慢性丙型肝炎患者重叠其它肝炎病毒感染的临床分析

对108例慢性丙型肝炎患者同步验测各项肝炎病毒血清标志物,发现单纯HCV感染为32例(占29.63％),另76例分别重叠感染HAV、HBV、HDV、HEV、CMV、EBV。其中重叠感染HBV最多(占59.21％),依次为CMV(21.33％)、HEV(11.5％)、EBV(9.33％)、HDV(6.5％)、HAV(5.26％)。单纯慢性丙型肝炎患者黄疸出现少,病情较轻;重叠HBV、HDV及三重、四重病毒感染者,病情较重,预后较差;而重叠HAV、HEV、CMV、EUV者预后与单纯丙肝相似。慢性丙肝患者重叠其它病毒感染,在临床上常表现为病情突然加重,血清转氮酶(ALT)、胆红素定量(TBil)明显升高,与单纯丙型肝炎病程活动表现出ALT波动,TDil轻度升高不同。     

316例慢性未定型肝炎临床与病理研究

探讨慢性未定型肝炎临床与病理特征，采用多种血清学及组织学方法研究316例慢性未定型肝炎。并以同期的慢性乙型肝炎及慢性丙型肝炎作为对照。慢性未定型肝炎具有以下临床及病理特征。1、青年男性发病居多，无输血及输血制品史，无季节性及家庭聚集性。2、起病隐袭，无明显急性过程，肝病症状及体征少而轻。3、血清ALT呈轻、中度升高，且反复波动，4、肝组织炎症改变较轻，退行变明显，不同程度脂肪变性较为突出，该型肝炎可能系一种或一种以上未知肝炎病毒感染所致。     

丙型肝炎病毒与性传播感染

大量文献证实乙肝病毒(HBV)可经性接触感染,Alter等甚至认为30％急性乙肝是由于性传播所致。虽然丙型肝炎主要传播途径是血行感染,但人群中仍有40％～50％的丙型肝炎病毒(HCV)感染者无明显经血暴露史。目前,HCV性传播感染已日益引起人们关注。现将近3年来国外有关资料综述如下。     

肝炎病毒血清学标志物阴性ALT异常60例临床分析

目的探讨肝炎病毒血清学标志物阴性ALT异常的原因。方法在60例肝炎病毒血清学标志物阴性ALT异常患者,进行肝穿组织学检查,并行免疫组化检测肝炎病毒标记物。结果在60例肝炎病毒血清学标志物阴性ALT异常患者中,发现慢性乙型肝炎轻度16例,中度8例,重度2例,慢性乙型肝炎轻度合并脂肪肝8例,中度合并脂肪肝4例,慢性丙型肝炎轻度1例,中度1例,非酒精性脂肪肝15例,自身免疫性肝炎5例。结论对肝炎病毒血清学标志物阴性的ALT异常患者,应行肝组织学检查,以明确诊断,指导治疗。     

传染病和寄生虫病

·5 14·中国医学文摘。内科学1,9,年第2()卷第兄期993139 33例TTv感染的血清病原学及l在床分析/蒋小玲…//实用医学杂志一19卿,15(2)一114一l]5 TTV是一种新的DNA病毒,称为经血传播病毒。Z8例有乏力、纳差、腹胀等消化症状,悦例有黄疽,余巧例均在健康普查时发现谷丙转氨酶(ALT)升高,症状轻微或缺如。33例中有输血史4例,注射过丙种球蛋白l例,静脉毒瘾者2例,其余26例均无输血史或使用血制品史。血清病原学结果,15例(45写)甲、乙、丙、丁、戊及庚型肝炎病毒标志物包括HBV DNA、HCV RNA及HGV RNA均阴性,9例(27%)合并乙型肝炎病毒感…     

急性甲型及乙型肝炎的同时感染

甲型肝炎病毒(HAV)与乙型肝炎病毒(HBV)在抗原与形态上都不同。两种病毒感染后并不发生交叉免疫。以往曾有过 HAV 与 HBV 同时感染的报道,但缺乏 HAV 的血清学指标。慢性 HBV 感染患者可再发生 HAV 急性感染,但尚未见有两种病毒同时急性感染且经实验室证实的病例报道。本文就一只黑猩猩同时发生 HAV 和 HBV 急性感染的临床经过及实验室资料作了介绍。     

慢性病毒性肝炎合并风疹病毒感染分析

探讨慢性病毒性肝炎合并风疹病毒 (RubellavirusRV)感染对肝功能及病毒复制的影响。对 30例慢性病毒性肝炎分别检测了抗 -RVIgM、HBV血清学标志物、抗 -HCV抗体及生化指标 ;另选择 2 0例健康人检测抗 -RVIgM做对照。慢性乙型肝炎病例中抗 -RVIgM阳性率为 4 5 4 % ,慢性丙型肝炎病例中抗 -RVIgM阳性率为4 7 5 %。血清抗 -RVIgM阳性的慢肝患者ALT、γ -GT水平及肝功能复常天数均明显升高和延长 ,并多伴有发热、呕吐、肝大症状或体征的加重。慢性病毒性肝炎合并风疹病毒感染可加重肝功能障碍同时延长病情恢复。     

浅谈重症丙型肝炎的救治方案

丙型肝炎是丙型肝炎病毒（HCV）主要经血液传播而感染，多数具有隐匿陛或慢性的特征，临床约占丙肝的50％-80％。而重症丙型肝炎病人相对少见．主要见于由慢性丙型肝炎进展而来的晚期肝硬化失代偿病人，目前称之为慢性肝衰竭：而由丙型肝炎病毒感染后直接引起的急性和亚急性的重型丙型肝炎极为罕见，但若与其他类型的肝炎病毒，特别是乙型肝炎病毒（HBV）混合感染，     

400例丙肝病毒感染者合并乙肝病毒感染的调查

丙型肝炎（HCV）与乙型肝炎（HBV）有共同的传播途径，反复接受血液或血制品、静脉内吸毒或不良性行为是造成HCV与HBV合并感染的主要原因。作者对400例HCV感染者和458例正常体检者血清作HBV5种标记物检查，了解HCV感染者的HBV感染情况,结果报告如下。     

干扰素与利巴韦林联合治疗丙型肝炎疗效观察

目前世界范围内1.7亿人感染丙型肝炎病毒(HCV),丙型肝炎较乙型肝炎更易慢性化。丙氨酸转氨酶(ALT)反复异常是其特征。我们用干扰素和利巴韦林治疗丙型肝炎取得一定的临床疗效。材料与方法一、病例选择我院从2000年2月～2003年5月共收集急性丙型肝炎患者53例,均符合2000年9月西安中华医学会传染病与寄生虫学分会、肝病学分会联合修订方案标准。男性30例,女性22例,年龄16～49岁。分为治疗组30例,对照组22例。均有明确的输血史及应用血制品和静脉吸毒史。二、治疗方法采用保肝治疗,干扰素(深圳科兴公司)500万U肌肉注射,第1个月每日1次,以后…     

Prevalence of TT virus infection in blood donors with elevated ALT in the absence of known hepatitis markers

OBJECTIVE: Recently a novel DNA virus (TT virus) has been identified in Japan and shown to be associated with elevated aminotransferase levels after blood transfusion. The exact role of TTV in the pathogenesis of liver disease is yet to be established. Our aim was to determine the prevalence and role of TTV in the pathogenesis of elevated transaminases in healthy blood donors in the absence of markers for viral hepatitis A-C. METHODS: Stored sera were collected from 99 healthy blood donors with elevated alanine amino transferase (ALT) values that were discovered at the time of blood donation. A total of 146 samples were obtained from healthy donors with normal ALT values who were used as controls. None of the patients or controls had a history of blood transfusion or had clinical signs of acute or chronic hepatitis. Serological markers for hepatitis A, hepatitis B, and hepatitis C viruses were negative. TTV DNA was amplified and detected using polymerase chain reaction followed by gel electrophoresis. RESULTS: Five of 99 (5%) samples obtained from donors with elevated ALT had TTV DNA detected by PCR, as compared to one of 146 (0.7%) of those with normal ALT (p = 0.006). Among those with elevated ALT, mean ALT values in patients with TTV (296 +/- 305 U/L) were higher than in patients without TTV (95 +/- 37 U/L), but the difference was not statistically significant (p = 0.08). The two samples with highest ALT values (both >450 U/L) were among the five samples with detectable TTV DNA in serum. CONCLUSIONS: Although TTV is not likely to explain the majority of elevated ALT cases in otherwise healthy blood donors, TTV infection may potentially be associated with some cases. Based on these findings, we propose that the role of TTV in the pathogenesis of acute and chronic liver diseases merits further investigation.     

Risk Factors Associated With Chronic Hepatitis C Virus Infection: Limited Frequency of an Unidentified Source of Transmission

Objective: Risk factors have been studied in patients with acute non-A, non-B hepatitis, and approximately 40–50% have no known risk factor for viral acquisition. A significant undefined source of viral transmission has been suggested. We sought to clearly delineate the risk factors in a population of patients with documented chronic hepatitis C virus (HCV) infection to assess the magnitude of HCV transmission without known risk factors.
Methods: Risk factor profiles were carefully assessed in 301 consecutive patients with chronic HCV infection. Patients were classified by gender and age. Overall risk factor distributions were calculated and comparisons were made between groups to detect differences in mode of HCV acquisition.
Results: One hundred ninety-six men and 105 women were studied; 223 were age ≤ 45 yr and 78 were > 45 yr. Overall, 25% of patients had a history of transfusion and 49% had a history of intravenous drug use (IVDU). Only 12% had no history of risk factor exposure. Men were more likely to have a history of IVDU and less likely to have a history of blood transfusion or sexual exposure/household contact. Younger patients were more likely to have a history of IVDU and older patients were more likely to have a history of blood transfusion and to deny all risk factor exposure. Conclusions: A careful history delineated a potential risk factor for HCV acquisition in 88% of patients with chronic HCV infection. Men and younger patients had different risk factor profiles than women and older patients, respectively. It is likely that an important unknown mode of HCV transmission occurs in a significant minority of patients.     

Prevalence of hepatitis C virus antibody in chronic HBsAg-negative non alcoholic hepatopathy]

The presence of antibody to hepatitis C virus was determined in 316 HBsAg-negative patients with non-alcoholic chronic hepatitis who did not receive any blood transfusion once the diagnosis was made. A titre of antinuclear antibodies of 1/40 or lower was found in 18 patients. Persistent chronic hepatitis was present in 21 patients, active chronic hepatitis in 145, hepatic cirrhosis in 128, and hepatocarcinoma in 22 patients. One hundred and three patients had previously received blood transfusion, 76 had undergone previous surgery without transfusion, a clinical episode of hepatitis could be traced in 14, 13 patients were drug addicts (all of them HIV negative), 1 patient had received multiples injections, another had been treated with acupuncture, and 108 patients were free of any of the above. Anti-HCV was present in 76.6% of patients; a significantly higher proportion (87.4%) was found among patients who had received blood transfusion than in patients with previous surgery (72.4%) (p = 0.012), clinical hepatitis (57.1%), or without previous hepatic disease (70.3%) (p = 0.003). The incidence of anti-HCV was lower among cirrhotics (70.3%) than in patients with active chronic hepatitis (84.1%) (p = 0.006); in contrast, previous blood transfusion was significantly higher (p = 0.001) among the latter (40.7%) than in cirrhotics (21.9%). The incidence of anti-HCV was similar among patients with (78.6%) and without (75.8%) type B infection. Our results suggest that infection with virus C may account for a high proportion of non-alcoholic non-B chronic hepatitis.     

Transfusion transmissible virus TTV and its putative role in the etiology of liver disease

TTV, the transfusion transmissible hepatitis virus infects mainly patients at risk for parenteral exposure and hence, prone to develop chronic liver disease, as well as healthy populations worldwide. Most TTV infections appear to occur parenterally, with viremia detected frequently in blood donors and blood products. The substantial proportion of asymptomatic individuals never exposed to blood-borne agents, and its high prevalence among healthy subjects implicates the fecal-oral route as another potential for transmission. According to the TTV DNA levels detected in liver tissue, it apparently replicates in hepatocytes, and TTV DNA is present in sera of patients with posttransfusion hepatitis of unknown etiology closely correlated with ALT levels. However, TTV initiating the development of chronic liver disease or causing posttransfusion hepatitis could not be confirmed, as most patients positive for TTV DNA remain asymptomatic and those progressing towards chronic liver disease are invariably coinfected with either the hepatitis B or C virus. Also, TTV coinfection does not aggravate the symptoms associated with hepatitis B or C. Similarly, it does not cause posthepatitis aplastic anemia, and high-risk patients can immunologically clear the viral DNA. In conclusion, being widely distributed and apparently nonpathogenic, TTV might represent an opportunistic but innocent virus reminiscent of hepatitis G virus, with a negligible role in the etiology of chronic liver disease.     

Heterosexual contact as a major route for transmission of acute hepatitis B among adults

Possible routes for transmission of acute hepatitis B were studied retrospectively in 78 consecutive adult patients seen at the Department of Infectious Diseases, Roslagstull Hospital in Stockholm. Sexual transmission was found to be a major route of transmission, being more common than intravenous drug abuse. A single possible route of transmission was found in 66/78 (84%) patients. Eleven of the 78 patients (14%) had two possible routes, sexual contact being one. Overall sexual contact possibly accounted for 53% of all cases of hepatitis B, homosexual contact being responsible for only 10%. Cases reported earlier as being of unknown origin or associated with a recent visit abroad or to be 'social contact cases' are probably most often due to heterosexual transmission. Seven patients (9%) were heterosexually infected by persons who had been recently receiving medical care for hepatitis B. Seven sexually transmitted cases of acute clinical hepatitis B secondary to the patients studied were seen also. These findings show that sexual transmission, mainly heterosexual, is a major route for transmission of hepatitis B in a western society. They also emphasise the importance of taking an adequate sexual history as a prerequisite for providing effective prophylaxis for sexual partners of patients with acute hepatitis B.     

A prospective study of posttransfusion hepatitis in Taiwan.

In a follow-up study of 6 months or more of two hundred and ninety-six patients who had received blood transfusion, 37 (12.5%) developed acute posttransfusion hepatitis. Patients with posttransfusion hepatitis had significantly higher donor numbers and transfusion amounts than patients without hepatitis. Frequency was not related to the age, sex or hepatitis B carriage of recipients. There were no cases of fulminant hepatitis. Of 37 patients with hepatitis, 36 were diagnosed as non-A, non-B hepatitis and one as hepatitis B. Twenty-two (59.5%) of the 36 patients with non-A, non-B hepatitis seroconverted to hepatitis C antibody. Two of these were positive for hepatitis C antibody before transfusion and 12 were negative for hepatitis C antibody. Thirty-three of the 36 patients were followed-up for more than 6 months after the onset of hepatitis. While 13 of the 33 patients recovered, the remaining 20 (60.6%) patients still had persistent liver test abnormalities 6 months after the onset of hepatitis. Seventeen (85%) of the 20 patients who developed chronic hepatitis were hepatitis C antibody positive. In contrast, only four (30%) of the 13 patients who recovered after acute hepatitis were positive for the hepatitis C antibody. Chronicity rate was not related to the patient's sex, age, transfusion amount or donor number. Our results suggest a high frequency of posttransfusion hepatitis C in Taiwan and that the infection has a high risk of chronicity.