease was considered to be sporadic. Clinical or biochemical differences between patients with post-transfusional and sporadic non-A, non-B chronic hepatitis were not observed, but liver histology showed a higher proportion of patients with chronic persistent hepatitis in the sporadic (72%) than in the transfusional group (53%). On follow-up, sustained normalization of liver function tests was observed in 46% of the cases with sporadic hepatitis but only in 13% of the cases with post-transfusion hepatitis. These observations suggest that non-A, non-B chronic hepatitis is more severe in patients with transfusion-related infection than in sporadic cases.     

散发性戊型肝炎病理特征的初步观察

目的：观察散发性戊型肝炎的病理特征。方法：收取10例散发性戊型肝炎患者的肝活检标本作病理组织学检查（通过光镜和电镜）。结果：6例急性黄疸型戊型肝炎和3例淤胆型戊型肝炎突出表现为肝细胞气体细胞气球样变和胆汁郁积,并见到淋巴细胞与变性肿胀肝细胞的紧密接触以及凋亡小体,支持戊型肝炎的免疫发病观点,1例亚急性重型戊型肝炎肝细胞大片坏死,但未完全崩解,而且残留部分变性肿胀肝细胞,B超观察肝脏外形一直未见缩小,与亚生重型乙型肝炎的病理改变不尽相同,各临床型肝炎均未见到肝星状细胞增多及胶原增生,似可为戊型肝炎不易转慢性提供佐证。结论：研究散发性戊型肝炎的病理特征有助于阐明其发病机制。     

散发性戊型肝炎156例临床分析

目的 探讨散发性戊型肝炎（HE）的临床特点,为临床诊治提供参考。方法 2012年1月~2015年12月我院收治的156例HE患者,回顾性分析其流行病学、临床资料及其预后情况,采用ELISA法检测血清抗-HEV IgM和抗HEV-IgG。结果 156例患者发病年龄为（52.9± 12.7）岁,男性129例,女性27例,男女比例为4.8:1;各季度均有发病,发病高峰为1~5月,尤以2月份高发,占20.5%;HE重叠慢性乙型肝炎患者血清TBIL水平为（180.8± 111.1） μmol/L,和住院时间（23.1± 12.2）d,显著高于或长于HE组的（148.6± 89.9） μmol/L和（16.7± 8.8） d（P< 0.05）,两组肝衰竭发生率分别为（10.0%和3.8%,P< 0.05）;≥ 60岁患者血清TBIL水平和住院时间分别为（194.6± 121.4）μmol/L和（22.1± 7.0） d,显著高于或长于18~59岁年龄组的（144.1± 104.9） μmol/L和（16.9± 0.05）,两组肝衰竭发生率分别为（10.5%和4.0%,P< 0.05）。结论 HE患者以中老年男性多见,春季多发,老年及慢性肝病重叠感染者黄疸深,肝衰竭发生率高,病程时间长,需引起临床医生的重视,但总体预后良好。     

Blood transfusion and hepatitis: still a threat?

Summary The incidence of post-transfusion hepatitis (PTH) in recipients of blood products is reviewed. PTH was observed in 10%–12% of recipients of blood products in the United States, 2%–4% in northern Europe and 15%–20% in southern Europe. All studies indicate that 80%–90% of all PTH cases are attributed to non-A/non-B. At least 40% of the patients with PTH non-A/non-B will develop chronic hepatitis or cirrhosis. No specific tests for the detection of the non-A/non-B agent(s) exist. However, several independent studies indicate that part of the donors carrying the infectious non-A/non-B agent have increased levels of alanine amino transferase (ALT). When donors are excluded with elevated ALT values, it is estimated that about 30% of the PTH non-A/non-B cases would be prevented. Some studies indicate that anti-hepatitis B core (anti-HBc) positive donors may carry an increased risk to transmit the non-A/non-B agent, but more recent studies do not confirm this. There is hope that a specific non-A/non-B test will be developed soon.     

Treatment of hepatitis C

Hepatitis C virus is a leading cause of chronic liver disease, with over 170 million people infected worldwide. It is also the leading indication for liver transplantation. Complications from chronic hepatitis C infection include cirrhosis, hepatic decompensation, and hepatocellular carcinoma. As a result, treatment strategies to prevent such complications have been widely researched, although many questions remain unanswered. To date, the standard therapy for chronic hepatitis C infection is the combination of peginterferon and ribavirin. Treatment strategies differ based on factors such as genotype and liver biopsy results. Other strategies must be considered for special groups, such as patients with acute hepatitis C infection, hepatitis C/human immunodeficiency virus (HIV) coinfection, and prior nonresponse to interferon or relapse after its use. The goal of therapy is to achieve a sustained virologic response (ie, no detectable hepatitis C ribonucleic acid 6 months after completion of therapy). The substantial adverse effects associated with both interferon alfa and ribavirin often make it difficult for patients to continue with their therapies.     

Occult hepatitis C virus infection： A new form of hepatitis C

INTRODUCTION The etiology of liver disease is unknown in approximately 10% of patients with abnormal results on liver function tests. Some authors have reported that occult hepatitis B virus could be the cause of a proportion of these cryptogenic chronic …     

重型丙型肝炎肝外组织丙型肝炎病毒感染状态免疫组化研究

目的　探讨丙型肝炎患者肝外组织丙型肝炎病毒（ＨＣＶ） 感染状态、致病性及其意义。方法　采用免疫组化法检测９ 例重型丙型肝炎患者肾、心、胰腺和肠等肝外组织内ＨＣＶ 多种抗原表达,并观察各组织病理改变。结果　９ 例中６ 例（６６ ．７ ％ ） 在肝外组织检出ＨＣＶ 抗原。抗原定位于细胞浆内,呈均质型、包涵体型和膜下型。组织内抗原表达阳性细胞数量较少,不同组织间阳性细胞种类、数量和分布略有差异。病理学观察未发现细胞内ＨＣＶ 抗原阳性表达与组织病变有明确相关性。结论　ＨＣＶ 可以感染肝外组织,但未显示显著致病性。作为致病因子的ＨＣＶ 持续存在肝外多种脏器细胞内,在丙型肝炎慢性化和干扰素治疗后病情复发中可能起重要作用     

Global epidemiology of hepatitis C virus infection: an up-date of the distribution and circulation of hepatitis C virus genotypes

AIM To review Hepatitis C virus(HCV) prevalence and genotypes distribution worldwide.METHODS We conducted a systematic study which represents one of the most comprehensive effort to quantify global HCV epidemiology,using the best available published data between 2000 and 2015 from 138 countries(about 90% of the global population),grouped in 20 geographical areas(with the exclusion of Oceania),as defined by the Global Burden of Diseases project(GBD). Countries for which we were unable to obtain HCV genotype prevalence data were excluded from calculations of regional proportions,although their populations were included in the total population size of each region when generating regional genotype prevalence estimates.RESULTS Total global HCV prevalence is estimated at 2.5%(177.5 million of HCV infected adults),ranging from 2.9% in Africa and 1.3% in Americas,with a global viraemic rate of 67%(118.9 million of HCV RNA positive cases),varying from 64.4% in Asia to 74.8% in Australasia. HCV genotype 1 is the most prevalent worldwide(49.1%),followed by genotype 3(17.9%),4(16.8%) and 2(11.0%). Genotypes 5 and 6 are responsible for the remaining 5%. While genotypes 1 and 3 are common worldwide,the largest proportion of genotypes 4 and 5 is in lower-income countries. Although HCV genotypes 1 and 3 infections are the most prevalent globally(67.0% if considered together),other genotypes are found more commonly in lowerincome countries where still account for a significant proportion of HCV cases.CONCLUSION A more precise knowledge of HCV genotype distribution will be helpful to best inform national healthcare models to improve access to new treatments.