Public Health Policy for Management of Hepatitis B Virus Infection: Historical Review of Recommendations for Immunization

ABSTRACT Chronic hepatitis B virus (HBV) infection is the leading cause of cirrhosis, liver failure, and liver cancer, and an estimated 620,000 persons die annually from HBV‐related liver disease ( Goldstein et al., 2005; World Health Organization, 2000 ). Immunization with the HBV vaccine is the most effective means of preventing HBV infection and its consequent acute and chronic liver diseases such as cirrhosis and hepatocellular carcinoma. The HBV vaccine has been used against HBV in the United States since 1982 ( Centers for Disease Control and Prevention, 1982 ); during the last 25 years, HBV vaccine policy continued to evolve in response to public health issues and epidemiologic data. Although the number of newly acquired HBV infections has substantially declined as a result of implementation of a national immunization program, the prevalence of chronic HBV infection remains high. The purpose of this article is to review the epidemiology of HBV, provide a historical review of health policies for HBV immunization, and summarize the recent evidence‐based public health guidelines for management of HBV infection in the United States     

乙肝相关性肝病患者幽门螺杆菌感染的研究

目的研究慢性乙型肝炎(乙肝)、乙肝肝硬化、乙肝后肝癌等肝病患者幽门螺杆菌(Hp)感染情况。方法收集慢性乙肝、乙肝肝硬化、乙肝后肝癌等肝脏疾病患者273例,日期正常体检人群60例,采用免疫层析法检测患者血清中抗Hp抗体(Hp-IgG),定量PCR检测HBV DNA。结果乙肝相关性肝病患者Hp感染率73.3%,正常体检人群为40.0%,2组比较差异有统计学意义(P<0.01);慢性乙肝、乙肝肝硬化、乙肝后肝癌3组患者Hp感染率分别为62.7%、77.0%、79.7%,后二者Hp明显高于慢性乙肝患者(P<0.05);按病毒载量分级,HBV DNA阴性组Hp感染率低于HBV DNA阳性组,而阳性组按低、中、高分组,各组间Hp感染率分别为69.4%、65.0%、66.1%(P>0.05);乙肝肝硬化患者按Child-push分级后,A、B、C各级之间的Hp感染率分别为51.9%、63.4%、65.6%(P>0.05)。结论 Hp感染可能参与乙肝肝病患者肝脏损伤,显示Hp具有肝细胞毒性作用;肝硬化、肝癌感染率高于慢性乙型肝炎,提示Hp感染与慢性肝病疾病进展和肝癌的发生有一定相关性。     

襄阳地区乙肝肝癌流行状况调查及相关因素分析

目的了解乙型肝炎(简称乙肝)肝癌患者的流行病学特征并观察其血清学转换和乙型肝炎病毒DNA(HBV-DNA)变化趋势,探索乙肝病毒血清学转换与肝癌预后的关系。方法收集襄阳地区两家三甲医院乙肝肝癌患者病历,统计其吸烟史、饮酒史、家族史、感染乙肝时间,HBV-DNA定量检测结果和HBV血清学标志物检测结果,对仍在院的乙肝肝癌患者,用荧光定量PCR检测HBV-DNA水平和酶联免疫吸附测定法检测HBV血清学标志物。结果1475例乙肝肝癌患者中男性明显多于女性,51~60岁的人数最多;乙肝肝癌患者感染乙肝时间大多分布于10~<20年;HBV-DNA阳性率为61.47%,且HBV-DNA定量检测结果多位于103~106 copies/mL;最常见的乙肝“两对半”模式是“小三阳”;抗-HBs阳性的患者也不少,占12.17%;2013-2016年,HBV-DNA定量检测结果不同区间变化趋势不同。结论性别、年龄、家族史、感染时间是乙肝肝癌的高危因素。肝癌患者HBV-DNA检测结果多为阳性,需定期监测HBV-DNA载量并综合乙肝“两对半”及肝功能结果来指导抗病毒治疗。     

Greek nursing students' immunization coverage: data from central continental Greece

Abstract   Nursing students are at risk of acquiring vaccine-preventable diseases. To estimate the vaccination rates for nursing students, a cross-sectional survey was conducted in a major district of central continental Greece with an anonymous and self-administered questionnaire in a sample of 432 nursing students (the response rate was 97%). The eligible nursing students completed the questionnaire after informed consent was obtained. The vaccination rates of the nursing students ranged from 65.2% for the oral polio (SABIN) vaccine and 65.7% for the hepatitis B virus vaccine to 74.6% for the diphtheria-tetanus-pertussis (DTP) vaccine. The parents' level of education did not correlate with the students' underimmunization. The t -test showed that the senior students were more knowledgeable about the compulsory vaccines. Almost half of the nursing students were somewhat satisfied with the available information on vaccination, while 9.5% were not at all satisfied and 38.5% were underimmunized. The proportion of male students who had completed the SABIN and DTP vaccination schedules was higher compared to the female students. More health education programs could increase the vaccination rates among nursing students.     

Early therapeutic plasma exchange may improve treatment outcomes in severe acute toxic Hepatitis

Background and objectivesAcute toxic hepatitis can result in a different clinical course from a completely curable disease to subacute hepatitis, chronic hepatitis, and fulminant hepatitis failure, which is quite mortal. For this purpose, therapeutic plasma exchange (TPE) can be used for improving treatment outcomes by reducing the harmful substances caused with and/or without liver function in acute toxic hepatitis. We aimed to evaluate treatment outcomes in severe acute toxic hepatitis patients who applied early TPE procedure.Materials and MethodsA total of 335 patients who received TPE between 2010–2021 were retrospectively screened and 59 (male/female, 30/29; min/max-age, 22–84) patients with acute toxic hepatitis who underwent TPE in the first 24 h were included in the study. TPE was performed in patients who had high total bilirubin level (>10 mg/dL). Laboratory parameters of the patients before and after the TPE procedure, number of patients developed complications of acute toxic hepatitis and mortality rates were evaluated for effectiveness of TPE.ResultsAcute toxic hepatitis was associated with hepatotoxic drugs in 44 (74.5 %), herbal medication 6 (10.2 %), mushroom poisoning 6 (10.2 %) and with substance abuse 3 (5.1 %) in patients. When the patients were compared based on INR, liver function tests, ammonia, lactate and Model For End-Stage Liver Disease (MELD) score at baseline, 48 h after TPE (independently of TPE number) and before final state a statistically significant decrease was observed in all parameters (p < 0.05). Fifty three (90 %) of patients improved without complications, the remaining 6 (10 %) patients were diagnosed with fulminant hepatitis. All these remaining patients died before liver transplantation (LTx) could be performed.ConclusionTPE is a safe, tolerable therapy option and early TPE may improve treatment outcomes in severe acute toxic hepatitis.     

四种肝病相关自身抗体联合检测在肝功能异常血清中的临床价值

目的探讨4种肝病相关自身抗体在肝功能异常患者血清中的阳性率及其诊断价值。方法间接免疫荧光法检测血清中ANA、SMA、AMA、抗LKM-I，根据荧光反应强弱判定结果。结果150例肝功异常患者（ALT〉50U／L）自身抗体阳性率为18.7％（28／150），其中抗核抗体（ANA）、抗平滑肌抗体（SMA）及抗线粒体抗体（AMA）的阳性率分别为12.7％（19／150）、6.7％（10）／150）和7.3％（11／150）；未检出抗肝肾微粒体I型抗体（LKM-I）；女性患者自身抗体的检出率明显高于男性患者（P〈0.05）：病毒性肝炎标志物阴性组自身抗体检出率明显高于阳性组（P〈0.05）。结论自身抗体对自身免疫性肝病在诊断疾病、了解病程和观察疗效中具有很重要的价值，肝功能异常的非病毒性肝炎病人适合进行肝病相关自身抗体的检测。     

病毒性肝炎患者抗肝抗原自身抗体的检测与分析

目的分析病毒性肝炎患者中几种抗肝抗原自身抗体的存在状况和临床意义。方法采用酶联免疫吸附试验和免疫印迹法检测941例病毒性肝炎患者和32例自身免疫性肝病患者血清中肝肾微粒抗体Ⅰ型(LKM-1)、肝细胞胞溶质抗原Ⅰ型(LC-1)、可溶性肝抗原(SLA)等自身抗体。结果 941例病毒性肝炎患者中,抗肝抗原自身抗体检测阳性率分别为LKM-1 0.9%(9/941)、LC-1 0.2%(2/941)、SLA 0.0%(0/941),其中153例丙型肝炎患者中,抗肝抗原自身抗体检测阳性率分别为LKM-1 4.5%(7/153)、LC-1 1.3%(2/153)、SLA 0%(0/153);552例乙型肝炎患者中,仅检测出2例(0.4%)LKM-1阳性,在甲型肝炎、戊型肝炎和丁型肝炎中未检测出抗肝抗原自身抗体。在32例自身免疫性肝病患者中,抗肝抗原抗体LKM-1、LC-1和SLA的检出率分别为9.4%、3.1%和9.4%,其中在11例自身免疫性肝炎中,LKM-1、LC-1和SLA阳性率分别为27.3%、9.1%和18.2%。病毒性肝炎患者抗肝抗原自身抗体检出率低,与自身免疫性肝病患者比较,LKM-1和SLA差异有统计学意义(P<0.01)。结论少数丙型病毒性肝炎患者血清中存在多种抗肝抗原自身抗体,对病毒性肝炎患者进行包括抗肝抗原在内的自身抗体检测有助于病毒性肝炎合并自身免疫性肝病的诊断。     

自身抗体在自身免疫性肝病诊断中的价值

目的：探讨自身抗体谱分析在自身免疫性肝病（ALD）诊断中的价值。方法回顾性分析864例肝病患者中各类自身免疫性肝病的分布、年龄、性别特征及自身抗体（ANA）、肝抗原自身抗体阳性率。结果864例患者中,病毒性肝炎763例、自身免疫性肝炎（AIH）51例、原发性胆汁性肝硬化（PBC）37例、原发性硬化性胆管炎（PSC）4例和重叠综合征（OS）9例。ALD多见于40岁以上女性。病毒性肝炎组ANA、抗平滑肌肌动蛋白抗体（ASMA）、抗肝肾微粒体抗体1型抗体（LKM-1）的阳性率分别为23．3％、4．6％、1．0％;AIH组ANA、ASMA、抗LKM-1、抗肝细胞溶质抗原1型抗体（抗LC-1）、抗可溶性肝抗原/肝胰抗原抗体（抗SLA/LP）、抗中性粒细胞胞浆抗体（ANCA）的阳性率分别为78．1％、70．6％、7．8％、5．9％、9．8％、29．4％;PBC组ANA、ASMA、抗线粒体抗体亚型M2（AMA-M2）的阳性率分别为83．9％、37．8％、86．5％。结论自身抗体检测是诊断自身免疫性肝病的必要条件,但这些自身抗体也可见于病毒性肝炎。     

慢性重型肝炎、肝衰竭患者43例护理观察

目的观察慢性重型肝炎、肝衰竭患者的临床疗效,总结相关护理经验。方法在常规内科综合治疗基础上,对43例慢性重型肝炎、肝衰竭患者采用系统的针对性护理,对照统计患者治疗前后效果,记录护理要点,总结护理经验。结果治疗总有效率达72.0%,比较患者治疗前后总胆红素、凝血酶原活动度、终末期肝病模型评分变化,差异有统计学意义(P<0.05)。结论慢性重型肝炎、肝衰竭患者病情重,治疗中系统地采用针对性护理,可及时发现患者病情变化,对改善预后、降低病死率、提高临床疗效具有重要意义。     

Statin therapy in chronic viral hepatitis: a systematic review and meta-analysis of nine studies with 195,602 participants

BackgroundConflicting data suggest that statins could cause chronic liver disease in certain group of patients, while improving prognosis in those with chronic viral hepatitis (CVH).PurposeTo quantify the potential protective role of statins on some main liver-related health outcomes in clinical studies on CVH patients.Data Sources: The search strategy was explored by a medical librarian using bibliographic databases, from January 2015 to April 2020.Data synthesis: The results showed no significant difference in the risk of mortality between statin users and non-users in the overall analysis. However, the risk of mortality significantly reduced by 39% in statin users who were followed for more than three years. Moreover, the risk of HCC, fibrosis, and cirrhosis in those on statins decreased by 53%, 45% and 41%, respectively. Although ALT and AST reduced slightly following statin therapy, this reduction was not statistically significant.LimitationsA significant heterogeneity among studies was observed, resulting from differences in clinical characteristics between statin users and non-users, study designs, population samples, diseases stage, comorbidities, and confounding covariates.ConclusionNot only long-term treatment with statins seems to be safe in patients affected by hepatitis, but also it significantly improves their prognosis.     

慢性乙型肝炎患者外周血单个核细胞内乙型肝炎病毒脱氧核糖核酸与肝组织损伤程度相关性分析

目的研究慢性乙型肝炎患者外周血单个核细胞(PBMC)内乙型肝炎病毒脱氧核糖核酸(HBV-DNA)与肝组织损伤程度的相关性。方法采用聚合酶链反应方法测定119例慢性乙型肝炎患者PBMC内HBV-DNA定量,并对肝组织进行病理学诊断。结果119例乙型肝炎患者PBMC内HBV-DNA检出率为71.4%,轻度、中度、重度慢性乙型肝炎患者PBMC内HBV-DNA阳性率分别为58.1%、69.4%、84.6%;慢性乙型肝炎患者PBMC内HBV-DNA检出率与肝组织损伤程度呈正相关(rs=0.912,P<0.05)。结论PBMC中HBV-DNA阳性率随肝损害加重而升高。     

成都市健康体检人群乙型肝炎血清流行病学研究

目的：探讨成都市健康体检人群乙型肝炎病毒血清流行病学状况,并为乙型病毒性肝炎防治提供可靠依据。方法：收集2007年6月至2007年12月成都市体检人群共计10112人,分别统计年龄、性别、乙型肝炎“两对半”结果和肝功能。结果：成都市健康体检人群HBsAg阳性率为4．62％,男性和女性HBsAg阳性率分别为6．0％和2．96％,男性明显高于女性;乙型肝炎病毒感染者中HBeAg阳性和HBeAg阴性分别占16．1％和83．9％;抗-HBs阳性率为56．94％,乙型肝炎标志物全阴为36．17％。结论：成都市健康体检人群HBsAg阳性率明显低于全国平均水平;乙型肝炎病毒感染者中HBeAg阴性占83．9％。     

Initial laboratory predictors of severe hepatitis and acute kidney injury in patients with acute hepatitis A

The number of adult patients with acute hepatitis A (AH-A) has markedly increased during the last 10 years in Korea. Of special note, an increase in severe complications of AH-A, such as severe liver dysfunction and acute kidney injury (AKI), has emerged as a significant problem. The objective of this study was to identify the initial predictors for development of severe AH-A and AKI in AH-A. We retrospectively reviewed the medical records of 194 patients with AH-A from January 2007 to March 2009. Severe AH-A and AKI developed in 16 (9.3%) and 11 (6.4%) patients, respectively. Independent predictors for severe AH-A were low albumin [odds ratio (OR), 10.91; 95% confidence interval (CI), 2.324-51.215; P=0.002], low total cholesterol (OR, 5.54; 95% CI, 1.389-22.113; P=0.015), and elevated alanine aminotransferase (OR, 20.87; 95% CI, 4.581-95.067; P<0.001). Also, high level of C-reactive protein was independently associated with AKI occurrence in AH-A (OR, 10.91; 95% CI, 2.324-51.215; P=0.002).     

四川省攀钢社区儿童病毒性乙型肝炎疫苗免疫效果分析

目的评价社区儿童接种病毒性乙型肝炎（乙肝）疫苗(HepB)的免疫效果。方法用酶联免疫吸附试验（ELISA）法检测儿童接种HepB后血清乙肝病毒表面抗原（HBsAg）、乙肝病毒表面抗体（抗-HBs）、乙肝病毒核心抗体(抗-HBc)。结果儿童HepB首针（HepBsub1/sub)及时接种率、全程及时接种率及全程接种率均逐年上升。抗-HBs阳性率86.12%,HepB保护率91.74%。2006年随机抽检＜15岁儿童735人,与纳入计划免疫管理前的1991年相比,HBsAg阳性率1.09%,HBsAg阳性率下降了85.69%;抗-HBs、抗-HBc阳性率分别为65.71%、8.03%, 差异均有统计学意义（I/Isup2/sup=346.70、12.30,IP/I均0.01）;102名抗-HBs阴性儿童复种大剂量HepB后抗-HBs阳性率79.41%;加强免疫和未加强免疫儿童抗-HBs阳性率差异有统计学意义（I/Isup2/sup=15.61,IP/I＜0.01）。结论社区儿童接种HepB有很好的免疫效果,抗-HBs阴性儿童复种大剂量HepB能提高抗-HBs阳性率。     

Public Health Management of Perinatal Hepatitis B Virus

ABSTRACT Infants who are born to hepatitis B surface antigen (HbsAg)-positive women are at high risk for contracting perinatal hepatitis B virus (HBV) infection. When maternal status is known, postexposure prophylaxis (PEP) consisting of a birth dose of (HBV) vaccine and Hepatitis B Immune Globulin may be administered within 12 hr of birth to provide 90% protection. Providers' reporting of maternal HBsAg positivity or perinatal HBV should prompt public health nurses to initiate nurse case management (NCM). NCM is the most successful way to ensure that at-risk infants receive PEP and follow-up serology. Unfortunately, reporting laws vary greatly by state and the Centers for Disease Control and Prevention estimate that perinatal HBV is significantly under-reported nationally. This article discusses public health measures for preventing perinatal HBV and presents a case study that used a novel method to assess the extent of under-reporting. We discuss barriers to public health NCM and the importance of a universal HBV vaccine birth dose to protect undetected and unreported cases. Finally, we suggest implications for public health nursing practice.     

成都市新津县公益性医疗卫生服务体系改革绩效评估系列之八:新津县2009～2011年基本公共卫生服务绩效评估

目的综合评估2009~2011年4月成都市新津县基本公共卫生服务绩效,为完善和推行成都市公益性医疗卫生服务体系提供证据。方法根据成都市新津县区域卫生信息平台数据,定量描述和比较新津县健康档案、慢病管理、分娩管理和精神卫生情况。结果①新津县2010年体检88?772人,检出健康问题14?497例(检出率16%),每检出1例成本为122.5元。②截至2011年4月,新津县健康档案建档率达98.2%,但不同机构建档率差异较大(68.08%~109.02%),部分档案内容不完整。③高血压患者共7 318例,建档率90.1%;糖尿病患者共2?187例,建档率95.1%。④2009~2011年死胎、死产和新生儿产后死亡率均低于4‰,连续8年产妇零死亡,剖宫产率达61%。⑤2010年精神病患者管理率97.3%,比2009年减少2.7%。结论①新津县全民免费体检率不高,疾病检出率低。②健康档案建档率较高,覆盖人群较广,接近全民覆盖。③慢病建档率较高,但慢病发现率较低。④对精神病患者的管理率接近100%。⑤新津县实施产科上收至县级医疗机构,有效控制和降低了产妇与新生儿死亡风险,但剖宫产比例过高。⑥新津县基于区域卫生信息系统的公共卫生服务与管理具有一定示范意义,但数据收集、使用和挖掘需进一步改进。     

强化教育对慢性乙型肝炎患者口服核苷(酸)类似物治疗依从性的影响

目的研究强化教育对提高慢性乙型肝炎患者口服核苷(酸)类似物抗病毒治疗依从性的作用。方法将198例服用核苷(酸)类似物抗病毒治疗的慢性乙型肝炎患者随机分为强化教育组(100例)和对照组(98例)。第一次处方药物时,对所有患者均进行关于口服抗病毒治疗依从性的教育,在上述基础上,对强化教育组患者每2周左右通过电话、手机短信或电子邮件等方式进行口服抗病毒治疗依从性的强化教育。在4、12、24和48周时,对两组患者的治疗依从性进行比较。结果在4、12、24和48周内,强化教育组患者的自行停药率分别为0、1.0%、3.0%以及3.0%,连续服药(无漏服)率分别为98.0%、97.0%、97.0%和96.0%;相应的时间点内,对照组患者的自行停药率分别为1.0%、3.1%、7.1%和9.2%,连续服药率分别为96.9%、94.9%、91.8%和88.8%,强化教育组患者24、48周时的治疗依从性优于对照组患者。结论对口服核苷(酸)类似物抗病毒治疗的慢性乙型肝炎患者进行强化教育,有助于提高他们的治疗依从性。     

某科研单位职业健康体检结果分析

目的了解某科研单位职业危害作业人员的健康状况,为今后进一步开展职业健康监护工作提供科学依据。方法分析2010年某科研单位420名职业危害作业人员的职业健康体检结果。结果 420例受检职工中79.8%存在不同程度的健康问题,异常检出率位列前五位的是体重超重及肥胖（32.5%）、肝功能异常（32.3%）、血常规异常（16.9%）、肺功能异常（15.9%）、胸部X射线异常（15.4%）;男职工体重超重及肥胖、肝功能异常检出率超过女职工,差异有统计学意义（P〈0.05）;不同年龄组、工龄组之间体重超重及肥胖、肝功能异常、肺功能异常、胸部X射线异常、心电图异常、超声检查肝胆肾异常、血压高检出率差异均有统计学意义（P〈0.05）。结论该科研单位职工健康状况不容乐观,40岁及以上男性职工是今后职业健康监护管理工作的重点人群。