维持性血液透析病人庚型、丙型和乙型肝炎病毒感染的研究

目的 :评价维持性血液透析 (HD)病人庚型、丙型和乙型肝炎病毒感染状况和危险因子。方法 :应用第二代ELISA方法对 10 5例本院HD病人进行HGV、HCV和HBV检则 ,并与透析时间、输血次数等关系进行对比分析。结果 :10 5例HD病人肝炎感染率分别为 :HGV 14.3%、HCV 5 1.4%、HBV 2 2 .9% ,均明显高于对照组 (P <0 .0 5～ <0 .0 1)。其中HCV感染率与透析时间、输血次数相关程度密切 (P <0 .0 0 1) ,且输血次数相对危险性 (OR =2 .735 1)大于透析年度 (OR =2 .0 315 )。结论 :透析环境是HD病人感染HGV、HCV和HBV的危险因子 ,其中HCV感染率随透析年度增加呈增高趋势 ,可能是通过共用透析机和重复透析器传播。输血仍是感染HCV另一重要危险因子 ,且比透析年度危险性更大     

血液透析患者乙型肝炎和丙型肝炎病毒感染的血清学调查

目的 :了解血透患者乙型肝炎和丙型肝炎病毒感染的情况。方法 :用第二代酶联免疫法 (ELISA)及聚合酶链反应法 ,(PCR)分别检测丙型肝炎抗体 (抗 -HCV)和HCVRNA ,以ELISA法检测乙型肝炎病毒标志物 (HB VM )。结果 :抗 -HCV阳性率为 4 5 .1% ,HCVRNA阳性率为 6 4 % ,总阳性率为 6 7.6 % ;HBVM阳性率为 5 5 .6 %。结论 :乙型和丙型肝炎病毒在血透患者中感染率较高。筛查献血员及血制品对预防丙型及乙型肝炎传播十分重要。     

251例血液透析患者HBsAg与抗-HCV检测结果分析

目的分析血液透析患者乙型肝炎表面抗原（HBsAg）与丙型肝炎抗体（抗-HCV）检测结果,旨在寻求血透患者感染的依据,减少医源性感染。方法应用酶联免疫吸附法（EuSA）检测2006年12月份在我院进行血液透析的251例患者HBsAg与抗-HCV,并对透析1年以上的149例患者的肝炎标志物阳性率与透析年限、输血史、手术史的相关性进行分析。结果透析1年以上的149例患者中,HBsAg阳性者19例,阳性率为12．8％;抗-HCV阳性者29例,阳性率19．5％。HB—sAg、抗-HCV同时为阳性者仅1例（0．4％）。抗-HCV阳性率随透析年限、输血次数、手术次数增加而增高（P〈0．05）,多因素非条件多元Logistic回归分析提示,透析年限是抗-HCV阳性率最有统计学意义的因素（OR〉I）;而HBsAg阳性率与透析年限、输血、手术、性别的相关性均无明显统计学意义（P〉0．05）。结论透析年限、输血、手术与抗-HCV阳性率具有显著相关性,随着透析年限的增加抗-HCV阳性率上升,而与HBsAg阳性率无明显相关性。     

Hepatitis B and Hepatitis C Virus Infection and Outcome of Hemodialysis and Kidney Transplant Patients

Aim. A comparison of the outcome of hepatitis virus-positive and -negative kidney transplant and hemodialysis patients was the aim of this investigation. Materials and Methods. The study involved 384 kidney transplant patients (67 HBsAg positive, 39 anti-HCV positive, 278 hepatitis negative), transplanted between 1987 and 2001, and 403 hemodialysis patients (128 HBsAg positive, 83 anti-HCV positive, 192 hepatitis negative) who had started hemodialysis and were referred to the kidney transplant waiting list during the same period. Results. Hemodialysis patients were older than transplant patients. Comparison of the groups’ survival rates, adjusted for patient age, showed that all kidney transplant patients survived longer than hemodialysis patients (p < 0.001). HBV infection had a negative impact on patient survival, especially in hemodialysis patients. HCV infection did not have a significant influence on patient survival. Cardiovascular disease was the main cause of death of all hemodialysis- and hepatitis-negative transplant patients. Liver failure was one of the leading causes of death in HBV-positive transplant patients. Mortality risk was higher for older patients, HBV-positive and -negative hemodialysis patients. Conclusions. Kidney transplantation offers longer survival for hepatitis-positive and -negative hemodialysis patients. HBV but not HCV infection had a negative impact on ESRD patient survival.     

Reviews of Research on Risk Factors of Hepatitis C Virus Infection

Viral hepatitis C is one of the most prevalent infectious diseases in the world and may cause serious hepatic diseases in the future. Hepatitis C-infected people account for approximately 2% to 3% of the world's population. The main causes of hepatitis C infection in developing countries are unsafe medical injection and contaminated blood and blood products; whereas in developed countries, it is mainly caused by injection, drug abuse, and high-risk sexual behavior. The focus of hepatitis C prevention and control should be placed on safer blood supply, safer health care and related unnecessary injection, reduction of injection drug use, and high-risk sexual behavior because effective vaccine and postexposure prophylaxis are not yet available.     

Hepatitis C Virus Infection After Renal Transplantation

Hepatitis C virus (HCV) infection is the main cause of liver disease after renal transplantation. Most patients have seroconverted on dialysis to positive RNA. The viral load increases during immunosuppressive therapy. The risk of developing chronic liver disease is related to the histopathologic findings, duration and severity of the disease, immunosuppression, and transplantation time. Hepatitis C virus infection can predict onset, of proteinuria and diabetes. We studied 868 patients who received renal transplants between (1987 and 2006), of whom 18.7% were seropositive for HCV. We observed a higher rate of HCV-seropositive patients related to the duration of hemodialysis therapy. Of the HCV seropositive patients, 77% had received renal allografts before 1998. There was no difference between the sexes; however, the HCV positive patients were younger. Polymerase chain reaction tests results were positive in 91.6% of the patients with HCV antibodies. The prevalence of diabetes was greater among HCV positive patients, as was as the persistence of proteinuria. Cryoglobulins were positive in 30.8%. The incidence of acute rejection episodes in the first year was similar between groups. Of the HCV-positive patients, 80.2% were treated with cyclosporine, most patients continued this therapy throughout the study. We observed no significant difference in mortality end graft survival rate between the two groups. However, renal function differed significantly at some points during the evolution of the clinical course. Renal transplantation is still the best treatment option in patients with chronic renal disease.     

Incidence of Hepatitis C Virus (HCV), Hepatitis B Virus (HBV) and Dual Infection in Egyptian Patients on Haemodialysis

Hepatitis viral infections are important causes of morbidity and mortality in haemodialysis patients. The aim of the present work is to study the prevalence and possible risk factors of hepatitis C virus (HCV), hepatitis B virus (HBV) and dual infection in haemodialysis patients. Three hundred forty patients with end-stage renal disease, 266 males (78.2%) with mean age of 50.9?±?11.6 years and 74 females (21.8%) with mean age of 53.5?±?10.5 years on haemodialysis, were recruited from four haemodialysis units. They were screened for the presence of HCV, HBV and dual HCV and HBV infections and possible risk factors for acquiring these infections in those patients during the period between June 2007 and August 2009. One hundred ninety-six (57.7%) patients were HCV positive while 12 (3.5%) patients had HBV infection. A dual infection with both viruses was observed in 26 patients (7.6%).There was a significant difference in the number of blood transfusions among HCV-positive, HBV-positive and dual infection patients and negative patients (12.4?±?7.6, 13.8?±?6.8, 13.5?±?8.3 vs. 5.2?±?3.4 transfusions, p?<?0.01). HCV, HBV and dual HCV and HBV patients have been on dialysis for a longer period than the negative patients (7.5?±?5, 6.2?±?3.6, 7.5?±?5.4 vs. 4.4?±?4 years, p?<?0.01). Higher HCV was associated with longer haemodialysis duration and history of previous blood transfusion and not associated with dialysis in multicentres. HBV and dual infection is less prevalent than HCV in haemodialysis units.     

Clinical Characteristics and Surgical Outcome in Hepatocellular Carcinoma without Hepatitis B Virus Surface Antigen or Hepatitis C Virus Antibody

Objective We investigated clinical characteristics and surgical outcome of hepatocellular carcinoma in association with hepatitis viral status. Summary Background Data No consensus exists concerning differences in surgical outcome in patients with hepatocellular carcinoma according to viral hepatitis status, especially those negative for hepatitis B virus surface antigen and antibody to hepatitis C virus. Methods Clinicopathologic data were available for 39 hepatectomy patients with hepatocellular carcinoma who were negative for hepatitis B virus surface antigen and hepatitis C virus antibody. Clinical characteristics and surgical outcome were analyzed retrospectively and compared to those patients with positive hepatitis viral markers. Results Patients negative for viral hepatitis markers were more likely to have large, advanced-stages tumors with relatively well-preserved liver function and had a lower incidence of intrahepatic recurrences (P = 0.009). The intrahepatic recurrence rate reached a plateau at approximately 3 years after resection in patients with negative viral markers, while it continued to increase steadily in patients positive for viral hepatitis markers. By multivariable analysis, the absence of viral hepatitis markers predicted a decreased rate of intrahepatic recurrence (relative risk, 0.222; P = 0.001). Conclusions Adequate surgical resection in hepatocellular carcinoma patients negative for viral markers offers a good survival benefit, regardless of the etiology of the hepatocellular carcinoma.     

Advances in Animal Models of Hepatitis B Virus Infection

Hepatitis B virus(HBV) infection seriously affects human health. Stable and reliable animal models of HBV infection bear significance in studying pathogenesis of this health condition and development of intervention measures. HBV exhibits high specificity for hosts, and chimpanzee is long used as sole animal model of HBV infection. However, use of chimpanzees is strictly constrained because of ethical reasons. Many methods were used to establish small-animal models of HBV infection. Tupaia is the only nonprimate animal that can be infected by HBV. Use of HBV-related duck hepatitis virus and marmot hepatitis virus infection model contributed to evaluation of mechanism of HBV replication and HBV treatment methods. In recent years, development of human–mouse chimeric model provided possibility of using common experimental animals to carry out HBV research. These models feature their own advantages and disadvantages and can be complementary in some ways. This study provides an overview of current and commonly used animal models of HBV infection.     

Hepatitis C Virus Compartmentalization and Infection Recurrence after Liver Transplantation

Hepatitis C virus (HCV) compartmentalization may have important implications in the pathogenesis of HCV infection. The aim of this study was to investigate the presence and relevance of HCV compartmentalization in the setting of liver transplantation (LT). We collected samples of serum, peripheral blood mononuclear cells (PBMC), perihepatic lymph nodes (PLN) and liver explant at the time of LT, and serum and PBMC after transplantation from 57 HCV-infected cirrhotic patients undergoing LT: 38 individuals received antiviral treatment before LT and 19 were untreated controls. HCV-RNA levels were determined by real-time PCR and the hypervariable region 1 (HVR-1) was sequenced. HCV-RNA was detected in all samples from control patients. In virological responders, recurrence after LT was associated with residual HCV-RNA in the liver explant. Within the entire cohort, 47% of patients harbored differences in direct sequences from distinct compartments. Quasispecies analysis revealed that in most cases, HVR-1 sequences recovered after infection recurrence were identical or closely related to those isolated from the liver explant and serum at the time of LT. Our study shows that a significant proportion of HCV-infected cirrhotic patients exhibit compartmentalization. Viral variants originating within the liver appear to be the main cause of HCV recurrence after LT.     

Association Between Chronic Hepatitis C Virus Infection and Bone Mineral Density

Whether chronic hepatitis C virus (HCV) infection is a risk factor for the development of bone disease has long been controversial. For this reason, chronic HCV-infected participants (n?=?69) were recruited into a prospective cohort study and underwent dual-energy X-ray absorptiometry for determination of bone mineral density (BMD). Fibrosis staging was evaluated according to the noninvasive index FIB-4. T scores at the femoral neck and lumbar spine were used as the primary outcome variables to assess the association between degree of liver disease and BMD. The study cohort was 41?% male with a mean age of 53.6?years. The mean BMD, Z score, and T score values of lumbar spine in chronic hepatitis C (CHC) patients were significantly lower than those in healthy controls (p?<?0.001). The rate of osteoporosis for CHC patients aged 45–54?years was significantly higher than that of the control group (p?=?0.011). Bone alkaline phosphatase and C-terminal cross-linking telopeptide of type I collagen levels were also significantly higher in CHC patients with reduced BMD. Patients with more advanced liver fibrosis had significantly lower BMD. In conclusion, reduced BMD is common in this population of chronic HCV-infected patients and associated with liver disease severity. This extrahepatic manifestation is probably secondary to increased bone turnover in osteodystrophy pathogenesis.     

Treatment for Recurrent Hepatitis C Virus Infection After Liver Transplantation

Cirrhosis due to hepatitis C virus (HCV) infection is the current leading indication for orthotopic liver transplantation (OLT) in the world. This series reports our program's experience with the treatment of HCV infection after the development of histological hepatitis. Between March 2002 and June 2008, patients with recurrent HCV were selected for treatment if the liver biopsy showed at least the F2 degree of Metavir score. HCV viral load was measured at 4, 12 and 24 weeks as well as at the end of treatment and at 6 months thereafter for patients who became HCV RNA negative (sustained virological response [SVR]). In this period, we performed 287 liver transplantations in 279 patients, including 117 (42%) who had HCV cirrhosis as the indication for OLT of whom 25 were eligible for antiviral treatment. Twelve patients completed treatment, 7 remain on treatment, and 6 were discontinued. The principal collateral effect was anemia. Only 1 patient had an episode of acute cellular rejection, which responded to adjustment of immunosuppression. Antiviral treatment in transplanted patients was feasible and did not seem to induce severe immunological effects. Adjuvant therapies to reduce cytopenias are frequently required, principally erythropoietin. The best results were observed with the pegylated interferon alfa (PEG) plus ribavirin (RBV) group: 38.9% of SVR. We recommend antiviral treatment of eligible patients with confirmed HCV recurrence using PEG plus RBV.     

Hepatitis C Virus Infection in Dialysis: A Continuing Problem

Patients on chronic dialysis are at increased risk of acquiring parenterally transmitted hepatitis viruses from blood product transfusions or nosocomial transmission in hemodialysis units, and biochemical abnormalities in liver function are seen in 10–44% of patients on chronic hemodialysis. In the past, hepatitis B virus (HBV) was the major cause of parenterally transmitted viral hepatitis in dialysis patients, and the remaining cases were attributed to non-A, non-B hepatitis (NANBH). The discovery of the hepatitis C virus (HCV) has shed light on the cause and clinical course of NANBH in patients on dialysis. The current debate is focused on strategies to reduce the transmission of HCV among dialysis patients and to lessen the consequences of liver disease among patients already infected.