丁型肝炎病毒感染标志物在乙型肝炎病毒感染者中的检测研究

目的 通过检测和分析乙型肝炎病毒(HBV)感染者中丁型肝炎病毒(HDV)感染标志物的分布状况及HBV感染相关指标关联性分析,阐述HDV感染标志物的检测在HBV-HDV重叠感染患者中的临床意义.方法 收集HBV感染者的一般资料和血样,通过酶联免疫分析法检测五项血清HBV感染免疫学标志物指标、HDVAg和Anti-HDV,结合临床诊断和生化指标进行分析,探讨指标间相关性.结果 收集确诊HBV感染者样本346例,其中乙型肝炎病毒携带者62例占17.9％,急性乙型肝炎8例占2.3％,慢性乙型肝炎147例占42.5％,慢性重型乙型肝炎4例占1.2％,乙型肝炎后肝硬化125例占36.1％;检出总体HDV感染率为4.6％,男性显著高于女性,慢性重型乙型肝炎的HDV感染率最高,为25.0％,HDV感染者肝损伤发生率较高.结论 重症肝病病例的HDV感染显著增高,提示HDV感染与肝病的严重程度相关,建议对肝病患者开展血清HDV感染标志物检查,鉴别是否存在HDV重叠感染.     

HBV、HCV和HDV混合感染在慢性肝病中的意义

采用酶联免疫法(ELISA)检测127例慢性肝病患者血清中的HBV、HCV和HDV感染标志,并采用逆转录—聚合酶链反应(RT-PCR)技术检测部分患者血清HCV-RNA。HBV、HCV和HDV混合感染共37例(29.1%)。混合感染者发生慢重肝的频率明显高于单独HBV感染者(P<0.05),混合感染占慢重肝病因的74.2%。混合感染所致慢重肝患者的凝血酶原时间、血清总胆红素及病死率明显高于单独HBV感染者。结果表明:HBV、HCV和HDV混合感染可能是慢性肝病重型化的主要原因,所致慢重肝患者的病情重、预后差。     

丁型肝炎患者血清HDV-IgM检测结果及资料分析

目的分析丁型肝炎的年龄分布、男女比例与乙型肝炎病毒(HBV)重叠感染以及肝功能指标变化的情况.方法用酶联免疫吸附法(ELISA)对患者血清进行HBV抗体IgM(抗-HDV-IgM)的检测,同时观察肝功能指标的变化.结果两组人群检测丁型肝炎抗体IgM(1)乙型肝炎人群组,丁型肝炎病毒(HDV)感染率4.9%(137/2 789),(2)非乙型肝炎人群组,HDV感染率0.13%(1/795).138例丁型肝炎患者,肝功能指标异常率81.2%(112/138),乙型肝炎患者未合并HDV感染,肝功能指标异常率3.2%(85/2 652),两组比较P＜0.05,有显著性差异.HDV感染者以中老年多见,占72.5%;且男多于女,男女比例为2.91.结论乙、丁二型肝炎病毒重叠感染时,肝功能指标大多异常,临床上引起严重的和进行性肝病,并与暴发型肝炎和肝硬化密切相关,提示中老年乙型肝炎患者是丁型肝炎易感者,应积极治疗乙型肝炎,并做好自我保护,避免再染丁型肝炎.     

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.     

山东省部分地区HBV感染者丁型肝炎病毒感染的血清流行病学研究

HDV是亲肝细胞的缺陷性RNA病毒,必须依赖HBV才能复制,常与HBV引起联合感染或重叠感染。为掌握乙型肝炎(HB)病人和HBsAg携带者的HDV感染情况,探讨HBV与HDV感染的关系,我们收集了192份HB病人和54份HBsAg携带者的血清,进行了抗—HD检测。结果报告如下:     

济南地区丁型肝炎病毒感染的血清流行病学调查

丁型肝炎病毒(HDV)是一单股动物小RNA病毒,其复制过程的完成需要嗜肝DNA病毒的帮助,常与HBV联合感染或在HBV携带的基础上重叠感染.临床常表现出慢性化和肝病加重趋势.本文通过对542例各类肝病患者血清抗—HD和HBV多项血清标志物的检测分析,提供了HDV感染程度和分布特征的基本资料.探讨了HDV和HBV感染的关系.1 对象和方法1.1 研究对象 非甲非乙型肝炎(HNANB)、急性乙型肝炎(AHB)、慢性迁延性乙型肝炎(CHP)、慢性活动性乙型肝炎(CAH)、重症乙型肝炎(FH)、乙型肝炎后肝硬化(LC)选自济南市传染病院住院病人,原发性肝癌(HCC)选自山东省立医院和山东医科大学附院确诊病例,无症状携带者(ASC)由济南市传染病院健康查体发现.1.2 研究方法 采取询问和填表方式对每位研究对象进行调查.抗—HD试剂购自北京市肝病研究所,用ELISA竞争抑制法检测.乙肝血清标志物的出测试     

丁型肝炎病毒感染的诊断

丁型肝炎病毒(HDV)是一种小RNA病毒,仅在同时感染HBV的体内才能复制和引起肝炎。丁型肝炎的特点表现在肝内或血清中可检出HDV抗原和在血清中检出抗-HD。 HDV感染既可与HBV联合感染,也可使HBV携带者重叠感染。区别这两种感染很重要,因为它们的预后不同,重叠感染更易导致慢性HDV感染,且两者血清学改变也不相同。 HDV感染的重要性在于它往往导致重     

乙型肝炎病毒和丙型肝炎病毒在合并感染者中的相互作用

目的 了解HBV和HCV在合并感染的慢性肝病患者中相互作用的特点.方法 收集2006年1月～2007年10月在我院治疗的慢性肝病(包括HBV和HCV合并感染引起的慢性肝炎或肝硬化、肝炎后肝硬化、慢性乙型肝炎、慢性丙型肝炎)患者的肝穿病理样本及其血清.所有病例均常规检测肝功能,血清HBV DNA、血清HBV标志物、血清HCV RNA、抗-HCV;所有肝活检样本均用10%中性福尔马林固定,石蜡包埋,作苏木精-伊红、Masson和网状纤维染色,并进行肝炎分级分期,HBsAg和HBcAg免疫组化,HBV DNA和HCV RNA原位杂交检测.结果 HBV和HCV合并感染的患者重型慢性肝炎(G4)发生率比HBV或HCV单独感染的患者高,分别为62.50%、27.05%和30.56%(P＜0.01).在HBV和HCV合并感染引起的慢性肝炎患者中,HBV DNA阳性率为4/32(12.5%),HCV RNA阳性率为24/32(75%),而HBV或HCV单独感染组分别为HBV DNA阳性107/122(87.7%)和HCV RNA阳性58/72(80.56%).结论 HBV和HCV合并感染可增加重型慢性肝炎的发生率.在HBV和HCV合并感染的患者中,HBV和HCV呈相互抑制的作用,主要表现为HCV对HBV的抑制.     

山东省丁型肝炎病毒感染调查研究

为了解山东省丁型肝炎病毒感染状况 ,并探讨丁型肝炎病毒 ( HDV)感染与乙型肝炎病毒 ( HBV)感染的关系 ,应用酶联免疫吸附试验 ( EL ISA)对山东省 2 681例乙型肝炎病毒感染者进行了血清丁型肝炎病毒抗体 (抗 - HDV)检测 ,共检出抗 - HDV阳性者 2 0 7例 ,阳性率 7.72 %。HBs Ag携带者组抗 - HDV阳性率 3.16% ,乙肝患者组抗 - HDV阳性率 13.15% ,两组之间的差异有非常显著性 ( P<0 .0 0 1)。在乙肝患者组中 ,慢性活动性肝炎患者和重症肝炎患者抗 - HDV阳性率高于急性肝炎患者和慢性迁延性肝炎患者 ,差异有非常显著性 ( P<0 .0 0 1) ,表明乙肝病史越长、病情越重 ,其抗 - HDV阳性率越高。提示乙肝患者联合或重叠感染 HDV与乙肝慢性化和病情加重的形成有关。     

HBV和HCV相关性肝细胞癌的临床特征分析

目的探讨乙型病毒性肝炎(HBV)和丙型病毒性肝炎(HCV)相关性肝细胞癌(HCC)患者的临床特征,为其防治和早期诊断提供参考依据。方法回顾性分析2012年1月～2015年12月解放军302医院感染一科434例临床资料完整的HBV和HCV相关性HCC患者,分析其一般资料、实验室检查和影像学检查等临床特征。结果 434例HCC患者中,男女之比为6∶1,45～59岁患者所占比例最高,为55.30%。其中,93.55%的患者为HBV感染者,"小三阳"感染模式最多,为56.23%;确诊HCC时87.19%的HBV感染者已进展为肝硬化。HCC患者中,甲胎蛋白(AFP)阳性患者占70.97%,大于200 ng/ml者占47.93%。HCC大体分型中结节型肝癌所占比例最高,为31.80%;巴塞罗那临床肝癌分期(BCLC)显示,C期(进展期)肝癌所占比例最高,为49.54%。淋巴结为最常见的肝外转移部位,发生率为14.98%,门静脉为最常受侵犯血管,发生率为5.99%。结论中年男性、HBV和(或)HCV感染后肝硬化及HBeAb阳性患者为肝癌高危人群,应加强HCC的筛查。     

乙型肝炎患者超声诊断胆囊病变100例分析

目的探讨乙型肝炎（HB）患者超声诊断胆囊病变及其临床意义。方法对100例HB患者症状、肝功能及B超观测胆囊病变综合分析。结果发现HB患者HB不同类型，胆道系统损伤情况不同，总损伤率以重型肝炎最严重（50．0％），肝炎肝硬化（24．3％）和慢性肝炎（14．9％）次之，急性肝炎（8．9％）最轻。HB患者胆囊壁普遍模糊增厚（62％），呈非特异性炎症表现，与病程、病情有密切关系。结论无明显原因的胆囊壁模糊增厚可作为HB的佐证。胆囊炎、胆石症、胆囊息肉在HB患者中高发，可能与HB病毒持续感染及肝功能异常有关。     

Incidence of hepatitis B, C and D infection in chronic liver diseases]

The authors tested hepatitis B (HBsAg, anti-HBs, anti-HBc, IgM anti-HBc, HBe, anti-HBe), C (anti-HCV) and D (anti-HD, IgM anti-HD) virus markers in the sera of 204 patients, who suffered from histologically confirmed chronic liver diseases (age: 18-72, average: 46.8 y) by Sorin Biomedica RIA and Abbott ELISA kits. On the basis of detailed virus serological tests, they obtained data indicating viral etiology in 62% of the cases. 33.3% of the patients were anti-HCV, 52.5% of the patients were HBV marker seropositive and 11.2% of the HBV seropositive cases were anti-HD seropositive. In 2% of the cases seropositivity of all the three viruses was proved. In 26% of the patients seropositivity of two viruses (HBV and HCV, or HBV and HDV) was proved. They observed severe, progressing liver diseases in patients with HBV, HCV and HDV marker seropositivity in a higher ratio than in seronegative patients. In the cases of combined virus marker seropositivity the incidence rate of chronic hepatitis and liver cirrhosis was higher than in only HBV marker seropositive patients, but did not differ significantly from those only anti-HCV seropositive. In the cases of fought-off HBV infection the severity of the liver disease was milder than in the cases of replication and integration stage. Anti-HD seropositivity occurred in all stages of HBV infection, but active HDV infection, in most of the cases, was observed only in cases in the integration stage. Anti-HCV seropositivity was observed mainly in the fought-off HBV infection stage. Their results suggest that HCV infection, like HDV infection, may suppress HBV replication.(ABSTRACT TRUNCATED AT 250 WORDS)     

丁型肝炎病毒感染的血清流行病学观察

1987年4月至1988年10月间,本文应用酶联吸附法(EIA)对石家庄地区Ml例乙型肝炎病毒感染者进行了抗-HD的检测,共发现35例阳性,阳性率12.92%,其中男性阳性率14.06%(27/102),女性为10.13%(8/79),男女间差异无统计学意义(P>0.05),提示石家庄地区可能为丁型肝炎病毒感染的高发区.在这些人群中,慢性活动性肝炎、慢性迁延性肝炎和肝硬化的抗-HD阳性率明显高于HBsAg携带者,但三者相互间差异无统计学意义,表明合并或重香感染HDV对乙肝慢性化及肝硬化的形成具有重要的意义。本研究证明在乙型肝炎病毒感染人群中丁型肝炎病毐与年龄、性别、职业等因素关系不密切。     

Epidemiology and long-term consequences of hepatitis delta virus infection in the Yucpa Indians of Venezuela.

To define better the epidemiology and clinical impact of hepatitis delta virus (HDV) infection among hepatitis B virus (HBV) carriers in less developed countries, the authors prospectively studied a cohort of 216 Yucpa Indian HBV carriers in Venezuela. HBV carriers were followed regularly between 1983 and 1988 by physical examination, laboratory testing for liver enzymes and HBV and HDV markers, and epidemiologic history. Among the cohort, 74 (34%) were initially positive for HDV infection, and 35 additional persons became infected during the study. Risk factors for new HDV infection included living in southern Yucpa villages; being young adults (15-19 years) or young children (1-9 years), and living in a household with a person with acute HDV infection. Persons with HDV infection were at high risk of developing chronic liver disease; 56% of HDV-infected persons had moderate-to-severe chronic liver disease at the end of the study compared with none of the HBV carriers without HDV infection. Mortality rates were 6.9% and 8.8% per year, respectively, among initially HDV-positive HBV carriers and those with new HDV infection, because of rapidly progressive chronic liver disease and fulminant hepatitis; mortality was significantly lower in HBV carriers without HDV infection and in non-HBV carriers. HDV superinfection is a devastating disease in HBV carriers in tropical South America. Prevention of HBV infection with hepatitis B vaccine is the best available tool to reduce the impact of this problem.     

Delta virus infection in Egypt.

The present study was carried out on 124 serum samples of acute hepatitis B, 51 with chronic HBV infection, and 41 chronic HBsAg carriers. Sera were tested by ELISA for HBV markers and anti-delta (anti-HDV). Delta infection (anti-HDV) in acute HB was found to be 16.9% (21 out of 124), 23.5% in chronic HB cases (12 out of 51), and 21.9% among chronic HBsAg carriers (9 out of 41). Out of the twelve delta positive in chronic HB patients, ten (83%) were suffering from CAH (chronic active hepatitis) denoting a possible role of delta infection in deteriorating the course of the disease. A competitive inhibition of HBV replication by coexistent delta infection was demonstrated in the present study. This was reflected on anti-HBc IgM in the acute cases and on HBeAg in chronic HB cases. Anti-HBc IgM was 71.42% (15 out of 21) in delta positive acute HB patients versus 92.23% (95 out of 103) in delta negative acute HB patients. On the other hand, HBeAg percentage was 8.33% (1 out of 12) and 46.15% (18 out of 39) in delta and non-delta chronic HB patients respectively. The difference in both anti-HBc IgM and HBeAg as regards delta positive and negative patients was found to be statistically significant. Out of the twelve chronic HB cases with delta infection, four cases were negative for HBsAg (33.33%). This observation might be attributed to the clearance effect of hepatitis D virus (HDV) on HBsAg (Ischimura et al., 1988) or due to suppressing effect resulting in low undetectable HBsAg level in serum, (Sherlock, 1989). From the present study it may be concluded that delta infection is endemic in Egypt (its incidence ranged from 16.94% in acute HB to 23.53% in chronic HB infection), delta infection possibly also worsens the outcome of chronic HB patients. Delta infection may exert a competitive inhibitory effect on HBV replication.     

Hepatitis delta virus and hepatocellular carcinoma: an update

Hepatitis delta virus (HDV) is a defective RNA virus that depends on the presence of hepatitis B virus (HBV) for the creation of new virions and propagation of the infection to hepatocytes. Chronic infection with HDV is usually associated with a worsening of HBV infection, leading more frequently to cirrhosis, increased risk of liver decompensation and hepatocellular carcinoma (HCC) occurrence. In spite of a progressive declining prevalence of both acute and chronic HDV infection observed over several years, mainly due to increased global health policies and mass vaccination against HBV, several European countries have more recently observed stable HDV prevalence mainly due to migrants from non-European countries. Persistent HDV replication has been widely demonstrated as associated with cirrhosis development and, as a consequence, development of liver decompensation and occurrence of HCC. Several treatment options have been attempted with poor results in terms of HDV eradication and improvement of long-term prognosis. A global effort is deemed urgent to enhance the models already existing as well as to learn more about HDV infection and correlated tumourigenesis mechanisms.Key words: Cirrhosis, epidemiology, hepatitis delta virus, hepatocellular carcinoma, natural history, treatment     

Hepatitis B & D viral infections among schistosomal patients in Egypt.

A comparative study was done between schistosomal and non-schistosomal groups of acute and chronic HB patients to explore the possible role of schistosomiasis in predisposition to HBV and HDV infections in Egypt. The studied groups were 116 cases of acute hepatitis (78 cases without schistosomiasis and 38 cases with schistosomiasis). The second group of the study was 51 chronic HB patients (31 with schistosomiasis and 20 cases without schistosomiasis). All cases were tested for HBV markers and anti-HDV using ELISA technique. In acute hepatitis patients, the percentage of HBV infection as detected by HBsAg was significantly higher in the schistosomal group (63.15%: 24 out of 38) compared to non-schistosomal patients (37.17%: 29 out of 78) (Table 1). Also, Anti-HBs was detected in a significantly higher proportion among schistosomal group (85.71%: 12 out of 14) compared to non-schistosomal acute HB cases (44.9%: 22 out of 49) (Table 2). The infection rate of HBV (HBsAg+anti-HBs) was found to be statistically higher among schistosomal compared to non-schistosomal patients (94.73%: 36 out of 38 and 65.38%: 51 out of 78 respectively) (Table 3). As regards HDV among schistosomal and non-schistosomal patients suffering from acute HB, frequency of anti-HDV was found to be 33.33% (8 out of 24 HB cases) in schistosomal group versus 17.24% (5 out of 29 HB cases) in the non-schistosomal (Table 4). In chronic HB patients, anti HDV was present as 29.03% (9 out of 31) and 15% (3 out of 20) in schistosomal and non-schistosomal groups respectively (Table 5). But the differences between schistosomal and non-schistosomal groups, as regards delta infection (anti-HDV) among acute and chronic HB patients, were not statistically significant. From the present study, it was concluded that schistosomiasis contributes to significantly increased HBV infection and possibly also HDV infection.     

河南省人群丁型肝炎病毒感染的血清流行病学调查研究

为了了解河南省丁型肝炎病毒的人群感染情况，从１９９１－１９９３年对河南省十三个地区１１８２例ＨＢｓＡｇ阳性的各型乙肝病人及无症状ＨＢｓＡｇ携带者血清标本进行ＨＤＡｇ、抗ＨＤＶ和ＩｇＭ－抗－ＨＤＶ三项标志检测。结果表明，河南省人群ＨＤＡｇ、抗－ＨＤＶ、ＩｇＭ－抗－ＨＤＶ的总感染率分别为３．０％、３．５％、３．５％、８．１％。     

大兴区乙肝病毒感染有关慢性肝病死亡情况分析

[目的]了解人群乙肝病毒感染有关慢性肝病死亡的规律，找出防治的重点人群。[方法]查阅1995—2002年死亡证明书，回顾性调查直接死因为肝癌、肝硬化、慢性乙肝患者的性别、年龄、病程等相关信息。[结果]查阅18763份死亡证明书。共677人死于乙肝病毒感染有关慢性肝病，死亡率均男性高于女性，男性死亡年龄均早子女性；肝癌死亡有慢性乙肝病史者占19．84％，患病平均病程为13、09年，肝硬化死亡有慢性乙肝病史者占34．73％，患病平均病程为11．29年，不同性别差异均无统计学意义。[结论]男性为乙肝病毒感染有关慢性肝病高发人群，也是防治的重点人群：预防慢性乙肝是防治乙肝病毒感染有关慢性肝病的根本措施