肝细胞癌和其它慢性肝病HCV HBV感染比较分析

对１２８例有病理诊断依据的肝细胞场（ＨＣＣ）、４７例慢迁肝（ＣＰＨ）、１０５例慢活肝（ＣＡＨ）、４６例肝硬化（ＬＣ）．采用嵌套式ＰＣＲ技术检测其血标本中的丙型肝炎病毒（ＨＣｖ）ＲＮＡ和乙型肝炎病毒（ＨＢＶ）ＤＩＩＡ，对这两种病毒的血清学标志也进行了研究。结果：在ＨＣＣ组。ＨＣＶＲＮＡ１４．１％阳性，ＨＢＶＤＮＡ７ｉ．３％阳性。ＣＰＨ，ＣＡＨ，ＬＣ和ＨＣＣ的ＨＢＶ感染率均在９０％左右，而ＨＣＶ感染率则分别为８．５％、９．５％、１７．４％和１９．５％，显示ＨＣＶ感染率随肝病严重程度的增加而有增加的趋势；晚期肝病组的ＨＣＶ感染率（１９．０％）显著高于慢性肝炎组（９．２％，Ｐ＜０．０５）。提示ＨＣＶ感染后经过慢性肝炎、肝硬化发展为ＨＣＣ可能是一个逐渐演进的病理过程。ＨＣＶ，ＨＢＶ重叠感染率。ＨＣＣ组高于ＣＰＨ，ＣＡＨ，而与ＬＣ相近，显示ＨＣＶ重叠感染在原有ＨＢＶ感染的基础上促进病变向着迁延化、慢性化，进而向着肝硬化、ＨＣＣ方向发展。     

三种肝炎病毒在肝细胞癌组织及慢性肝炎肝组织中的表达

目的:探讨乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)及庚型肝炎病毒(HGV)在肝细胞癌(HCC)及慢性肝炎肝组织中的存在状态。方法:分别采用抗HBVS,抗-HBVC,抗HCVNS5及抗-HGVNS5单克隆抗体,以免疫组织化学SPAB法检测27例HCC及37例慢性肝病患者石蜡包埋的肝组织中HBVS抗原(HBsAg)、HBVC抗原(HBcAg)、HCVNS5抗原(HCAg)和HGVNS5抗原(HGAg)。结果:HCC中检出HBsAg18例(66.7%),HCAg13例(48.2%)及HGAg9例(33.3%)。其中HBV/HCV/HGV重叠感染7例,HBV/HCV重叠感染4例,HBV单独感染7例,HCV单独感染2例,HGV单独感染2例;在慢性肝炎中检出HBsAg26例(70.3%),HCAg19例(51.4%)及HGAg12例(32.4%)。其中HBV/HCV/HGV重叠感染10例,HBV/HCV重叠感染5例,HBV单独感染11例,HCV单独感染5例,HGV单独感染2例。HBsAg、HCAg、HGAg均表达于肝细胞或肝癌细胞浆内,呈细颗粒状分布。HBcAg表达于肝细胞或肝癌细胞胞核或胞浆内。结论:慢性肝炎及HCC患者有较高的HBV、HCV及HGV感染率,HBV感染在HCC的发生过程中起重要作用,HCV和HGV的感染可能是HCC发生的相关因素。     

Preliminary report on seroepidemiology of HCV and HBV infection in northern China.

1 141 serum samples from various population groups in north China were examined for C100-3Ab by ELISA. Antibody to C100-3 antigen derived from HCV genome (C100-3A) and HBsAg were measured in 438 normal population in Beijing. The C100-3Ab positive rate was 2.1% and the HBsAg positive rate was 2.5%. There is increased occurrence with age. In 649 cases of chronic liver diseases, the HBsAg positive rate was 87.1% in chronic persistent hepatitis (CPA), 88.8% in chronic active hepatitis (CAH), 64.9% in liver cirrhosis (LC) and 67.3% in hepatocellular carcinoma (HCC). The C100-3Ab positive rate was 10.5% (CPH), 12.1% (CAH), 42.6% (LC) and 38.4% (HCC). It is noteworthy that the C100-3Ab positive rate significantly increased with disease progression from CPH to CAH, LC and HCC. Prevalence of cases positive for both C100-3Ab and HBsAg was 0% in the normal population, 6.7% in CPH, 8.4% in CAH, 31.1% in LC and 28.8% in HCC. Investigation of patients with HCV infection showed that only 36.8% had blood transfusions. HCV and HBV infection may play important pathogenic roles in CPH, CAH, LC and HCC in north China.

     

慢性肝病和肝癌中丙型肝炎病毒感染的病理学研究

目的 研究广西肝细胞癌（ＨＣＣ）及慢性肝病病变组织中丙型肝炎病毒（ＨＣＶ）感染状况。探讨ＨＣＶ感染在肝癌发病中的应用。方法 用免疫组化ＳＰ法,检查２０１例病变肝组织中丙肝病毒核心区抗原（Ｈｅｐａｔｉｔｉｓ Ｃ Ｃｏｒｅ Ａｎｔｉｇｅｎ,ＨＣＡｇ）和乙肝病毒表面抗原（ＨＢｓＡｇ）,分析各种肝脏病变中ＨＣＶ的感染状况及其与病变程度的关系。结果：１１６例ＨＣＣ和８５例慢性现中的ＨＣＶ感染率分别是４４．８     

丁型肝炎病人肝组织HDAg与HBsAg/HBcAg和HBV DNA表达及关系

目的：探讨丁型肝炎病人肝组织中ＨＤＡｇ与ＨＢｓＡｇ／ＨＢｃＡｇ和ＨＢＶＤＮＡ表达及关系。方法：应用免疫组化双重染色和原位杂交,检测７９例丁型肝炎病人肝组织ＨＤＡｇ、ＨＢｓＡｇ、ＨＢｃＡｇ和ＨＢＶＤＮＡ表达,以５２例乙型肝炎作对照。结果：丁型肝炎ＨＢｓＡｇ、ＨＢｃＡｇ检出率（８１％、７１％）较乙型肝炎（９４％、９２％）低（Ｐ〈０．０５或０．０１）。ＨＤＡｇ以肝细胞核表达为主,ＨＢｓＡｇ以肝细胞浆表达     

人肝癌及癌周组织中HBsAg、HBcAg和糖原的研究

用组化和免疫组化方法,对人肝癌癌旁组织中增生灶、增生结节与肝癌的关系及其HBsAg,HBcAg和糖原的表达进行了观察。结果表明,嗜酸性细胞和(或)透明细胞增生灶、增生结节与周围癌组织有明显过渡性;嗜酸性细胞增生灶、增生结节的HBsAg,HBcAg和糖原均可阳性表达。提示HBV在肝癌发生中起重要作用。作者对人肝癌发生的可能途径进行了讨论。     

五华县60例HBsAg阳性携带者转归及其家庭成员乙肝感染调查结果分析

目的了解五华县HBsAg阳性携带者转归及其家庭成员HBV感染情况。方法对在2006年血清学调查中发现的60例HBsAg阳性携带者及其家庭成员进行肝功能及HBV相关指标检测,并进行分类诊断。结果60例HBsAg阳性携带者3年后分类诊断为HBsAg阴转5例（8．33％）,HBV携带者47例（78．33％）,慢性乙肝7例（11．67％）,肝细胞癌1例（1．67％）。检测其家庭成员126人,检出HBsAg阳性25人,阳性率19．84％,分类诊断为HBV携带者21例（84．00％）,慢性乙肝4例（16．00％）。结论HBsAg阳性携带者家庭成员HBsAg阳性率高于普通人员。     

四川省自贡市159例慢性HBV感染者的HBV基因型分布及其与疾病进展关联研究

目的 了解四川省自贡市慢性HBV感染者的HBV基因型分布情况,并探讨其与慢性乙肝患者病情进展的关系。方法 收集2015年9月—2018年6月159例经本院确诊的慢性HBV感染者,且HBV-DNA水平含量在 10³ IU/mL以上,根据疾病诊断将慢性HBV感染者分为三组：慢性乙型肝炎组（CHB）、乙肝相关性肝硬化组（LC）、乙肝相关性肝癌组（HCC）。采用多通道实时荧光探针PCR法检测乙肝病毒的3种基因型（B、C、D型）,同时检测HBV-DNA及HBV的五项标记物。采用SPSS17.0软件对数据进行统计分析。结果 本文研究显示B基因型115例（72.3%）,C基因型43例（27.0%）,B/C混合型1例（0.6%）,D基因型0例;B基因型的HBV-DNA水平高于C基因型（P<0.05）;慢性HBV感染患者中,男、女组均以B基因型为主,B基因型和C基因型分布在年龄、性别、HBeAg阳性率方面比较差异无统计学意义（P>0.05）;乙肝相关性肝癌组（HCC）的C基因型比例明显高于CHB组和LC组（P<0.05）。结论 自贡市HBV主要流行B基因型,其次是C基因型;B基因型和C基因型的慢性HBV感染患者进展为肝硬化或肝癌可能存在一定的差异。     

Prevalence of hepatitis B surface antigen among patients suspected of liver diseases in a Nigerian hospital

Hepatitis B virus (HBV) infection has been reported to be the aetiological factor for hepatocellular carcinoma (HCC), hepatitis and liver cirrhosis. This study was therefore carried out to determine the seroprevalence of hepatitis B surface antigen (HBsAg), a specific marker of HBV infection in patients with suspected liver diseases. The investigation was carried out among patients attending the University of Maiduguri Teaching Hospital (UMTH), Nigeria with clinical symptoms suggestive of liver diseases and others with non-specific clinical features during the period from 1990-1995. A total of 197 (38%) of 517 patients tested positive for HBsAg, 81 (49%) out of 144 with symptoms suggestive of hepatitis, 75 (50%) of 149 HCC and 10 (56%) of 18 liver cirrhosis were HBsAg positive. Comparison of the yearly total prevalence values of HBsAg for the six years under study showed no significant difference. Similarly, yearly prevalence values amongst patients with suspected liver diseases showed no significant differences. Nevertheless, significant difference, (P < 0.05) between the prevalence of HBsAg among suspected cases of liver diseases and others with non-specific signs and symptoms was observed. Similarly, HBsAg was statistically significantly higher among males than females. The high prevalence rate of HBsAg in our environment may be associated with the suspected cases of liver diseases, which are equally prevalent in our locality. Health education to prohibit traditional practices that could predispose individuals to HBV infections is emphasised. The incorporation of HBV vaccination in the national programme on immunization currently in use in Nigeria is highly recommended. This would be an effective method of preventing HBV infection from childhood.     

肝细胞癌组织中HBV，HCV，HGV的表达

目的　探讨乙型肝炎病毒 (HBV) ,丙型肝炎病毒 (HCV)及庚型肝炎病毒 (HGV)在肝细胞癌 (HCC)组织中的存在状态。方法　分别采用抗 -HBVS ,抗 -HCVNS5及抗 -HGVNS5三种单克隆抗体 ,以免疫组织化学SPAB法检测 2 6例HCC患者石蜡包埋的肝癌及癌旁肝组织中HBVS抗原 (HBsAg) ,HCVNS5抗原 (HCAg)和HGVNS5抗原(HGAg)。结果　检出HBsAg 17例 ( 65 % ) ,HCAg 13例 ( 5 0 % )及HGAg 9例 ( 3 5 % ) ,其中HBV/HCV/HGV重叠感染 7例 ,HBV/HCV重叠感染 4例 ,HBV单独感染 6例 ,HCV单独感染 2例 ,HGV单独感染 2例 ,另有 5例均不表达上述三种抗原 ;HBsAg与HGAg阳性率之间差异有显著性 (P <0 0 5 ) ,HBsAg与HCAg及HCAg与HGAg阳性率之间差异均无显著性(P >0 0 5 ) ;HBV ,HCV及HGV均表达于肝细胞或肝癌细胞浆内 ,呈细颗粒状分布 ,癌组织表达强度均弱于癌旁组织。结论　HCC患者中有较高的HBV ,HCV及HGV感染率 ,感染率顺序为HBV >HCV >HGV ;推测HBV感染在HCC发生过程中起重要作用 ,HCV和HGV感染可能是HCC发生的相关因素。     

105例原发性肝癌的临床及病理特征分析

目的探讨乙型肝炎病毒（HBV）感染与原发性肝癌（PHC）之间的关系和其病理特征。方法：经病理证实的105例PHC患者，检测了解其HBV感染史和感染模式，并分析肝组织的病理学变化，以探讨乙型肝炎病毒感染与原发性肝癌（PHC）之间的关系。结果：105例PHC患者中HBV感染102例，感染率达97．1％，以HBsAg、抗-HBe和抗-HBc的阳性率最高（53．3％）。而HBsAg（＋）、HBeAg（＋）、抗-HBc阳性率次之（为23．8％），肝组织病理学特征：肝细胞癌（HCC）占94．3％（99／105），结节型、巨块型、小肝癌分别占60．9％、30．5％、和8．6％。多分布在肝右叶（占63．8％），85％合并有肝硬化。结论：HBV感染与原发性肝癌的发生关系密切，是PHC的主要病原学因素。PHC以肝细胞癌、低分化为主，主要分布在肝右叶、以结节型为主。     

HBV感染各阶段血清乙肝表面抗原与HBV DNA及年龄的相关性分析

目的:探析未接受抗病毒干预治疗的慢性乙型肝炎病毒(HBV)感染者各阶段的血清乙肝表面抗原(HBsAg)定量值与HBV DNA及患者年龄的关系.方法:2015年3月~2016年12月在我院就诊但未接受抗病毒治疗的498例慢性HBV感染患者的临床资料.根据临床诊断结果,将入选者分成非活动性HBsAg携带组(145例)、慢性HBV携带组(57例)、乙型肝炎E抗原(HBeAg)(+)慢性乙型肝炎(CHB)组(151例)、HBeAg(-)CHB组(65例)、HBeAg(-)乙肝肝硬化(LC-B)组(43例)和HBeAg(+)LC-B组(37例)6组.对血清HBsAg定量与血清HBV DNA及患者年龄进行相关性分析.结果:各组间的HBsAg定量值有统计学差异,其中HBeAg(-)、(+)的CHB组间HBsAg水平差异显著.除外非活动性HBsAg携带的HBV感染者的HBV DNA与血清HBsAg定量值呈显著正相关性.HBV感染者的血清HBsAg定量值与其年龄间存在显著负相关性.年龄>40岁的非活动性HBsAg携带者血清HBsAg定量值明显低于同年龄段的HBeAg(-)CHB患者.结论:HBV感染各阶段的血清HBsAg水平各不相同,该水平与患者的年龄及HBV DNA关系密切,是区分年龄超过40岁的非活动性HBsAg携带者与HBeAg(-)CHB患者的一个重要预测指标.     

Immunohistochemical detection of hepatitis C virus antigen from hepatocellular carcinoma]

To investigate the infection of HCV and the expression of HCV antigen (HCAg) in HCC, immunohistochemical protocol was performed on tumorous liver tissues from 40 patients with HCC to detect HCAg and hepatitis B virus surface antigen (HBsAg) simultaneously. The results showed that the positive rates for HCAg and HBsAg were 17.5% (7/40) and 70% (28/40) respectively. HBsAg and HCAg were simultaneously detected in six of 40 cases and only one case had HCAg positive alone in the liver tumorous tissue. The positive signals were localized in diffuse cytoplasm of hepatocytes and the positively stained cells were mainly distributed in local pattern. The results suggested that HCV infection did exist in some cases of HCC, so HCV might be a viral risk factor in addition to HBV in the genesis of HCC in China.     

肝细胞癌组织中丙肝病毒抗原及HBsAg的免疫组化检测

为了解丙肝病毒（ＨＣＶ）感染与我国肝细胞癌（ＨＣＣ）之间的关系,以及ＨＣＶ抗原成分（ＨＣＡｇ的）在ＨＣＣ组织中的分布状况,应用鼠抗ＨＣＶ单克隆抗体,采用免疫组化技术检测ＨＣＣ组织中ＨＣＡｇ的表达,同时检测了乙肝病毒表面抗原（ＨＢｓＡｇ）。结果：４０例ＨＣＣ标本组织中ＨＣＡｇ、ＨＢｓＡｇ检出率分别为１７．５％（７／４０）和７０％（２８／４０）,其中单一ＨＣＡｇ阳性者仅１例,ＨＣＡｇ和ＨＢｓＡｇ同时存在的检出率为１５％（６／４０）。镜下见ＨＣＡｇ呈细颗粒状分布于细胞胞浆,ＨＣＡｇ阳性细胞以局灶型分布为主。提示我国部分肝癌患者的癌组织中确实存在ＨＣＶ,ＨＣＶ感染可能是除乙肝病毒以外,导致我国ＨＣＣ发生的另一相关因素。     

GSTM1基因多态与HBV相关性肝细胞癌易感

目的:探讨谷胱甘肽转硫酶(GSTs)M1基因多态性与乙型肝炎相关性肝细胞癌及其与HBV感染引起的慢性乙型肝炎和肝硬化的相关性.方法:采用病例-对照流行病学研究方法,选取了91例原发性肝癌(HCC)患者、58例肝硬化(LC)患者、63例慢性乙型肝炎(CHB)患者和134例正常对照者.以多重PCR技术,检测GSTM1缺失情况.结果:正常组GSTM1基因缺失率(46.92%)与HCC组(61.53%)差异有显著性(P<0.05),与LC组(45.61%)、CHB组(49.18%)差异无显著性.携带GSTM1空白基因型者比非空白基因型者患原发性肝癌的风险高1.81倍(OR=1.81,95% CI=1.05～3.12).携带的55岁前发病的HCC病人GSTM1空白基因型分布明显较55岁后发病者高(P<0.05).结论:GSTM1空白基因型与肝癌易感性有关,且与其发病年龄有关,与肝硬化和慢乙肝无明显相关.     

肝细胞癌癌组织、癌外肝组织内HBV标志的免疫组织化学研究

本文用PAP法观察50例早、中期肝细胞癌(HCC)癌组织,癌外肝组织和40例慢性肝病肝组织内HBsAg、HBcAg的检出率与表达方式。HCC癌外肝组织内HBsAg和HBcAg的检出率分别为76％和30％,癌组织内相应的检出率为14％和6％;癌外肝组织HBAg的检出率、表达方式与慢性肝病患者基本相同,提示乙肝病毒(HBV)感染与HCC有密切的关系。本文还观察了HCC患者HBV感染的类型、癌外肝组织内HBAg与病理变化的关系。     

肝细胞癌及相关慢性肝病的乙型肝炎病毒检测

为了探讨乙型肝炎病毒（HBV）的致癌机理,采用免疫组化染色和原位分子杂交方法,对慢性肝炎、肝硬化、癌旁肝硬化、肝细胞癌和正常肝组织共108例进行乙型肝炎表面抗原（HBsAg）、核心抗原（HBcAg）和HB-VDNA检测。结果：HBsAg HBcAg和HBVDNA的阳性率分别为慢性肝炎61.9%(13/21),42.9%(9/21)和75.0%(12/16);肝硬化64.0%(16/25),36.0%(9/25)和83.3%(15/18）;癌旁肝硬化72.7%(16/22),61.1%（11/18)和85.7%(12/14）;肝细胞癌45.2%(14/31),50.0%/(14/28)和64.3%(9/14);正常肝组织不表达,慢性肝炎、肝硬化和癌旁肝硬化HBVDNA阳性信号较肝细胞癌多而强,结果表明大多数肝细胞癌与HBV感染所致的慢性肝炎和肝硬化密切相关,癌旁肝硬化可能为癌前肝硬化在癌周的残留。     

HBV感染与原发性肝癌关系的探讨

采用配比的方法,以原发性肝癌、肝硬化、慢性乙型肝炎和非肝病病人为研究对象,检测其HBV感染6项血清学标志。结果表明,原发性肝癌、肝硬化、慢性肝炎的HBV感染总阳性率分别为98.21%,93.75%和96.43%;与对照组有显著差异;3组的感染标志组合较一致,HBsAg和抗-HBc双阳性为主;HBeAg在肝硬化和慢性肝炎中明显高于肝癌组;抗-HBe和抗-HBcIgM3组间无显著差别。提示HBV感染的慢性化与原发性肝癌病因有密切联系。     

Distribution of Hepatitis B Virus Genotypes and Its Clinical Significance in Hubei Province, China

The distribution of hepatitis B virus genotype in Hubei province and its clinical signifi- cance were investigated. HBV genotypes of 276 patients were detected by PCR-microplate sandwich hybrization-ELISA technique. The level of HBV DNA was detected by using PCR-fluorescence quantification test. Among 276 patients, there were 78 cases of HBV asymptomatic carriers, 110 cases of chronic hepatitis B (CHB), 62 cases of severe hepatitis (SH) or liver cirrhosis (LC) and 26 cases of hepatocellular carcinoma (HCC). The genotypes of HBV included C, B, mixtures (B C, B D, C D) and D, accounting for 55.8%, 25.4%, 16.7% and 2.1% respectively. The average level of HBV DNA in genotypes C, B, mixtures and D was 1.20×106, 7.81×104, 3.26×105 and 5.01×104 cop- ies/mL respectively. The ratio of SH, LC and HCC in genotype B, C and mixtures was 20%, 30% and 48% respectively. Statistical analysis revealed the percentage of genotype mixtures infection was sig- nificantly higher than that of genotype B infection. There was no significant difference in the per- centage between genotype B and genotype C or between genotype C and mixtures. The distribution of genotype B, C and mixtures in SH, LC and HCC was significantly different. The frequency of HCC was zero in patients with co-infection. Genotype D was only related with SH and LC. The in- creased ALT could be converted to categorical grades of severity. From mild, moderate to severity, the prevalence of genotype C showed an opposite trend, although no statistically significant differ- ence was observed. The HBeAg positive rate was higher in patients with genotype C infection than in those with genotype B, especially in the patients whose ages were from 31 to 40 years old. Compared with genotype B, genotype C showed a higher HBeAg positive rate in patients with SH and LC. The percentage of SH, LC and HCC was higher in patients with genotype C and mixtures infection. On the contrary, the percentage of genotype B was lower. The HBeAg positive rate in patients with genotype C infection was higher than those with genotype B infection. Genotype C and mixtures may be associated with development of severe liver disease.     

肝癌患者乙肝病毒标志与肝功能分析

目的 研究肝癌患血清乙型肝炎病毒(HBV)标志物情况及肝癌治疗前后肝功能的变化。方法 回顾性调查227例肝癌住院患的HBV标志物及肝功能变化。结果 在HBsAg阳性肝癌患中，抗—MBe阳性占63．8％；肝癌患经介入或外科手术治疗后均可引起肝功能损害加重，且外科手术治疗后谷丙转氨酶(ALT)升高比介入治疗更显，其差异有统计学意义，但两种方法治疗后总胆红素(TBIL)升高的差异无统计学意义。结论 HBV感染与肝癌发生密切相关，而且以HBsAg、抗—HBe、抗—HBc阳性模式为主，在肝癌阶段仍有部分患HBV处于复制活跃状态；介入与外科手术治疗肝癌均可引起肝功能损害的加重，以外科手术治疗引起ALT升高更显。