乙肝核心抗体阳性供肝在肝移植中的应用

背景：现已经证实使用anti-HBc（＋）供肝会使移植后乙肝复发的风险,但anti-HBc（＋）供肝的应用明显缓解了供肝的相对匮乏。目的：分析应用anti-HBc（＋）供肝移植后乙肝复发风险及有效的预防措施。方法：应用计算机检PubMed数据库中1994-01/2009-12关于anti-HBc（＋）供肝文章,在标题和摘要中以＂Hepatitis B core antibody;donor;liver transplantation＂为检索词进行检索。选择与anti-HBc供肝相关文章。初检得到109篇文献,根据纳入标准选择48篇文章进行综述。结果与结论：HBsAg（＋）患者接受anti-HBc（＋）供肝移植术后乙肝复发率为11%,生存率为67%～100%,与HBsAg（＋）受者接受anti-HBc（-）供肝相似。HBsAg（-）受者接受anti-HBc（＋）供肝总体感染率为19%,其中未感染过乙肝受者移植术后乙肝感染率为48%,感染过乙肝受者后感染率为15%。未感染乙肝与感染过乙肝受者移植后采取有效预防措施后感染率分别为3%,12%。采用HBIG、拉米夫定、联合用药的移植后感染率分别为19%,2.6%,2.8%。提示,采用anti-HBc（＋）供肝做为供体是安全的,尤其是用在HBsAg（＋）、anti-HBc（＋）、anti-HBs（＋）受者。而HBsAg（-）受者移植后接受拉米夫定可以有效复发乙肝感染。     

肝移植供肝修整的护理配合

目的探讨供肝修整的护理配合。方法回顾性分析我院45例肝移植之供肝修整术，并针对可能出现的护理问题实施相应的护理对策。结果45例供肝修整术中护理配合满意，保证了良好的供肝质量。结论充分的术前准备、术中配合以及修整术后供肝保存的护理，是保证供肝修整顺利完成的重要护理措施。     

不同冷保存时间热缺血供肝在肝移植中的应用

背景:目前国内临床肝移植供肝的主要来源仍然是无心跳供体供肝,国外近年来也越来越多地使用无心跳供体供肝,但无心跳供体供肝这类经历了热缺血的供肝能够耐受冷保存的安全时限尚没有统一标准,也鲜有这方面的临床报道.目的:评价不同冷保存时间的热缺血供肝在临床肝移植中的应用安全性及疗效.设计、时间及地点:随机对照观察,于2006-01/2007-12在中山大学附属第一医院器官移植中心完成.对象:无心跳供体供肝热缺血时间在10 min内的肝移植病例154例.方法:根据冷保存时间不同分为3组,8 h内组58例,8～2 h组62例,13～16 h组34例.供肝按供体分配原则按随机数字表法分配给3组患者,移植后采用相同的免疫抑制方案.主要观察指标:比较3组患者肝移植后谷丙转氨酶峰值、原发性移植肝无功能、急性排斥反应、胆道并发症、血管并发症、感染,以及移植肝存活和受体存活情况的差异.结果:随访8～32个月,3组患者移植后均未发生原发性移植肝无功能.8～12 h组患者移植后仅谷丙转氨酶峰值高于8 h内组(P＜0.05),其余治疗两组比较差异均无显著性意义(P＞0.05).与8 h内组患者比较,13～16 h组患者的移植后谷丙转氨酶峰值、感染发生率和胆道并发症发生率显著升高(P＜0.05),移植肝存活率和受体存活率显著降低(P＜0.05).结论:热缺血时间在10 min内的无心跳供体供肝能够耐受12 h的冷保存损伤,超过此时限,移植后胆道并发症和感染的发生率明显升高,移植肝存活率和受体存活率明显降低.     

化学发光免疫分析法检测乙肝核心抗体的应用分析

目的探究乙肝核心抗体检测采用化学发光免疫分析法的临床应用价值。方法从时间段2017年11月-2018年11月期间,抽选我院收治的疑似乙肝患者50例,所有患者均进行血液样本采集,并分别采用化学发光免疫分析法和酶联免疫吸附法对乙肝病毒及核心抗体进行检测,分析检测结果。结果在核心抗体抗IgM阳性率、抗IgG阳性率检测上,化学发光免疫分析法明显优于酶联免疫吸附法,P<0.05。结论乙肝病毒、核心抗体检测采用化学发光免疫分析法,临床应用价值显著,对核心抗体具有较高阳性检出率。     

大鼠肝移植不同供肝切取技术对供肝质量的影响

目的:探讨在大鼠肝移植供肝切取过程中不同方法对供肝质量的影响。方法:SD大鼠120只,随机分成3组,即标准法组(A组)、快速法组(B组)和改良快速法组(C组),每组各行20对大鼠原位肝移植,观察术中资料和术后3周存活率及冷灌洗后肝脏形态学改变。结果:在供肝切取手术时间上C组明显较A、B两组为短(P<0.05),其术后3周存活率也高于A组(P<0.05)。光镜下C组与A、B两组相比肝窦内未见红细胞。结论:标准法和快速法适合于刚建立大鼠肝移植模型的单位,为提高供肝质量、改善术后存活率应选择改良快速法。     

单项乙型肝炎病毒核心抗体假阳性结果分析

我国人群乙型肝炎病毒（HBV）感染率高,HBV感染血清学标志物是临床实验室最主要的检测项目之一。但是常常发现一些人其他HBV标志物阴性而仅仅乙型肝炎病毒核心抗体（抗-HBc）阳性,即所谓单项抗-HBc阳性者。抗HBc单项指标存在的意义是：（1）急性HBV感染恢复期,乙型肝炎病毒表面抗原（HBsAg）消失而乙型肝炎病毒表面抗体（抗-HBs）尚未产生,抗-HBc是惟一能检出的指标;（2）慢性乙型肝炎感染,乙型肝炎病毒e抗原（HBeAg）水平很低,用一般的血清学方法不能检测出HBeAg;（3）过去的乙型肝炎感染,由于抗HBc比抗HBs在体内存在的时间长,因此抗-HBs已消失或在可检测水平以下时,抗-HBc仍存在。     

边缘供肝在肝移植中的应用研究进展

肝脏移植是治疗终末期肝脏疾病的唯一有效途径,已经得到广泛认同。近年来,由于理想供肝的严重短缺,边缘供肝逐渐被人们重视起来。大量的文献研究表明,合理的利用边缘供肝可以得到满意的临床效果。本文就边缘供肝在肝移植中的应用研究进展做一综述。     

肝中静脉的解剖及其在活体肝移植中的应用

肝移植是治疗各种终末期肝病的有效手段,但世界性的供肝短缺问题导致每年全球约有10%的患者在等待移植过程中死亡。活体肝移植(1iving donor liver transplantation,LDLT)是在尸体供肝短缺的背景下产生的,成人间的LDLT多需切取供体的右半肝作为移植物。尽管活体右半肝移植取得了令人振奋的效果,但是关于活体右半肝移植时是否保留供体的肝中静脉(middle hepatic vein,MHV)问题上一直存在争议。同时,不包含MHV的活体右半肝移植在MHV引流的V、VIII段属支的处理问题上一直存在争议。本文就MHV的局部应用解剖、LDLT手术时MHV的供体或受体归属、不带MHV的半肝移植时MHV属支重建与否等问题结合华西医院肝脏移植中心的经验及相关文献做一综述。     

多层螺旋CT在活体供肝移植供体术前的应用

活体供肝移植（living donor liver transplantation,LDLT）是将活体的部分肝组织移植给受体,该技术解决了肝源紧缺的难题,是肝移植的一大突破,现临床多采用LDLT。为筛选出合适的肝脏供体,确保手术顺利进行,术前影像学评估尤为重要,其应包括：     

乙型肝炎核心抗体阳性与阴性慢性乙型肝炎患者血清可溶性白介素2受体检测

目的　分析比较慢性乙型肝炎核心抗体 (抗 HBc)阳性的患者和抗 HBc阴性的患者血清中可溶性白细胞介素 2受体 (sIL 2R)和乙型肝炎病毒DNA(HBV DNA)含量的变化及意义。方法　将 10 0例诊断为慢性乙型肝炎肝者分为两组 ,A组为 5 0例 ,HBsAg阳性、HBeAg阳性和抗 HBc阳性 ,B组为 5 0例 ,HBsAg阳性 ,HBeAg阳性和抗 HBc阴性。另选 30例健康体检者 ,HBV标志均为阴性 ,作为对照组。sIL 2R采用双抗体夹心间接酶联免疫吸附测定法 ,HBV DNA采用荧光定量聚合酶链法 ,丙氨酸转氨酶 (ALT)采用赖氏法。结果　乙型肝炎表面抗原 (HBsAg)阳性、乙型肝炎e抗原 (HBeAg)阳性、抗 HBc阳性组血清中sIL 2R和ALT水平均明显高于HBsAg阳性、HBeAg阳性、抗 HBc阴性组 ,P <0 .0 5 ,与正常对照组比较 ,P <0 .0 5 ,且年龄偏向于青少年段 ,但比较HBV DNA含量在两组患者差异无统计学意义 (P >0 .0 5 ) ,HBsAg阳性、HBeAg阳性、抗 HBc阴性组sIL 2R水平亦高于正常对照组 P <0 .0 5。结论　以上结果表明抗 HBc阴性的慢性乙型肝炎患者机体的免疫系统处于一种免疫耐受的状态 ,而sIL 2R可作为肝炎患者免疫状态的监测指标而用于机体免疫状态的分析     

Detection and characterization of hepatitis B virus of anti-hepatitis B core antigen-reactive blood donors in Quebec with an in-house nucleic acid testing assay

BACKGROUND: Hepatitis B virus (HBV) infection can be detected in blood donations by many serologic markers. Since the introduction of routine anti-hepatitis B core antigen (HBc) donor screening at Héma-Québec in April 2003, a large number of donors have been deferred on the basis of reactive anti-HBc test results. The objective of this study was to evaluate the correlation between the anti-HBc–reactive donations and the detection of HBV DNA with an in-house nucleic acid testing (NAT) assay.
STUDY DESIGN AND METHODS: The in-house HBV NAT assay is a conventional polymerase chain reaction amplifying part of the viral S  gene. From October 2004 to November 2005, a total of 1169 anti-HBc–reactive donations were tested with this in-house assay. The results were correlated with hepatitis B surface antigen (HBsAg) and anti-HBs markers. HBV DNA–positive samples were further investigated by DNA sequencing.
RESULTS: All HBsAg-positive samples were detected by the NAT assay. Overall, 38 (3.25%) of anti-HBc–positive samples were found to be positive for the presence of HBV DNA. Of these 38, a total of 12 donations with a low level of HBV DNA were HBsAg-negative. The sequencing results clearly showed various genotypes and subtypes within a same genotype.
CONCLUSION: The 3.25 percent HBV DNA positivity rate among the anti-HBc–reactive donations and more particularly the low level of HBV DNA observed in occult donations underline the importance of the use of a sensitive assay to detect HBV DNA in conjunction with other markers. The HBV genetic diversity found in our donor population reflects the province demographics, particularly in the Montreal area where most of the positive donors were from.     

A study of anti-hepatitis C positive blood donors: the first year of screening

SUMMARY. In the U.K., blood donations have been routinely screened for anti-HCV since September 1991. In order to get the most epidemiological benefit from these extensive screening data, the histories obtained at counselling from donors confirmed to be anti-HCV positive, 'indeterminate' and falsely positive have been analysed in detail. In addition, the associations with potential risk factors have been investigated by comparing these groups of donors with a control group of 771 routine donors bled on one day during the study, at North London Blood Transfusion Centre. This paper documents the prevalence and demography of HCV infection in asymptomatic blood donors, to assess varicus possible sources of infection and the association between liver function test results and alcohol consumption in donors. One in 1400 previously untested donors was confirmed positive for anti-HCV. Age (the group 30–49 years being highest), tattooing and intravenous drug use in both sexes, ear-piercing in males and blood transfusion in females were all significantly associated with an increased risk of HCV infection. Intravenous drug use proved to be the factor most strongly associated with risk. Liver function tests (alanine aminotransferase) were elevated in a significant number of donors confirmed to be anti-HCV positive but no clear correlation between alanine aminotransferase level and either time since infection or alcohol consumption was found. Alcohol consumption was significantly higher in donors confirmed to be anti-HCV positive and was particularly marked in those admitting to previous intravenous drug use. Although donors confirmed to be anti-HCV positive had a 5–10 times greater chance of non-Caucasian ethnic origin compared with controls, the association with ethnic origin was not as marked as it was for HBsAg positive donors.     

肝移植后乙型肝炎复发核苷类抗乙肝药物联合小剂量乙肝免疫球蛋白可能防治吗?

背景:近年来国内外均报道,抗乙型肝炎免疫球蛋白和拉米夫定在预防乙型肝炎、肝硬化肝移植后乙型肝炎的复发中取得了良好效果,但各大中心对于抗乙型肝炎免疫球蛋白使用剂量的报道不尽相同.目的:拟验证和探讨核苷类抗乙肝药物联合小剂量乙肝免疫球蛋白预防肝移植后乙型肝炎病毒复发的效果.方法:回顾性分析2006-05/2009-02昆明市第一人民医院暨昆明医学院附属甘美医院肝移植中心因乙型肝炎相关性肝病行肝移植患者59例,移植前诊断为乙型肝炎后肝硬化失代偿期50例,其中乙型肝炎病毒DNA阳性15例.移植前5例给予拉米夫定治疗,1例给予阿德福韦酯治疗,1例给予恩替卡韦片治疗,治疗时间为2周-1年.移植后所有患者术后第1天开始肌注200 U/d的乙肝免疫球蛋白,1个月后根据患者的乙肝两对半的滴度情况进行调整,55例患者同时口服拉米夫定,3例服用阿德福韦酯,1例服用恩替卡韦.结果与结论:2例患者移植后出现乙型肝炎病毒再感染,未检测是否为YMDD变异毒株感染,移植后1年和1年以上乙型肝炎病毒再感染率均为2%.移植前血清乙型肝炎病毒DNA阴性者移植后乙型肝炎病毒再感染率为2%,乙型肝炎病毒DNA阳性者移植后乙型肝炎病毒再感染率为7%.提示因乙型肝炎相关性肝病而行肝移植患者,移植后服用核苷类抗乙肝药物,同时联合200 U小剂量乙型肝炎免疫球蛋白可以很好地预防肝移植后乙型肝炎的复发.     

Increased risk of a positive test for antibody to hepatitis B core antigen (anti-HBC) in autologous blood donors

Controversy exists about the suitability of blood from autologous donors for homologous use. We compared the infectious disease test results of 426 autologous donors, designated by donor history as suitable for homologous use, to those of 86,138 volunteer donations collected over the same 5 month period. Although donor characteristics differed, the relative risk of a positive test for anti-HBc in the autologous group was 2.09. When 413 autologous donors were compared to 413 volunteer donors matched for age, sex, and zip code, the relative risk of a positive test for anti-HBc in the autologous group was 3.2. If anti-HBc is a marker for non-A, non-B hepatitis transmissibility, then our autologous group is not as safe as our volunteer donors. We recommend that autologous blood, even when designated by donor history and laboratory screening results as suitable for homologous transfusion, not be used for other than the intended autologous recipient.     

Hepatitis B core particles with endogenous DNA polymerase activity from chimpanzee liver

Hepatitis B core antigen (HBcAg) particles, approximately 27-28 nm in diameter and rho = 1.30-1.35 g/cm3, were purified from the liver of a chimpanzee experimentally infected with hepatitis B virus (HBV) while under cyclophosphamide treatment. The purified HBcAg particles incorporated radioactive deoxythymidine triphosphate. The product was precipitable by trichloroacetic acid and sensitive to DNase, but resistant to digestion by RNase. The reaction required four deoxyribonucleosise triphosphates- dATP, dCTP, dGTP and dTTP. Exogenous template did not enhance the reaction. From these findings, it was suggested that HBcAg particles purified from the HBV-infected chimpanzee liver contained DNA polymerase and endogenous DNA.     

Relationship between antibody to hepatitis B core antigen and retroviral infections in blood from volunteer donors

Background: The value of the test for antibody to hepatitis B core antigen (anti-HBc) as a surrogate screening assay in the time before sensitive, virus-specific screening tests were available has been well established. There is significant debate, however about the residual value of anti-HBc screening after the implementation of human immunodeficiency virus (HIV)-, human T-lymphotrophic virus (HTLV)-, and hepatitis C virus (HCV)-specific assays and, in particular, about its utility as a lifestyle marker to identify persons at risk for retrovirus infections. Study Design and Methods: Screening tests for antibodies to HIV, HTLV, and HBc, as well as confirmatory or supplemental test results for anti-HIV and anti-HTLV, were obtained from approximately 2.8 million donations collected from 1991 through 1993 by five blood centers within the United States. The sensitivity, positive predictive value, and relative prevalence of anti-HBc for each retrovirus were calculated and compared among demographic subgroups. Results: The overall relationship between anti-HBc and anti-HIV was similar to that between anti-HBc and anti-HTLV. When calculated from the measured endpoint of the prevalence of anti-HIV-positive and anti- HTLV-positive donations, the sensitivities were 31.1 and 26.2 percent, the positive predictive values were 0.18 and 0.21 percent, and the relative prevalences were 30.1 and 23.8, respectively. Among 27 anti- HIV-seroconverting donors and 9 anti-HTLV-seroconverting donors, the sensitivities were 7.4 percent (95% CI: 0.9–24.3%) and 0 percent (95% CI: 0.0–28.3%), respectively. It was estimated that for each HIV- infected window-period donation detected by anti-HBc, from 19,000 to 81,000 HIV-noninfected donations are discarded. Similarly, more than 33,000 HTLV-noninfected donations are likely to be discarded for each HTLV-infected donation detected by anti-HBc. Conclusion: Although anti- HBc-reactive donations are more likely to be seropositive for a retrovirus than are anti-HBc-nonreactive donations, the low positive predictive value limits the test's effectiveness. If the anti-HBc test is retained in the blood donor setting, efforts should be focused on reducing the number of false-positive results.     

核苷类抗乙型肝炎病毒药物进展

乙型肝炎病毒(hepatitis B virus，HBV)引起的乙型肝炎在全球流行，世界卫生组织估计全世界超过20亿人被HBV感染，其中3．5亿人为慢性HBV携带者，中国约占1／3。每年至少有120万慢性HBV感染患者死于HBV相关疾病(肝硬化，肝癌)。虽然疫苗控制HBV感染发挥很大作用，但现