成人传染性单核细胞增多症30例临床分析

目的 分析成人传染性单核细胞增多症的临床特征及治疗.方法 回顾性分析2002至2007年华山医院住院诊治的30例成人传染性单核细胞增多症的临床资料.结果 本组患者中男性略多于女性,平均年龄31.8岁.70%患者有脾肿大,10%出现肝肿大,33%出现皮疹,77%有肝功能异常,20%的患者EB病毒IgM抗体阳性,2例患者为慢性活动性EB病毒感染(CAEBV).本病治疗以抗病毒和对症治疗为主.结论 传染性单核细胞增多症l临床表现多变,易误诊.成人CAEBV少见.本组病例预后良好.     

儿童EB病毒感染的分子生物学诊断及临床分析

目的探讨儿童EB病毒感染的临床特征及多系统损害情况,提出分子生物学诊断对临床早期诊断、合理用药的重要意义。方法应用荧光定量PCR技术检查患儿呼吸道分泌物EB-DNA,并结合其他实验室检查进行回顾性分析。结果确诊68例EB病毒感染的患儿临床表现多样,多数患儿有并发症,明确诊断后进行抗病毒治疗,效果良好。结论应用荧光定量PCR技术进行EB病毒检测,在确诊EB病毒感染和指导临床治疗方面具有良好的应用前景。     

成人EB病毒重叠新型布尼亚病毒感染1例

<正>成人EB病毒和新型布尼亚病毒同时感染的临床相关报道较少,临床表现复杂,诊断困难。现将我院收治的1例成人EB病毒重叠新型布尼亚病毒感染患者的诊治过程报道如下。患者女,51岁,因"发热、恶心、呕吐伴腹泻1周"于2015年9月10日收入感染科。入院查体:T38.7℃,神清,精神差,左侧颈部可触及一黄豆大小质软淋巴结,活动度可,无压痛,左腹股沟可触及成     

68例非嗜肝病毒所致肝炎患者病因学分析及其临床特点

目的 探讨非嗜肝病毒所致肝炎的病因和临床特征。方法 对68例非甲—非戊型肝炎患者进行临床研究，用常规方法检测甲—戊型肝炎的标志物，排除嗜肝病毒感染。再检测单纯疱疹病毒、EB病毒、巨细胞病毒、柯萨奇病毒IgM、IgG型抗体和自身抗体(线粒体抗体和抗核抗体)，随访6个月，并将其临床症状和体征与同期嗜肝病毒所致急性肝炎比较。结果 68例非嗜肝病毒所致肝炎中单纯疱疹病毒感染9例，EB病毒感染12例，巨细胞病毒感染8例，柯萨奇病毒感染l4例，线粒体抗体和抗核抗体阳性的13例，不明原因者12例。排除13例线粒体抗体和抗核抗体阳性患者和12例不明原因患者后，43例由非嗜肝病毒感染所致肝炎患者中35例发生在冬春季节，其临床症状似较嗜肝病毒所致急性肝炎轻。结论 单纯疱疹病毒、EB病毒、巨细胞病毒、柯萨奇病毒感染可以肝脏损害为突出表现，临床表现为急性肝炎，有一定的季节性，其临床症状较轻。     

EB病毒性肝炎的研究进展

EB病毒性肝炎是由EB病毒感染引起的肝脏炎症反应,大多数为自限性肝炎或轻中度肝损伤,预后良好,少数可发展为慢性肝病、重型肝炎,甚至肝内胆管细胞癌等。该病的临床表现及组织病理学特征缺乏特异性,容易漏诊、误诊,需要引起临床医师更多的关注与重视。介绍了EB病毒的感染机制以及EB病毒性肝炎的相关研究进展。     

如何改善非酒精性脂肪性肝炎患者的肝功能

为了探讨改善非酒精性脂肪性肝炎患者肝功能的中西医治疗方法.根据中、西医对本病病因病机的不同认识,在饮食运动治疗的基础上,西医运用保肝降酶类药物、胰岛素增敏剂及他汀类药物等治疗.中医采用辨病辨证相结合,中药复方与单味药相结合的治疗原则,达到既保护患者肝脏功能,又调节血脂及肝脏脂肪代谢能力.加用水飞蓟宾改善非酒精性脂肪性肝炎患者的肝功能效果明显.     

拉米夫定治疗乙肝合并抗结核药致肝功损害的临床研究

目的 探讨拉米夫定在HBVDNA阳性合并肺结核患者的治疗作用.方法 选择抗结核治疗及中药保肝后,肝功能再次异常30例,且HBVDNA阳性30例,予拉米夫定抗病毒治疗并中药保肝治疗,肝功能恢复正常后,恢复抗结核治疗,完成疗程.结论 HBVM且HBVDNA阳性,抗病毒治疗可以有效保护并恢复正常肝功能.     

六味五灵片治疗慢性乙型肝炎疗效观察

目的观察六味五灵片治疗慢性乙型病毒性肝炎的临床疗效。方法选择慢性乙型肝炎（CHB）患者115例,随机分为治疗组（60例）和对照组（55例）,两组均服用抗病毒药物进行治疗。治疗组加用六味五灵片,每次3片,每日3次口服,两组疗程均为24周,观察两组治疗前后临床症状及肝功能指标变化。结果两组治疗前后临床症状及肝功能均有明显改善,治疗组有效率95.0%,对照组有效率80.0%,两组疗效比效差异有统计学意义（P〈0.05）。结论六味五灵片能较快地改善临床症状,减轻肝细胞变性和坏死,恢复肝功能、抗病毒、抗肝纤维化等作用。     

α-干扰素联合中药方剂治疗慢性乙型肝炎的临床研究

目的研究α-干扰素联合中药方剂治疗慢性乙型肝炎的临床疗效及其机理。方法选择慢性乙型肝炎患者134例,分别给予α-干扰素联合中药方剂或单用治疗6个月,观察患者治疗前后肝功能、乙型肝炎病毒标志物的变化情况。结果在肝功能复常方面,治疗组优于两对照组,但无统计学差异(P>0.05);在HBeAg、HBV DNA阴转方面,治疗组明显优于两对照组,差异有统计学意义(P<0.01或0.05)。结论α-干扰素联合中药方剂治疗慢性乙型肝炎具有较好疗效,中药方剂能明显提高α-干扰素的抗病毒效果。     

新型布尼亚病毒感染相关噬血细胞综合征12例临床分析

目的 探讨新型布尼亚病毒感染相关噬血细胞综合征的临床特点.方法 对12例新型布尼亚病毒感染相关噬血细胞综合征患者的临床资料进行回顾性分析.结果 12例患者均急性起病,散发于山区,多发病于夏秋季节.临床表现均以发热为首发症状,伴纳差、肌肉酸痛及不同程度的出血,部分患者伴有肖化系统及神经、精神症状,同时表现为肝脾大、血细胞减少、肝功能异常和凝血功能异常.外周血见较多异型淋巴细胞,骨髓中见噬血组织细胞吞噬红细胞、白细胞及血小板现象等.新型布尼亚病毒核酸阳性.经抗病毒、支持、对症治疗后,患者痊愈10例,死亡2例.结论 新型布尼亚病毒感染继发性噬血细胞综合征临床表现复杂,病情进展迅速,易引起多脏器功能衰竭和弥漫性血管内凝血(DIC)而死亡,以支持、对症治疗为主.     

肝炎病毒感染对肾移植患者肝损害的临床观察

分析肝炎病毒感染对肾移植术后肝损害的影响,以探讨治疗病毒性肝损害的可行办法.将42例肝炎病毒感染者作为阳性组,同期无病毒感染者144例为阴性组.术后采用相同的三联免疫抑制方案(Pred MMF CsA),同时监测肝功能、HBV-DNA、HCV-RNA及CsA药物浓度,对肝功异常者停用CsA改用FK506,并行保肝治疗,HBV-DNA( )者还加用拉米夫定.结果显示:不同肝炎病毒感染者术后药物性肝损害发病率均高于无病毒感染者,若术前肝功异常,术后肝损害发病率更高、损害更重.因此,对有肝炎病毒感染的肾移植患者更应警惕术后肝损害的发生.     

巨细胞病毒、柯萨奇病毒及EB病毒混合感染性肝炎临床特征

目的观察巨细胞病毒(CMV)、柯萨奇病毒(COXV)及EB病毒(EBV)混合感染引起肝炎的临床特征。方法通过检测CMV、COXV及EBV的IgM及IgG进行病例确诊。结果 2种病毒混合感染者20例,3种病毒混合感染者10例。发烧在2周以上者占60%(18/30),最长的病例达56 d,最高体温39.8℃;血清总胆红素>171μmol/L者占53%(16/30),最高达532μmol/L;ALT>400 U/L者占73%(22/30),最高达3 258 U/L;AST>400 U/L者占53%(16/30),出现合并症者占33%(10/30),急性重型肝炎3例,通过血浆置换和内科综合治疗均治愈;骨髓移植1例;因急性造血功能衰竭死亡1例。结论发烧、高黄疸和出现合并症主要以CMV与COXV、CMV与COXV及EBV混合感染为主。     

Treatment of patients with dual hepatitis C virus and hepatitis B virus infection: Resolved and unresolved issues

Dual hepatitis C virus (HCV)/hepatitis B virus (HBV) infection is not uncommon in HCV or HBV endemic areas and among subjects at risk of parenteral transmission. In patients dually infected with hepatitis C and B, the disease manifestations are usually more severe than those with either virus infection. In the past decade, the following issues have been resolved. In dually infected patients with active hepatitis C, combined pegylated interferon alfa plus ribavirin was effective, the treatment outcomes being similar to patients with HCV monoinfection. During long‐term follow‐up, the HCV response was sustained in around 97% of patients; and the long‐term outcomes including the development of hepatocellular carcinoma and liver‐related mortality were improved. However, several clinical issues remain to be resolved. First, host and viral factors influencing the long‐term outcomes and treatment options in patients with dual HCV/HBV infection await further studies. Second, about 60% of dually infected patients with baseline undetectable serum HBV DNA levels develop HBV reactivation after the start of treatment. How to prevent and treat HBV reactivation should be clarified. Third, about 30% of dually infected patients lose hepatitis B surface antigen at 5 years after the end of combination therapy; the mechanisms need further investigations. Fourth, the optimal treatment strategies for dually infected patients with active hepatitis B or established cirrhosis should be explored in future clinical trials. Finally, the role of new direct‐acting antiviral‐based therapy for the treatment of patients with dual HCV/HBV infection also remains to be evaluated.     

酒精性肝病合并肝炎病毒感染的临床特点分析

目的 探讨酒精性肝病合并肝炎病毒感染的临床特点,评价酒精性肝病与肝炎病毒感染的关系.方法 选择我院2004年1月至2011年5月收治经确诊的271例酒精性肝病患者,对其临床资料及实验室结果进行回顾性分析.结果 271例酒精性肝病中118例(43.5％)肝炎病毒标志物阳性,其中乙型肝炎病毒标志物阳性的101例(37.3％),丙型肝炎病毒标志物阳性的2例(0.7％),戊型肝炎病毒标志物阳性的14例(5.2％),甲型肝炎病毒标志物阳性的1例(0.3％),无肝炎病毒感染的153例(56.5％).肝炎病毒感染阳性组上消化道出血、肝性脑病百分率比较差异有统计学意义(P＜0.05).两组血清肝功能均有不同程度的异常,且阳性组ALT、AST、TBil、GGT明显高于阴性组,差异有统计学意义(P＜0.05).结论 酒精与肝炎病毒对肝脏损伤有协同作用,酒精性肝病合并肝炎病毒感染加重肝脏的损伤.     

短程化疗中乙肝病毒标志物阳性对肝功能影响及处理

目的 探讨抗结核治疗中乙肝病毒感染对肝功能的影响及其对策。方法 回顾性分析1746例肺结核病人及其中160例药物性肝损害的相关临床资料。结果176例乙型肝炎病毒标志物(HBVM)阳性结核病人中有68例(38.6%)出现肝损害,HBVM阴性患者1490例中出现肝损害70例(4.7%),另有80例未测HBVM者中22例(27.5%)出现肝损害。HBVM阳性与阴性的肝损害发生率差异极显著(P<0.01)。在治疗过程中出现肝损时间多为15～90d。结论 短程化疗中乙肝病毒感染对肝功能有一定的影响,在抗结核治疗前检查HBVM及肝功能十分必要,对HBVM阳性者宜选择对肝脏损害较轻的药物,同时给予适当的护肝治疗,并密切监测肝功能的变化。     

Chronic hepatitis C virus infection and neurological and psychiatric disorders:An overview

Hepatitis C virus(HCV)infection is considered a systemic disease because of involvement of other organs and tissues concomitantly with liver disease.Among the extrahepatic manifestations,neuropsychiatric disorders have been reported in up to 50%of chronic HCV infected patients.Both the central and peripheral nervous system may be involved with a wide variety of clinical manifestations.Main HCV-associated neurological conditions include cerebrovascular events,encephalopathy,myelitis,encephalomyelitis,and cognitive impairment,whereas“brain fog”,depression,anxiety,and fatigue are at the top of the list of psychiatric disorders.Moreover,HCV infection is known to cause both motor and sensory peripheral neuropathy in the context of mixed cryoglobulinemia,and has also been recently recognized as an independent risk factor for stroke.These extrahepatic manifestations are independent of severity of the underlying chronic liver disease and hepatic encephalopathy.The brain is a suitable site for HCV replication,where the virus may directly exert neurotoxicity;other mechanisms proposed to explain the pathogenesis of neuropsychiatric disorders in chronic HCV infection include derangement of metabolic pathways of infected cells,alterations in neurotransmitter circuits,autoimmune disorders,and cerebral or systemic inflammation.A pathogenic role for HCV is also suggested by improvement of neurological and psychiatric symptoms in patients achieving a sustained virologic response following interferon treatment;however,further ad hoc trials are needed to fully assess the impact of HCV infection and specific antiviral treatments on associated neuropsychiatric disorders.     

维持血液透析的尿毒症病人乙型丙型肝炎病毒感染情况研究

目的　了解北京地区 (东城、宣武、朝阳区 )接受规律性血液透析患者 ,乙型肝炎病毒 (HBV)和丙型肝炎病毒 (HCV)的感染情况及其相关因素。方法　 1998年 3～ 12月在北京协和医院、朝阳医院等 4家医院血液净化中心 ,长期维持血液透析的尿毒症患者 2 2 5例 ,血透中心工作人员及健康献血者 5 0例为对照组。分别用PCR法和高敏PCR法检测HBVDNA、HCVRNA ,ELISA法检测乙肝两对半及丙肝抗体 ,并分析其与透析时间、输血、肝功能损害的关系。结果　 2 2 5例血液透析病人中 ,HCVRNA阳性 37例 (16 4 %) ;HBVDNA阳性 3例(1 33%)。多元回归分析表明 :输血和透析时间是丙型肝炎感染的危险因素。共有 3 0 %(3/ 99)的病人同时感染乙肝和丙肝 ,均有肝功能的损害和临床症状 ,8 1%(8/ 99)HBcAb阳性患者同时合并HCV感染。结论　血液透析病人乙肝和丙肝感染远高于对照组 ,透析时间和输血次数是丙肝感染的危险因素 ,HBV和HCV同时感染问题值得重视。     

Characteristics of Epstein-Barr virus primary infection in pediatric liver transplant recipients

BACKGROUND/AIM: Pediatric liver transplant recipients are at high risk of Epstein-Barr virus infection. However the incidence of clinical symptoms and the graft function at the time of acute infection remains poorly documented. The aim of this study was to monitor the clinical and biochemical events associated with primary Epstein-Barr virus infection. METHODS: Clinical and biological patterns associated with Epstein-Barr virus infection were prospectively searched in 38 liver transplanted children. Polymerase chain reaction and anti-Epstein-Barr virus IgM antibodies were used at regular intervals to detect the timing of primary infection. RESULTS: Five children (13%) had pretransplant immunity, 26 (68.5%) developed primary Epstein-Barr virus infection 15 to 90 days after transplantation and seven (18.5%) remained Epstein-Barr virus negative. The four patients with clinical symptoms at the time of infection subsequently developed post-transplant lymphoproliferative disease. A single post-transplant lymphoproliferative disease occurred in non-symptomatic patients (overall incidence 13%). No mortality was associated with post-transplant lymphoproliferative disease. Two asymptomatic patients had abnormal liver function tests possibly related to primary Epstein-Barr virus infection. CONCLUSION: Epstein-Barr virus primary infection occurs in 80% of seronegative patients within 3 months after OLT. Clinical symptoms are rare and closely associated with post-transplant lymphoproliferative disease. Outside post-transplant lymphoproliferative disease, the consequences of infection are marginal.     

Liver disease in chelated transfusion-dependent thalassemics: the role of iron overload and chronic hepatitis C

Iron overload and hepatitis virus C infection cause liver fibrosis in thalassemics. In a monocentric retrospective analysis of liver disease in a cohort of 191 transfusion-dependent thalassemics, in 126 patients who had undergone liver biopsy (mean age 17.2 years; 58 hepatitis virus C-RNA positive and 68 hepatitis virus C-RNA negative) the liver iron concentration (median 2.4 mg/gr dry liver weight) was closely related to serum ferritin levels (R = 0.58; p<0.0001). Male gender (OR 4.12) and serum hepatitis virus C-RNA positivity (OR 11.04) were independent risk factors for advanced liver fibrosis. The majority of hepatitis virus C-RNA negative patients with low iron load did not develop liver fibrosis, while hepatitis virus C-RNA positive patients infected with genotype 1 or 4 and iron overload more frequently developed advanced fibrosis. Hepatitis virus C infection is the main risk factor for liver fibrosis in transfusion-dependent thalassemics. Adequate chelation therapy usually prevents the development of liver fibrosis in thalassemics free of hepatitis virus C-infection and reduces the risk of developing severe fibrosis in thalassemics with chronic hepatitis C.