急性病毒性肝炎患者54例临床分析

目的观察和分析急性病毒性肝炎(AVH)患者的临床特征。方法回顾性分析2012年1月至2013年3月本科室收治的54例AVH患者的临床资料及生物化学指标。结果 54例患者中,男性31例,女性23例,男女比例为1.35:1,平均年龄(43.85±15.95)岁。根据病原分布,分为急性乙型肝炎(AHB)组(29例,53.70%)、急性戊型肝炎(AHE)组(18例,33.33%)、未分型肝炎组(6例,11.11%)、乙型肝炎肝硬化基础上重叠戊型肝炎病毒感染组(1例,1.85%)。AHB组患者中有3例为妊娠期女性。AHB组[(37.76±13.67)岁]发病年龄低于AHE组[(54.11±13.97)岁],差异有显著统计学意义(P0.01)。血清白蛋白(ALB)水平方面,AHB组[(37.24±3.68)g/L]患者较AHE组[(33.73±4.61)g/L]高,差异有显著统计学意义(P0.01)。AHB、AHE两组患者的性别比、血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBil)、γ-谷氨酰转移酶(γ-GT)、碱性磷酸酶(AKP)、总胆汁酸(TBA)、胆碱酯酶(CHE)水平及住院时间,差异均无统计学意义(P均0.05)。结论 AHB、AHE是目前常见的AVH类型,AVH预后良好。妊娠合并AHB需引起注意。AHB多见于中青年,AHE多见于中老年。AHB患者血清ALB水平高于AHE患者。     

Pregnancy-associated acute liver disease and acute viral hepatitis: differentiation, course and outcome

BACKGROUND/AIMS: Pregnant women with acute viral hepatitis (VH) and those with pregnancy associated acute liver disease (PAALD) including acute fatty liver disease of pregnancy, hemolysis elevated liver enzyme and low platelet syndrome present with similar clinical features and liver tests abnormalities. Accurate differentiation between the two groups is critical to expedite early delivery in the latter and prevent progressive liver damage. There is scant data in the literature to differentiate between PAALD and VH. METHODS: We studied the clinical variables, hematological, biochemical and viral serological tests of 87 consecutive pregnant patients with jaundice from 2000 to 2003. RESULTS: There were 46 and 41 patients in PAALD and VH group, respectively. Two-thirds in VH group were due to hepatitis E. Univariate analysis identified hypertension, encephalopathy, oliguria, ascites, serum creatinine, and low platelets as significantly more common in the PAALD group. Multivariate analysis and recursive partitioning identified hypertension and ascites as predictors of PAALD with excellent predictive ability and c value of 0.92. Mortality was 41% in PAALD and 7.5% in VH. Increased bilirubin and oliguria were predictors of mortality in PAALD. CONCLUSIONS: Presence of ascites and hypertension differentiates PAALD from VH and should prompt early delivery. Mortality due to hepatitis E is low.     

病毒性肝炎合并急性胰腺炎临床分析

目的探讨病毒性肝炎合并急性胰腺炎的临床特点和预后。方法回顾性分析近10年收治的50例病毒性肝炎合并急性胰腺炎患者的临床表现、实验室检查以及预后等方面的资料。结果 50例患者中,重型肝炎合并急性胰腺炎者32例,其中好转者12例,恶化者20例;非重型肝炎合并急性胰腺炎患者18例,全部好转出院。HAV相关者5例,全部好转;HBV相关者36例,好转25例,恶化11例;HEV相关9例,全部恶化,其中6例病情加重自动出院,3例死亡。结论重型肝炎合并急性胰腺炎发生率高,预后明显差于非重型肝炎合并急性胰腺炎。HEV相关感染合并急性胰腺炎预后亦差于HAV及HBV相关感染合并急性胰腺炎。     

乙型肝炎病毒前S1抗原对判断病毒复制和乙型肝炎预后的价值

目的探讨乙型肝炎病毒前S1抗原与HBVM和HBV DNA的相关性,评价前S1抗原与病毒复制和在判断乙型肝炎预后中的作用。方法采用ELISA法检测前S1抗原;采用时间分辨免疫荧光法检测HBVM;采用酶学速率法检测肝功能;采用荧光定量PCR方法检测HBV DNA。结果在HBeAg阳性的141例患者中,HBV DNA和前S1抗原的检出率分别为97.2%和92.9%,抗-HBe阳性的183例中,分别为39.9%和37.2%;在HB-sAg阳性/抗-HBc阳性的59例中分别为62.7%和54.2%;慢性乙型肝炎轻度159例,中度132例,重度96例,其血清前S1抗原阳性率分别为56.6%、73.5%和61.5%,三组之间无显著性相差。结论检测前S1抗原可以较好地反映HBV的存在和复制,其在乙型肝炎发病中的临床意义还有待探讨。     

急性黄疸型乙肝恢复期复发并淤胆一例

患者,女,35岁.因"乏力、纳差、厌油9天,眼黄、尿黄3天"于2004年3月16日第1次入院.入院查体:皮肤巩膜轻度黄染,未见慢性病容、肝掌及蜘蛛痣,腹部无压痛、反跳痛,肝下界于右肋缘下1.5cm,质中,有触痛,脾未及.入院时肝功示:ALT 765U/L,AST 725U/L,ALP 181U/L,GGT 69U/L,TB104.4μmol/L,DB 65.4μmol/L,IB 38.8μmol/L;乙肝三对示HBsAb阳性,HBcAb-IgM阳性;抗HAV-IgM、抗HCV、抗HEV-IgM均为阴性;PTA 72%.     

37例急性乙型肝炎患者临床和病毒学变化特征分析

目的探讨急性乙型肝炎患者的临床和病毒学变化特征。方法对37例急性乙型肝炎患者进行血清和肝组织HBV标志物监测,并随访临床转归。结果 37例急性乙型肝炎患者入院时ALT水平为1143.64±698.32U/L,TBIL为83.99±80.44μmol/L;肝功能恢复正常时间为44.41±15.43天;血清HBsAg转阴时间为55.9±44.3天,HBV DNA转阴时间为39.4±25.2天;发病后6个月时患者HBsAg转阴率为91.9%,3例（8.1%）患者发展为慢性乙型肝炎,均已使用核苷类药物抗病毒治疗;在发病后45天内完成肝穿刺检查。结果显示,肝组织HBsAg转阴时间为22.6±10.0天,阴转率为51.4%;肝组织HBcAg转阴时间为29.8±16.5天,阴转率为73.0%。结论绝大多数急性乙型肝炎患者均可清除血液及肝细胞内的病毒,使病情得到较快的恢复,而发病初期病毒载量可能对患者预后具有重要的影响。     

Update on the management and treatment of viral hepatitis

This review aims to summarize the current evidence on the treatment of viral hepatitis, focusing on its clinical management. Also, future treatment options and areas of potential research interest are detailed. PubMed and Scopus databases were searched for primary studies published within the last ten years. Keywords included hepatitis A virus, hepatitis B virus (HBV), hepatitis C virus, hepatitis D virus (HDV), hepatitis E virus, and treatment. Outcomes reported in the studies were summarized, tabulated, and synthesized. Significant advances in viral hepatitis treatment were accomplished, such as the advent of curative therapies for hepatitis C and the development and improvement of hepatitis A, hepatitis B, and hepatitis E vaccination. Drugs that cure hepatitis B, going beyond viral suppression, are so far unavailable; however, targeted antiviral drugs against HBV (immunomodulatory therapies and gene silencing technologies) are promising approaches to eradicating the virus. Ultimately, high vaccination coverage and large-scale test-and-treat programmes with high screening rates may eliminate viral hepatitis and mitigate their burden on health systems. The development of curative hepatitis C treatment renewed the enthusiasm for curing hepatitis B, albeit further investigation is required. Novel therapeutic options targeting HDV life cycle are currently under clinical investigation.     

高病毒载量是急性乙型肝炎恢复趋势延缓的高危因素

目的 明确病毒因素与成人急性乙型肝炎(AHB)病情恢复的关系.方法 2003年至2007年入住上海长海医院的97例成人AHB患者纳入本研究,随访24周.收集患者肝功能、病毒学指标和相关流行病学资料,同时应用直接基因测序法对54例AHB患者血清HBV S区进行基因分型.组间均数差异应用t检验,频率差异用X2检验.结果 97例患者的临床表现均比较缓和,83例在病程中发生自发的HBeAg和HBsAg血清学转换.14例患者出现慢性化趋势,其HBVDNA较无慢性化趋势者高[(6.17±1.04)lg拷贝/mL比(3.86士1.85)lg拷贝/mL,t=5.95,P<0.01],其中6例接受抗病毒治疗后发生HBsAg血清学转换,8例未接受抗病毒治疗的患者发展为持续HBV携带.AHB的主要病毒基因型为B型和C型,两种病毒基因型感染者间流行病学和生化指标比较,差异无统计学意义.基线高病毒载量是发展为慢性感染的高危因素.结论 2003年至2007年长海医院收治成人AHB主要病毒基因型为B和C型,病毒基因型和临床转归无明显相关性.基线高病毒载量同临床转归具有明显相关性,适时抗病毒治疗可减少HBV感染持续率.     

慢性丙型肝炎患者感染病毒基因型对抗病毒治疗应答的影响

目的：探讨丙型肝炎病毒基因型与抗病毒治疗后病毒学应答之间的关系。方法113例慢性丙型肝炎患者接受聚乙二醇干扰素（PEG-IFNα-2a）联合利巴韦林治疗48周。采用 Simmonds 基因分型法进行 HCV 基因分型。结果在113例患者中,基因1型88例（78.0%）,非基因1型25例（22.0%）;非基因1型患者快速病毒学应答率（RVR）明显高于基因1型患者（80%对48.8%,P＜0.05）;非基因1型患者持续病毒学应答率（SVR）明显高于基因1型患者（80.0%对64.8%,P＜0.05）;低病毒载量患者RVR 明显高于高病毒载量患者（78.9%对46.7%,P＜0.05）。结论 HCV 基因型和 HCV RNA 复制水平对 PEG-IFNα-2a 联合利巴韦林抗病毒治疗的疗效有一定的影响,提示 HCV 基因分型有重要的临床意义。     

Epidemiology of viral hepatitis in Somalia: Systematic review and meta-analysis study

AIM To provide a clear understanding of viral hepatitis epidemiology and their clinical burdens in Somalia.METHODS A systematic review and meta-analysis was conducted as Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search of published studies on viral hepatitis was performed from 1977-2016 in Pub Med, Google Scholar, Science Direct, World Health Organization African Index Medicus and the Africa Journals Online databases, as well as on the Ministry of Health website. We also captured unpublished articles that were not available on online systems.RESULTS Twenty-nine studies from Somalia and Somali immigrants(United Kingdom,United States,Italy,Libya)with a combined sample size for each type of viral hepatitis[hepatitis A virus(HAV):1564,hepatitis B virus(HBV):8756,hepatitis C virus(HCV):6257,hepatitis D virus(HDV):375 and hepatitis E virus(HEV):278]were analyzed.The overall pooled prevalence rate of HAV was 90.2%(95%CI:77.8%to 96%).The HAV prevalence among different age groups was as follows:1 year old,61.54%(95%CI:40.14%to79.24%);1-10 years old,91.91%(95%CI:87.76%to94.73%);11-19 years old,96.31%(95%CI:92.84%to 98.14%);20-39 years old,91.3%(95%CI:83.07%to 95.73%);and40 years old,86.96%(95%CI:75.68%to 93.47%).The overall pooled prevalence of HBV was 18.9%(95%CI:14%to 29%).The overall pooled prevalence among subgroups of HBV was20.5%(95%CI:5.1%to 55.4%)in pregnant women;5.7%(95%CI:2.7%to 11.5%)in children;39.2%(95%CI:33.4%to 45.4%)in patients with chronic liver disease,including hepatocellular carcinoma(HCC);7.7%(95%CI:4.2%to 13.6%),12.4%(95%CI:6.3%to 23.0%)and 11.8%(95%CI:5.3%to 24.5%)in age groups20 years old,20-39 years old and40years old,respectively.The HBV prevalence among risk groups was 20%(95%CI:7.19%to 44.64%)in female prostitutes,21.28%(95%CI:7.15%to48.69%)in hospitalized adults,5.56%(95%CI:0.99%to 25.62%)in hospitalized children,60%(95%CI:31.66%to 82.92%)in patients with acute hepatitis,33.55%(95%CI:14.44%to 60.16%)in patients with ancylostomiasis,12.34%(95%CI:7.24%to 20.26%)in patients with leprosy and 20.19%(95%CI:11.28%to33.49%)in schistosomiasis patients.The overall pooled prevalence of HCV was estimated as 4.84%(95%CI:3.02%to 7.67%).The prevalence rates among blood donors,risk groups,children and patients chronic liver disease(including HCC)was 0.87%(95%CI:0.33%to 2.30%),2.43%(95%CI:1.21%to 4.8%),1.37%(95%CI:0.76%to 2.46%)and 29.82%(95%CI:15.84%to 48.98%),respectively.The prevalence among genotypes of HCV was 21.9%(95%CI:15.36%to 30.23%)in genotype 1,0.87%(95%CI:0.12%to 5.9%)in genotype 2,25.21%(95%CI:18.23%to 33.77%)in genotype 3,46.24%(95%CI:37.48%to 55.25%)in genotype 4,2.52%(95%CI:0.82%to7.53%)in genotype 5,and 1.19%(95%CI:0.07%to16.38%)in genotype 6.The overall pooled prevalence of HDV was 28.99%(95%CI:16.38%to 45.96%).The HDV prevalence rate among patients with chronic liver disease,including HCC,was 43.77%(95%CI:35.09%to 52.84%).The overall pooled prevalence of HEV was46.86%(95%CI:5.31%to 93.28%).CONCLUSION Our study demonstrates a high prevalence of all forms of viral hepatitis in Somalia and it also indicates that chronic HBV was the commonest cause of chronic liver disease.This highlights needs for urgent public health interventions and strategic policy directions to controlling the burden of the disease.     

糖尿病合并病毒性肝炎的临床分析

目的 分析糖尿病合并病毒性肝炎（VH）的临床特点.方法 回顾性分析278例糖尿病合并VH的临床资料.结果 （1）糖尿病合并病毒性肝炎（DM＋ VH）组平均年龄高于单纯病毒性肝炎（VH）组,但低于糖尿病（DM）组[（53.30±12,05）vs（37.58±14.39） vs （61.18±14.16）岁,P=0.00].（2）DM＋VH组临床类型以肝硬化为主（47.12％）,其次是慢性乙型肝炎（33.09％）.（3）糖尿病患者中以T2DM多见,其次是肝源性糖尿病（HGD）.结论 糖尿病合并VH以中年男性肝炎后肝硬化及慢性乙型肝炎患者常见.     

重型病毒性肝炎并发低血糖临床分析

目的 探讨重型病毒性肝炎患者血糖低于正常值的临床特点及防治对策。方法 回顾性分析2002年6月至2004年4月住院重型病毒性肝炎患者空腹血糖,对其在治疗过程中的变化做动态分析。结果 92例重型病毒性肝炎患者,空腹血糖低于正常67例(72．8％),其中死亡56例(68．7％),与其他并发症并存的发生率较高。动态分析空腹血糖降低患者治疗过程中血糖变化有三种形式,空腹血糖持续多次减低患者死亡率亦较高。空腹血糖减低患者中,仅部分呈典型低血糖症表现,死亡率最高。结论 重型病毒性肝炎常并发空腹血糖减低者的死亡率高。在积极综合治疗后,持续多次空腹血糖减低患者死亡率较高。呈低血糖症患者死亡率最高。血糖减低的治疗需要采取综合措施,个体化原则。     

合并病毒性肝炎的甲状腺功能亢进患者抗甲状腺功能亢进药物治疗的安全性及短期疗效

病毒性肝炎和甲状腺功能亢进(以下简称甲亢)都是临床常见的疾病,二者同时存在的情况并不少见.甲亢时机体呈高代谢状态导致内脏对氧的消耗增多,分解代谢亢进,肝细胞因缺氧及营养障碍而功能受损~([1]).     

乙型肝炎重症化的概念及自然史

正2006年全国乙型肝炎血清流行病学调查表明,我国1~59岁一般人群HBs Ag携带率为7.18%。由乙型肝炎病毒所致的重型肝炎一直以来是我国医药卫生事业中的重大课题。乙型肝炎重症化是指乙型肝炎从轻症(轻、中度炎症)发展至重症(肝衰竭)的过程。我国自2007年以来,启动了"乙型肝炎重症化临床监测及防治的基础研究"国家重点基础研究发展计划(973计划)科技攻关项目,对乙型肝炎     

New animal models for hepatitis C viral infection and pathogenesis studies

Hepatitis C virus (HCV) is a major cause of chronic live disease, cirrhosis and hepatocellular carcinoma (HCC) In man, the pathobiological changes associated wit HCV infection have been attributed to both the immun system and direct viral cytopathic effects. Until now, th lack of simple culture systems to infect and propagat the virus has hampered progress in understandin the viral life cycle and pathogenesis of HCV infection including the molecular mechanisms implicated in HCV induced HCC. This clearly demonstrates the need t develop small animal models for the study of HCV associated pathogenesis. This review describes an discusses the development of new HCV animal models t study viral infection and investigate the direct effects o viral protein expression on liver disease.     

丙型肝炎病毒感染者血清核心蛋白水平与抗病毒治疗效果相关性分析

目的 探讨血清HCV核心蛋白与抗病毒治疗效果的相关性.方法 采用ELISA法检测162例丙型肝炎患者血清HCV核心蛋白量,采用荧光定量PCR检测HCV RNA;观察35例接受聚乙二醇干扰素+利巴韦林治疗的患者在治疗前、治疗4周、治疗24周、治疗48周时HCV RNA与HCV核心蛋白水平,比较两者血清水平随临床疗效变化的一致性.两组计量资料比较采用t检验,多组配对资料进行方差分析.结果 162例患者中56例HCV RNA≤1×103IU/mL,HCV核心蛋白吸光度(A)值为0.100±0.029;9例1×103IU/mL＜HCV RNA≤1×104 IU/mL,A值为0.246±0.213;11例1×104IU/mL＜HCV RNA≤1×105IU/mL,A值为0.235±0.179;28例1×105 IU/mL＜HCV RNA≤1×106IU/mL,A值为0.422±0.319;51例1×106IU/mL＜HCVRNA≤1×107IU/mL,A值为0.603±0.330;7例1×107IU/mL＜HCV RNA≤1×108IU/mL,A值为0.900±0.379.对HCV RNA与HCV核心蛋白水平进行相关性分析,结果呈正相关(r=0.36,P＜0.05).35例接受抗病毒治疗患者治疗前、治疗4周、治疗24周和治疗48周时的核心蛋白A值分别为0.564±0.296、0.144±0.062、0.091±0.035和0.112±0.103.与抗病毒治疗前比较,治疗4周、24周、48周患者血清HCV核心蛋白水平均明显下降(t=8.563、9.195、9.250,均P＜0.05);治疗4周与24周比较,差异也有统计学意义(t=4.301,P＜0.05).结论 在疾病进程及抗病毒治疗过程中血清HCV核心蛋白的量的变化与HCV病毒载量变化是平行的.     

快速病毒学应答对干扰素治疗慢性丙型肝炎疗效的预测分析

目的 探讨干扰素治疗慢性丙型肝炎的快速病毒学应答(RVR)对疗效的预测及其相关因素.方法 对139例慢性丙型肝炎患者,根据其临床特点,给予标准干扰素(IFN)或聚乙二醇干扰素(PEG-IFN)治疗.IFN α3～5MU隔日注射1次;PEG-IFNα-2a 135～180 μg,或PEG-IFNα-2b 50～80 μg,每周注射1次.并根据患者的体质量给予600～1500 mg/d的利巴韦林,在治疗的0、4,12周和以后每间隔12周、治疗结束后的24周进行HCV RNA含量检测,根据患者治疗过程中的病毒学应答情况给予24～72周的疗程,以持续病毒学应答(SVR)作为疗效的评判指标.根据资料不同采用χ2检验或t检验.结果 132例患者完成了全程观察,其中4例治疗无效(3.0%),12例复发(9.1%),获得SVR有116例(87.9%).120例在治疗4周时检测了病毒学指标,101例(84.2%)获得了RVR,治疗前病毒载量为(5.883±1.246)lg拷贝/ml,19例无RVR,治疗前病毒载量为(6.502±0.693)lg拷贝/ml,两组比较,t:2.15,P=0.034,差异有统计学意义.97例完成全程观察的RVR患者中,88例(90.7%)获得SVR,17例无RVR的患者,14(82.4%)例获得了SVR,x3=0.371,P=0.543,差异无统计学意义.基因1型HCV感染患者的RVR为80.7%(46/57),非基因1型HCV感染患者的RVR率为92.6%(25/27),两组间比较,χ2=6.00,P=0.112,差异无统计学意义.初治患者的RVR率为87.8%,干扰素再治疗者的RVR率为65.0%,两组比较,χ2=4.651,P=0.031,差异有统计学意义. 结论 干扰素个体化抗病毒治疗慢性丙型肝炎,有较高的RVR获得率.RVR的获得与治疗前HCV RNA载量和患者是否为初次治疗相关,与基因型无关,RVR的获得可预测SVR的获得.