乙型肝炎病毒医院感染的分类管理

目的探讨乙型肝炎病毒(HBV)医院感染方式的分类管理方法,旨在使监控方法更为实用。方法在进行现有资料汇总分析的基础上,对HBV医院感染方式进行分类。结果 HBV传染源的病毒浓度相差极大,依≥107、≥104、≥100ID/ml为标准可分为高、中和低度传染性3个等级;HBV传播途径的入体血量相差极大,依10-4 ml和10-7 ml为标准可分为经大、小和微量血液传播3种类型;HBV感染对象的免疫状况相差很大,依感染阈值可分为患者和医务人员两个群体;HBV标志代表的病毒浓度相差很大,依传染性范围可选择HBV DNA、HBsAg和HBeAg3种传染源筛查指标。结论依据病毒浓度、接种血量、感染阈值和病毒标志与HBV传染源的关系将HBV医院感染方式分为3类,建立相应的监控方法,具有特定的监控范围,用于明确的预防对象。     

Seroprevalence of hepatitis B virus, hepatitis C virus and GB virus-C infections in Siberia

We studied the seroprevalence of hepatitis B virus (HBV), hepatitis C virus (HCV) and GB virus-C (GBV-C) infections in 348 Siberian natives who lived in the Kamchatka Peninsula of Russia. Of 348 samples studied, the seroprevalence of HBsAg and anti-HBs were 11.8% (41 of 348 samples) and 35.9% (125 of 348 samples), respectively. The prevalence of HCV infection was 1.4% (5 of 348 samples), and that of GBV-C RNA, using RT-PCR methods, was 7.5% (26 of 348 samples). In Siberia, the prevalences of HBV and GBV-C infections were about tenfold higher than those in Japan. The prevalence of HBsAg in subjects under 50 years of age was significantly higher than that in those over 50 years old (P < 0.05). Because HBV infection is highly endemic in Siberia, we propose that the community-based mass immunization must be conducted as soon as possible in this area.     

肿瘤患者肝炎病毒感染分析

目的以2070例肿瘤患者为研究对象,分析其乙型肝炎(HBV)及丙型肝炎(HCV)感染率,研究HBV及HCV感染与恶性肿瘤的关系。方法采用回顾性分析方法,按肿瘤类别、年龄和性别进行分组,对检测结果进行统计分析。结果肝癌的HBV、HCV及混合感染的感染率最高,分别为82.87%、6.71%和4.86%;45～55岁年龄段HBV及HCV单项感染率最高,为22.26%、3.71%;而55～65岁年龄段HBV及HCV混合感染率最高,为2.91%;肝癌及胃癌HBV和HCV单项感染率男性高于女性,而肺癌及结肠癌HBV及HCV单项感染率男性低于女性,肝癌及结肠癌的HBV及HCV混合感染率男性高于女性,肺癌及胃癌则男性低于女性。结论肝癌的HBV、HCV及混合感染的感染率最高;在HBV及HCV单项感染情况下,45～55岁年龄段感染率最高并且男性高于女性。     

Liver transplantation in patients with cirrhosis secondary to hepatitis B virus and hepatitis C virus infections

Liver cirrhosis main related to hepatitis C virus constitutes the main indication of liver transplantation in Europe and the USA, representing as many as 50% of the indications in adults, while cirrhosis associated with hepatitis B virus represents around 10%. The indications for transplantation in patients with infection by both viruses are fulminant hepatitis, decompensated cirrhosis and hepatocellular carcinoma. Both injections may relapse after transplantation. The evolution of the relapse in the graft is variable and can include non-significant alterations of the liver junction tests, chronic active hepatitis and cirrhosis. Less frequently, a particularly severe form called "fibrosing cholestatic hepatitis" can develop, which rapidly evolve to graft failure. The immunoglobin against the B virus and lamivudine reduce the risk of reinfection. The principal factor associated with reinfection is active viral replication before the transplantation, thus it is considered a contraindication for liver transplantation. INF-alpha has been used in the treatment of hepatitis B virus reinfection with discouraging results. More recently, lamivudine and adefovir have been used. Post-transplantation recurrence of hepatitis C is universal and its evolution towards cirrhosis is more rapid than in immunocompetent patients, with graft dysfunction being the most frequent cause of mortality and of indication for retransplantation. Different factors have been related to the severity of the recurrence including factors related to the donor, the recipient, the virus, immunosuppression and surgery. There are no preventive treatments against recurrence of post-transplantation hepatitis C. In the treatment of the hepatitis C virus recurrence, INF-alpha and rivabirin have been used in single form or in combination with variable results, with the combined therapy being more effective. Recently, encouraging results have been described with the combination of pegylated interferon and rivabirin without a higher incidence of rejection. Finally, the results of retransplantation in patients with recurrent hepatitis B or C have not been encouraging.     

我国吸毒人群中艾滋病病毒与丙型肝炎病毒的感染状况

相对其他人群,我国吸毒人群具有较高的艾滋病病毒与丙型肝炎病毒的感染率以及合并感染率,是影响该人群健康的主要问题之一。本文从地区分布、人群分布方面描述和比较了艾滋病病毒与丙型肝炎病毒在我国吸毒人群面的染GZ中的感染以及合并感染的情况,分析了两种病毒通过相互影响,在病毒传播与致病方面产生的危害,并对相应的防治工作提出了建议。     

HIV infection and hepatitis C virus genotype 1a are associated with phylogenetic clustering among people with recently acquired hepatitis C virus infection

The aim of this study was to identify factors associated with phylogenetic clustering among people with recently acquired hepatitis C virus (HCV) infection. Participants with available sample at time of HCV detection were selected from three studies; the Australian Trial in Acute Hepatitis C, the Hepatitis C Incidence and Transmission Study — Prison and Community. HCV RNA was extracted and Core to E2 region of HCV sequenced. Clusters were identified from maximum likelihood trees with 1000 bootstrap replicates using 90% bootstrap and 5% genetic distance threshold. Among 225 participants with available Core-E2 sequence (ATAHC, n = 113; HITS-p, n = 90; and HITS-c, n = 22), HCV genotype prevalence was: G1a: 38% (n = 86), G1b: 5% (n = 12), G2a: 1% (n = 2), G2b: 5% (n = 11), G3a: 48% (n = 109), G6a: 1% (n = 2) and G6l 1% (n = 3). Of participants included in phylogenetic trees, 22% of participants were in a pair/cluster (G1a-35%, 30/85, mean maximum genetic distance = 0.031; G3a-11%, 12/106, mean maximum genetic distance = 0.021; other genotypes-21%, 6/28, mean maximum genetic distance = 0.023). Among HCV/HIV co-infected participants, 50% (18/36) were in a pair/cluster, compared to 16% (30/183) with HCV mono-infection (P = < 0.001). Factors independently associated with phylogenetic clustering were HIV co-infection [vs. HCV mono-infection; adjusted odds ratio (AOR) 4.24; 95%CI 1.91, 9.39], and HCV G1a infection (vs. other HCV genotypes; AOR 3.33, 95%CI 0.14, 0.61).HCV treatment and prevention strategies, including enhanced antiviral therapy, should be optimised. The impact of targeting of HCV treatment as prevention to populations with higher phylogenetic clustering, such as those with HIV co-infection, could be explored through mathematical modelling.     

老年医院获得性嗜麦芽寡养单胞菌肺炎临床与药敏分析

目的分析和总结医院老年患者医院获得性嗜麦芽寡养单胞菌肺炎的临床特点及对抗菌药物的耐药性。方法对28例老年医院获得性嗜麦芽寡养单胞菌肺部感染患者的发病特点、高危因素、临床表现、胸部X线和实验室检查、细菌药物敏感性监测等进行统计分析。结果 28例患者均有基础疾病,营养不良、免疫抑制、意识障碍及各种侵入性治疗为该病高危因素,临床表现为发热、白细胞总数升高不典型,中性粒细胞升高较为多见;敏感率>50.0%的抗菌药物依次为米诺环素81.0%、左氧氟沙星76.2%、磺胺甲噁唑/甲氧苄啶65.1%、头孢哌酮/舒巴坦54.0%;对氨基糖苷类和头孢菌素类普遍耐药。结论老年患者医院获得性嗜麦芽寡养单胞菌肺炎,多发生在有各种基础疾病、免疫功能低下者,各种高危因素又促成该病发生;临床表现不典型;临床上应加强无菌操作、减少高危因素、合理应用广谱抗菌药物,并尽早进行病原学检查,根据药敏试验结果合理选用抗菌药物。     

丁型肝炎病毒与乙型肝炎病毒感染关系的探讨

目的 探讨丁型肝炎病毒(HDV)与乙型肝炎病毒(HBV)感染的相关性,为其临床防治提供可参考依据.方法 连续收集120例入住医院的乙型肝炎病毒感染患者,采用统一的调查表详细记录其病史及相关信息;采用酶联免疫吸附法检测HDV血清标记物HDAg、抗HD、抗HDIgM及HBV血清标记物HBsAg、抗HBs、HBeAg、抗HBe、HBcAg、抗HBc;同时检测所有患者的肝功能、HBV-DNA水平及肝硬化Child-Pugh评分.结果 120例HBV感染的患者中有20例患者同时存在HDV感染的影响,HDV感染的发生率为16.7％,8例为HDAg阳性,11例为抗HD阳性,1例为抗HDIgM阳性;HBV感染联合HDV感染的患者,其肝功能指标:谷丙转氨酶(ALT)为(178.9±8.6) U/L,总胆红素(TBil)为(61.9±9.2)μmol/L水平明显高于单独HBV感染组患者的(78.4±9.4)U/L、(41.4±9.1) μmol/L,而白蛋白(ALB)水平(26.7±7.6) g/L明显低于单独HBV感染组患者的(29.9±7.3) g/L,两组间比较差异均有统计学意义(P＜0.05); HBV感染联合HDV感染的患者,其肝硬化Child-Pugh评分(10.7±1.6)分明显高于单独HBV感染组患者(8.9±1.3)分,而HBV-DNA拷贝数(4.1±0.4)log10拷贝/ml低于单独HBV感染组患者(5.2±0.7) log10拷贝/ml,两组间比较差异均有统计学意义(P＜0.05).结论 HBV感染患者易并发HDV感染,进一步加重肝功能的损伤,进而加重患者的病情,且HDV感染可以抑制HBV的复制,减低其水平,临床对于HBV联合HDV感染患者要积极给予相应的对症治疗措施.     

Self-reported hepatitis B and C virus infections had low sensitivity among HIV-infected patients

OBJECTIVE: To determine the validity of self-reported hepatitis B virus (HBV) and hepatitis C virus (HCV) in HIV-infected injection drug users (IDUs) vs. nonIDUs. METHODS: A cross-sectional study was performed among HIV-infected IDUs and nonIDUs in the Penn Center for AIDS Research (CFAR) Database. Self-reported past HBV, HCV, and serostatus were obtained from the CFAR Database. RESULTS: Among 970 subjects (798 nonIDUs; 172 IDUs), there was no difference in sensitivity of self-reported HBV between nonIDUs (27% [95/346]; 95% CI, 23%-32%) and IDUs (26% [31/117]; 95% CI, 19%-35%; P>0.5), but specificity was greater among nonIDUs (96% [360/374; 95% CI, 94%-98%] vs. 78% [28/36; 95% CI, 61%-90%]; P<0.001). Sensitivity of self-reported HCV was greater among IDUs (78% [101/130; 95% CI, 70%-85%] vs. 62% [47/76; 95% CI, 50%-73%]; P=0.02), but there was no difference in specificity (97% [626/643]; 95% CI, 96%-98% for nonIDUs vs. 93% [26/28]; 95% CI, 76%-99%] for IDUs; P=0.2). CONCLUSIONS: The sensitivity of self-reported HBV and HCV compared to actual serostatus are not sufficiently high enough to warrant their use to estimate the prevalence and incidence of these infections.     

Prevalence and risk factors of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus infections among drug addicts in Bangladesh

This cross-sectional study investigated the prevalence and risk factors of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections among 266 drug users attending a drug-addiction treatment centre in Dhaka, Bangladesh, from November 1996 to April 1997. Of the 266 addicts, 129 were injectable drug users (IDUs), and 137 were non-injectable drug users (non-IDUs). The seroprevalences of hepatitis B virus surface antigen (HBsAg), anti-HBc, anti-HBs, and anti-HCV antibodies among the IDUs were 8 (6.2%), 41 (31.8%), 15 (11.6%), and 32 (24.8%), and among the non-IDUs were 6 (4.4%), 33 (24.1%), 9 (6.6%), and 8 (5.8%) respectively. None of the drug users were positive for anti-HIV antibody. Although the prevalence of HBV infection did not significantly differ between the IDUs and the non-IDUs, the prevalence of HCV infection was significantly higher among the IDUs. Among the IDUs, the prevalence of both HBV and HCV infections was associated with sharing of needles and longer duration of injectable drugs used. The seroprevalence of HBV infection in both IDUs and non-IDUs was significantly higher among those who had a history of extramarital and premarital sex. The prevalence of HCV infection was not associated with sexual promiscuity. There was no association between the seroprevalence of HBV and HCV infections and age. Active preventive programmes focusing on educational campaigns among the youths against substance abuse should be undertaken.     

Prevalence and incidence of HIV, hepatitis B virus, and hepatitis C virus infections among males in Rhode Island prisons

OBJECTIVES: We evaluated prevalence and intraprison incidence of HIV, hepatitis B virus, and hepatitis C virus infections among male prison inmates. METHODS: We observed intake prevalence for 4269 sentenced inmates at the Rhode Island Adult Correctional Institute between 1998 and 2000 and incidence among 446 continuously incarcerated inmates (incarcerated for 12 months or more). RESULTS: HIV, hepatitis B virus, and hepatitis C virus prevalences were 1.8%, 20.2%, and 23.1%, respectively. Infections were significantly associated with injection drug use (odds ratio = 10.1, 7.9, and 32.4). Incidence per 100 person-years was 0 for HIV, 2.7 for HBV, and 0.4 for HCV. CONCLUSIONS: High infection prevalence among inmates represents a significant community health issue. General disease prevention efforts must include prevention within correctional facilities. The high observed intraprison incidence of HBV underscores the need to vaccinate prison populations.     

人乳头状瘤病毒感染子宫颈病变的临床病理分析

目的 探讨妇女生殖道感染人乳头状瘤病毒(HPV)情况结合液基薄层细胞学检查(TCT)对子宫颈病变诊断的临床价值.方法 对286例HPV检测及TCT检查有异常的宫颈病变患者结合阴道镜下宫颈多点活检的病理结果进行分析.结果 HPV感染及宫颈上皮内瘤变(CIN)Ⅰ病变在25～35岁最多,而CINⅡ、CINⅢ及鳞状细胞癌(SCC)在＞35岁高发;随着宫颈病变的逐渐加重,在炎症、CINⅠ、CINⅡ以上及SCC 3组中HPV感染呈上升趋势,分别为54.2 ％、74.6％ 、96.7％,经比较差异有统计学意义(P＜0.01);TCT与病理诊断的阳性符合率为鳞状上皮内低度病变(LSIL)76.4％、鳞状上皮内高度病变(HSIL) 88.9％、SCC100.0％,HPV与TCT,阳性诊断符合率炎症10.3％、CINⅠ 54.2％、CINⅡ82.9％、CINⅢ93.3％、SCC100.0％,随着病理级别的升高,HPV和TCT均为阳性的检出率越来越高,差异有统计学意义(P＜0.01).结论 HPV感染检测结合TCT检查更能有效准确诊断子宫颈病变,对探讨宫颈病变的进展和宫颈癌的早期诊治有重要意义.     

Chronic hepatitis C virus infection

Following acute hepatitis C virus infection (HCV), a significant percentage of patients do not clear the virus and develop a chronic hepatitis C. The symptoms, when they exist, are usually unspecific. Besides, approximately one third of the patients present extrahepatic manifestations of the infection, basically due to the lymphotropism of HCV. Outstanding amongst these, due to their clear association with HCV, are mixed cryoglobulinaemia and the production of autoantibodies (autoAb). Other diseases such as non-Hodgkin lynphoma (NHL) or autoimmune thyroiditis do not have a clearly established association. Although the majority of patients with chronic hepatitis C have slight or moderately high levels and fluctuations of transaminases, as many as one third of those infected can show persistently normal levels of transaminases. The diagnosis of chronic HCV infection is based on serological tests, which detect the presence of antibodies against HCV, and on virological tests that detect RNA of the HCV, which confirm the existence of active infection. Finally, an important topic of chronic HCV infection, following diagnosis, is to ascertain the stage of fibrosis and the degree of inflammation, since both characteristics are very important for predicting the natural evolution and the need for treatment. Nowadays, this information can only be obtained through liver biopsy, which is recommended in patients with chronic HCV infection and high transaminases. Whether liver biopsy should be performed in patients with normal transaminases is still subject of controversy.     

A large nosocomial outbreak of hepatitis C virus infections at a hemodialysis center.

OBJECTIVE: To identify modes of HCV transmission during an outbreak of HCV infection in a hemodialysis unit. DESIGN: An epidemiologic study, virologic analysis, assessment of infection control practices and procedures, and technical examination of products and dialysis machines. SETTING: A private hemodialysis unit treating approximately 70 patients. PATIENTS: Detection of HCV RNA by PCR was performed among patients receiving dialysis in 2001. Case-patients were patients who had a first positive result for HCV RNA between January 2001 and January 2002 and either acute hepatitis, a seroconversion for HCV antibodies, or a previous negative result. Three control-patients were randomly selected per case-patient. RESULTS: Of the 61 patients treated in the unit in 2001 and not infected with HCV, 22 (36.1%) became case-patients with onset from May 2001 to January 2002 for an incidence density rate of 70 per 100 patient-years. Phylogenic analysis identified four distinct HCV groups and an index case-patient for each with a similar virus among patients already known to be infected. No multidose medication vials or material was shared between patients. Connection to a dialysis machine by a nurse who had connected an HCV-infected patient "just before" or "one patient before" increased the risk of HCV infection, whereas using the same dialysis machine after a patient infected with HCV did not. Understaffing, lack of training, and breaches in infection control were documented. Direct observation of practices revealed frequent flooding of blood into the double filter on the arterial pressure tubing set. CONCLUSIONS: During this outbreak, HCV transmission was mainly patient to patient via healthcare workers' hands. However, transmission via dialysis machines because of possible contamination of internal components could not be excluded.     

Acute hepatitis C virus infection

Acute hepatitis C virus infection produces clinical and biochemical features that is non-specific and indistinguishable from those caused by other hepatotropic viruses. The specific diagnosis of acute hepatitis C virus infection is based on the detection of serum RNA-HCV through a technique of PCR whose result will be positive after 1-2 weeks of the initial contact with the virus. The anti-bodies against HCV are detected later (after 7-8 weeks on average), and are not useful, as an isolated determination, in distinguishing acute infection from chronic infection or in clearing the virus (spontaneous or following treatment). Fifty-five to eighty-five percent of patients with acute HCV infection do not clear the virus and develop a chronic infection with risk of evolution to cirrhosis and of developing hepatocellular carcinoma. For this reason, the present tendency is to treat with interferon all those patients in whom RNA-HCV remains positive after 3-4 months following diagnosis of acute infection     

改良胃镜清洗消毒方法对防止医源性乙型肝炎病毒交叉感染的效果

目的 探讨改良胃镜清洗消毒方法对防止医源性乙型肝炎病毒(HBV)交叉感染的效果.方法 采用常规及改良消毒法监测4个项目,取样50次/项目,进行分组清洗消毒;改良胃镜清洗消毒方法是在常规消毒方法的基础上增加了增压泵及清洗喷枪,以取代常规方法中使用的注射器抽吸灌洗;对比分析两种消毒方法的效果.结果 改良胃镜清洗消毒方法的胃镜合格率为100.00％,明显优于常规消毒法的76.00％,差异有统计学意义(P＜0.05);且改良消毒组的活检钳的灭菌效果、2％戊二醛及消毒液的有效浓度合格率分别为96.00％、96.00％、98.00％,常规消毒法的合格率分别为72.00％、80.00％、80.00％,两种消毒方法差异有统计学意义(P＜0.05).结论 改良胃镜清洗消毒方法能够有效地防止医源性HBV交叉感染,且成本低、实用性强,值得临床推广.     

隐匿性丙型肝炎病毒感染

隐匿性HCV感染作为一种特殊的感染形式正逐渐受到重视,此文就隐匿性HCV感染的发生机制、生物学特性及临床特征作了简要概括.