40例血清HBV感染标记阳性乙肝患者尿及唾液中HBV感染标记模式观察

167例乙型肝炎血清HBV感染标记为HBsAg(+)、HBeAg(+)、抗-HBc(+)或抗-HBcIgM(+),对其中40例尿及唾液中的HBV感染标记的模式进行检测。40例尿及唾液HBV感染标记同时阳性者占17.5％(7/40)。尿HBV感染标记总检出率37.5％(15/40),其中HBsAg(+)+抗HBc(+)1例,抗-HBe(+)+抗-HBc(+)2例。唾液HBV检出率62.5％(25/40),其中HBsAg检出率为25％(10/40),抗HBc检出率为40％(16/40)。本组病例提示,唾液及尿亦具有传染性,尤以唾液为明显。     

急性与慢性乙型肝炎血清学鉴别的前瞻性研究

对临床诊断为“急性乙型肝炎”和抗-HBc～IgM阳性的61例患者,用ELISA间接法检测特异性抗-HBc-IgG,有28例(45.9％)急性期抗-HBc-IgG阴性,8～17个月后随访其中24例HBsAg阴转,19例(79.2％)抗-HBe阳转,5例(20.8％)抗-HBe阳转,SGPT均恢复正常。随访结果表明这些患者为初次感染HBV的急性乙型肝炎。另外33例(54.1％)急性期抗-HBc-IgG阳性病例,随访24例,HBsAg均持续阳性,其中8例(33.3％)临床复发,无一例产生抗-HBs,提示这些患者为持续感染HBV的慢性乙型肝炎。由此表明抗-HBc-IgM和抗-HBc-IgG可作为临床鉴别HBV初次急性感染和既往持续感染的免疫学指标。     

HBsAg和抗—HBs同时阳性患者的传染性及随访

在1660份HBsAg阳性血清中,112份血清检出抗-HBs(6.75％),HBsAg与抗-HBs同时阳性的血清中,49.1％HBeAg阳性,46％HBV-DNA阳性,提示此种血清近半数具有传染性。对36例HBsAg与抗-HBs同时阳性的慢性HBV感染者进行为期2～30月的随访观察,72％病例抗-HBs仅短暂出现,无一例HBsAg转阴,表明慢性HBV感染患者出现此血清学模式并非预示HBV行将消除。     

76例HBsAg阳性者4 1/2年的随访观察

本文通过对76例HBsAg阳性者HBV血清学标记进行41/2年随访,发现了慢性迁延性肝炎(CPH)和慢性活动性肝炎(CAH)备1例。半年后复查时阴转率为40.8％;45例仍持续阳性。45例HBsAg携带者在4年期间经多次检测HBV血清标记,HBsAg阴转13例。阴转率为28.9％,阴转时间平均1.13年。HBsAg携带者随着HBsAg和抗HBc滴度越高,阴转率越低。     

慢性乙型肝炎患者的HCV重叠感染

研究45例慢性乙型肝炎患者的HCV重叠感染。病例均为后发抗HCV阳性的慢性HBsAg携带者,无先抗HCV阳性而后HBsAg阳性的个案,这可能反映HBV和HCV两种病毒感染的先后次序、不同传播方式及HBV对HCV易感性的增进作用。用RT-PCR检出30/45例血浆HCV RNA阳性,不仅确证HCV重叠感染诊断,还证实HCV复制及传染性。23/30例HCVRNA阳性者有输血史,提示输血是其获得HCV重叠感染的主要途迳。用PCR检出25/45例血清HBV DNA阳性,其中抗HBe阳性者的HBV DNA检出率为42.9％(12/18),明显低于(P<0.001)我们前文报道,提示重叠HCV感染对HBV复制有抑制作用。此外有9例抗HBe阳性者,其HBV DNA阴性但HCV RNA阳性,反映HCV可能已取代HBV成为致肝损害的主要病因。     

慢性乙型肝炎患者的HCV重叠感染

研究45例慢性乙型肝炎患的HCV重叠感染。病例均为后发抗HCV阳性的慢性HBsAg携带，无先抗HCV阳性而后HBsAg阳性的个案，这可能反映HBV和HCV两种病毒感染的先后次序、不同传播方式及HBV对HCV易感性的增进作用。用RT-PCR检出30／45例血浆HCV RNA阳性，不仅确证HCV重叠感染诊断，还证实HCV复制及传染性。23／30例HCV RNA阳性有输血史，提示输血是其获得HCV重叠感染的主要途迳。用PCR检出25／45例血清HBV DNA阳性，其中抗HBe阳性的HBV DNA检出率为42．9％(12／18)，明显低于(P<0．001)我们前报道，提示重叠HCV感染对HBV复制有抑制作用。此外有9例抗HBe阳性，其HBV DNA阴性但HCV RNA阳性，反映HCV可能已取代HBV成为致肝损害的主要病因。     

晚期日本血吸虫病合并HBV感染的临床和病理研究

采用双桥PAP法检测155例晚期血吸虫病(晚血)患者肝内HBsAg和HBcAg,结果88例(56.8％)HBsAg或(和)HBcAg阳性,肝内HBAg阳性组的肝脏病理变化和临床表现显著比阴性组严重,晚血患者发生的门脉性肝硬化大多数与合并HBV感染有关。提示合并HBV感染可以明显加重晚血患者的临床表现和肝脏病变,甚至是晚血患者发生门脉性肝硬化的主要原因。     

乙肝病毒感染与原发性肝细胞癌的队列研究

目的：探讨HBV感染与原发性肝细胞癌（PHCC）的关系。方法：1992年在PHCC高发地区江苏省海门市建立了90236例的前瞻性研究队列。其中HBsAg（＋）14338例，HBsAg（-）75898例，对每一研究对象进行一项流行病学调查。采集外周静脉血10ml，检测HBsAg及其它相关研究指标，每年随访1次队列成员的生命状况至2003年终止。比较两组人群PHCC死亡密度和PHCC发病年龄的差别。计算相对危险度（RR）、归因危险度（AR）、归因危险度百分比（AR％），应用COX风险比例模型计算HBsAg（＋）在PHCC发生中的风险率比（HR）。结果：研究组与对照组PHCC死亡密度比较RR=15，63，AR：725．32（1／10万人年），AR％=93．60％，男性HR：22，3，95％CI为18．7～26．6，女性HR：37．2，95％CI为19．1～72．5。PHCC年龄组死亡密度的分析结果表明感染HBV可促使PHCC发病年龄提前。     

受血者输血前检测HBsAg、抗-HCV、抗-HIV及抗-TP的重要意义

目的:了解受血患者输血前HBV、HIV、HCV及梅毒螺旋体(TP)的感染情况。方法:采用酶联免疫吸附测定(ELISA)法测定HBsAg、抗-HCV、抗-HIV、TPPA(基白螺旋体明胶颗粒凝集试验)测定梅毒螺旋体抗体(抗-TP)。结果:4050例受血者输血前血清标志物HBsAg、抗-HCV、抗-HIV和抗-TP的阳性率分别为16.05%、2.84%、0.02%、0.94%。结论:受血者输血前乙肝、丙肝、梅毒的感染率较高。     

原发型肝癌的HBV感染及肝内的HBVDNA

应用~(32)P标记的3.2kb克隆HBVDNA探针对36例原发型肝癌患者的血清和肝组织作HBVDNA斑点杂交,结果:血清、肝癌组织、癌近邻肝组织和癌远邻肝组织的阳性率分别为56％、91％88％和80％,皆高于国内外一些同类研究,说明其HBV感染率比一般认为的还要常见,尽管肝内良恶组织的HBV DNA阳性率未见显著差别。此外,尚对HBV6项血清标记作了检测,结果HBsAg和PHSA·Re的阳性率均较高,分别为83％和75％,说明多数病例的HBV感染仍然处于病毒活动复制阶段。由于血清HBsAb阳性者,肝内HBV DNA全阳性,提示HCC阶段的“保护性抗体”并不能清除病毒感染。     

梅毒合并感染肝炎患者乙肝病毒检测分析

目的对梅毒合并感染肝炎患者乙肝病毒的感染情况进行调查分析,为临床研究提供有效的依据。方法选取2010年7月—2013年1月在该院治疗梅毒的患者166例,将其设为观察组;同期选取在该院健康体检患者402例,将其设为对照组。对两组患者进行乙肝病毒血清标志物检测。结果观察组中乙肝病毒感染率30.72%,＂大三阳＂的阳性率为50.98%,＂小三阳＂的阳性率为39.22%;对照组中乙肝病毒感染率17.91%,＂大三阳＂的阳性率为30.56%,＂小三阳＂的阳性率为55.55%。两组患者乙肝病毒携带率、＂大三阳＂的阳性率及＂小三阳＂的阳性率比较差异有统计学意义（P〈0.05）。结论相对于健康患者,梅毒患者乙肝病毒的感染率较高,应对梅毒患者在乙肝病毒的传播上加以重视。     

银川某医院就诊人群血清乙肝病毒标志表达模式的探讨

目的　探讨银川地区人群乙肝病毒 (HBV)血清标志表达模式。方法　采用ELASI法对日常工作中的 394 1份血清标本进行检测。为了表述方便 ,设定检测项目第 1- 5项的排列次序 :(1)乙肝病毒表面抗原(HBsAg) ;(2 )乙肝病毒表面抗体 (HBsAb) ;(3)乙肝病毒e抗原 (HBeAg) ;(4)乙肝病毒e抗体 (HBeAb) ;(5 )乙肝病毒核心抗体 (HBcAb) ,并以出现阳性的序号为该模式代码。结果　共 17种模式 ,乙肝病毒表面抗原 (HBsAg)阳性组有 8种模式 ,占 33.88% ;乙肝病毒表面抗体 (HBsAb)阳性组有 6种模式 ,占 6 0 .5 3% ;乙肝病毒e抗原 (HBeAg)阳性组有 4种模式 ,占 14 .6 4 % ;乙肝病毒e抗体 (HBeAb)阳性组有 7种模式 ,占 19.92 % ;乙肝病毒核心抗体 (HB cAb)阳性组有 10种模式 ,占 6 5 .4 8%。结论　该样本人群乙肝病毒血清标志表达模式为 17种。揭示了HBsAb、HBsAg和HBcAb组阳性占有较高的比例。     

Screening of Danish blood donors for hepatitis B surface antigen using a third generation technique

The profit to be gained by testing Danish blood donors for hepatitis B surface antigen (HBsAg) with a third generation technique instead of the currently used immunoelectrophoresis was investigated by additional screening of 48 750 blood units by radioimmunoassay three weeks after donation. Twenty nine units were positive for HBsAg on radioimmunoassay (0.059%). Only six of these were found by immunoelectrophoresis (0.012%). Most of the 23 donors positive on radioimmunoassay and negative on immunoelectrophoresis were healthy carriers of HBsAg (20) or had asymptomatic chronic liver disease (two). One donor had acute hepatitis B. Fifteen of the 23 blood units were transfused. The 15 recipients were monitored biochemically and serologically for up to nine months. One recipient developed fulminant hepatitis B, three developed acute hepatitis B, and one became a healthy carrier of HBsAg. All these patients had received blood from healthy carriers of HBsAg. Two recipients were immunised against HBsAg, and in one patient no seroconversion was observed. The remaining recipients died soon after transfusion or were protected by antibodies to HBsAg that had been present before the transfusion. Testing of Danish blood donors using a third generation technique identified a substantial number of donors positive for HBsAg overlooked by immunoelectrophoresis. Most of these donors were healthy carriers of HBsAg. Blood taken from such carriers is highly infectious when transfused, probably because of the large amount of material transmitted.     

抗—HBcIgM在HBV感染55例中的动态观察

本文ELLSA检测,对55例HBV感染者血清中的抗-HBcIgM随访研究其动态变化。结果发现,急性乙肝35例抗-HBcIgM的阳性率在入院时,6个月,12个月分别为100%（35/35）,86%（31/36）,及34%（6/18）,提示抗-HBcIgM在6个月大都保持阳性,至12个月大部分消失;“无症状”携带者20例抗-HBcIgM阳性率在首检时,6个月,24个月都为100%（各为20/20,17/17,及10/10）,提示“无症状”携带者的抗-HBcIgM很难自然消失,同时把抗-HBcIgM和HBsAg检测对比,提示HBsAg阴性不能排除急性乙肝的诊断。     

A randomized control trial on interruption of HBV transmission in uterus

Objective To study the interruptive effect of hepatitis B virus (HBV) specific immunolobulin (HBIG) before delivery in attempt to prevent intrauterine transmission of HBV.Methods Nine hundred and eighty HBsAg carrier pregnant women were randomly divided into HBIG group and control group. Each subject in the HBIG group received 200 IU or 400 IU of HBIG intramuscularly at 3, 2 and 1 month before delivery. The subjects in the control group did not receive any specific treatment. All newborn infants received 100 IU of HBIG intramascularty after venous blood samples were taken at birth and 2 weeks after birth, followed by 30 μg plasma-derived HB vaccine or 5 μg recombinant yeast-derived hepatitis B vaccine at 1, 2 and 7 months of age. Blood tests were performed for all the lying-in women and their neonates. Blood specimens were tested for HBsAg and HBeAg by enzyme immunoassay. All infants were followed up for 1 year.Results In the HBIG group, 491 neonates were born to 487 HBV carrier mothers; and in the control group, 496 neonates were born to 493 HBV carrier mothers. The rates of intrauterine transmission in the two groups were 14.3% and 5.7% respectively (χ2=20.280, P&lt;0.001), and the rates of chronic hepatitis B in the two groups were 2.2% and 7.3% respectively (χ2=13.696, P&lt;0.001). The high risk factors of intrauterine HBV infection included HBsAg HBeAg double positive and HBV DNA positive in the peripheral blood of pregnant women.Conclusion HBV infection in the uterus may be interrupted by injecting multiple intramuscular HBIG injections before delivery without causing any side-effects.     

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.     

Seroepidemiology of hepatitis B infection in children in Vanuatu. Implications for vaccination strategy

Four hundred and eighty-two unvaccinated children from three different age groups (12-18 months, 30-42 months, 54-115 months) in a hepatitis B virus (HBV) endemic area were tested for markers of HBV infection. HBV seromarkers were detected in 52.3% of children and 26.9% were hepatitis B surface antigen (HBsAg) positive. Evidence of infection was related to age, with HBV seromarker rates highest (67.5%) in school children aged 56-115 months. The HBsAg positive rate was highest (30.1%) in children 30-42 months of age. However, even children in the youngest age group (12-18 months) had high seromarker (26.8%) and HBsAg positive (17.0%) rates. A high proportion of HBsAg positive children (83.8%) were also hepatitis Be antigen (HBeAg) positive. Mothers of children in the youngest age group (12-18 months) were also tested, and 24.5% were HBsAg positive. Factors associated with higher rates of infection in children included maternal HBeAg positivity (for children in the youngest age group), increasing age, and residence on the islands of Emao or Nguna. Higher rates of HBsAg positivity were associated with these factors and with being male. Crossinfection between children is probably the most important source of infection, based on the evidence of the high rate of HBeAg positivity in children and the rising infection rate with age. A possible vehicle of spread is through skin infections and skin sores which are highly prevalent in children in Vanuatu. Since this study indicates that both perinatal and early child-to-child transmission are occurring, the most practical strategy to prevent the majority of infections is to vaccinate all children, commencing at birth and completing the course early in the first year of life.     

青少年原发性肝癌与乙型及丙型肝炎病毒感染的关系分析

目的研究我院收治的青少年原发性肝癌(PHC)患者乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)、HBV/HCV混合感染率,为采取有效的防治措施提供科学依据。方法收集2001年1月—2011年10月解放军302医院收治的青少年PHC患者为病例组,同期住院的其他肝病患者为对照组,对HBV、HCV、HBV/HCV血清标志物阳性率情况进行分析。结果病例组HBsAg、抗HBe、HBeAg、HBV-DNA阳性率分别为77.5%、55.0%、17.5%和40.0%,均高于对照组(25.0%、20.0%、5.0%和7.5%);抗HCV和HCV-RNA阳性率分别为12.5%和15.0%,HBV/HCV混合感染率为12.5%,均高于对照组(5.0%、2.5%和2.5%)。结论 HBV感染、HBV/HCV混合感染对青少年PHC患者的发病具有一定作用,但HBV感染仍是主要的因素。     

620例拟受血者八项传染性标志物检测结果分析

目的：对拟受血者进行输血前相关病原学标志物的检测,了解患者输血前传染病的感染情况,避免和预防患者医院感染、医务人员职业感染及防止医疗纠纷。方法：对620例拟受血者采用ELISA法检测乙型肝炎病毒两对半（ HBsAg、抗-HBs、HBeAg、抗-HBe、抗-HBc）、丙型肝炎病毒抗体（抗-HCV）、人类免疫缺陷病毒抗体（抗-HIV）以及梅毒螺旋体抗体（抗-TP）。结果：620例拟受血者中HBsAg、抗-HCV、抗-HIV、抗-TP阳性率分别为8.71%、1.77%、0.16%、1.94%。结论：检测拟受血者输血前相关病原学标志物对了解受血者输血前感染状况,确保输血安全,减少医疗纠纷,预防医院感染具有重要临床意义。     

Positive Rate of Different Hepatitis B Virus Serological Markers in Peking Union Medical College Hospital,a General Tertiary Hospital in Beijing△

Objectives To investigate the positive rate of different hepatitis B virus (HBV) serological markers, and the demographic factors related to HBV infection.
Methods We enrolled all patients tested for HBV serological markers, such as HBV surface antigen (HBsAg), HBV surface antibody (HBsAb), hepatitis B e antigen (HBeAg), hepatitis B e antibody (HBeAb), HBV core antibody (HBcAb), and HBV-DNA from July 2008 to July 2009 in Peking Union Medical College Hospital. The positive rate of each HBV serological marker was calculated according to gender, age, and de- partment, respectively. The positive rates of HBV-DNA among patients with positive HBsAg were also analyzed.
Results Among 27 409 samples included, 2681 (9.8%) were HBsAg positive. When patients were divided into 9 age groups, the age-specific positive rate of HBsAg was 1.2%, 9.6%, 12.3%, 10.9%, 10.3%, 9.7%, 8.0%, 5.8%, and 4.3%, respectively. The positive rate of HBsAg in non-surgical department, surgical department, and health examination center was 16.2%,5.8%,and 4.7%, respectively. The positive rate of HBsAg of males (13.3%) was higher than that of females (7.3%,P=0.000). Among the 2681 HBsAg (+) patients, 1230 (45.9%) had HBV-DNA test, of whom 564 (45.9%) were positive. Patients with HBsAg (+), HBeAg (+), and HBcAg (+) result usually had high positive rate of HBV-DNA results (71.8%,P=0.000).
Conclusions Among this group of patients in our hospital, the positive rate of HBsAg was relatively high. Age group of 20-29, males, and patients in non-surgical departments were factors associated with high positive rate of HBsAg.