Serum sIL-2R, TNF-α and IFN-γ in alveolar echinococcosis

AIM: To approach the relationship between alveolar echinococcosis (AE) pathology and level of sIL-2R,TNF-α and IFN-γ in sera and the significance of cytokines in development of AE.METHODS: After 23 patients with AE were confirmed by ELISA and ultrasound, their sera were collected and the concentrations of sIL-2R,TNF-α and IFN-γ were detected by double antibody sandwich. Twelve healthy adults served as controls. According to the status of livers of AE patients by ultrasound scanning, they were divided into 4 groups: P2,P3, P4 groups and C group (control). Average of concentrations of sIL-2R, TNF-α and IFN-yin homologous group was statistically analyzed by both ANOV and Newman-Keuls, respectively.RESULTS: The mean of sIL-2R in P2 group was 97±29, P3:226±80, P4:194±23 and control group (111±30)×10^3 u/L(P<0.01). The mean of TNF-α in P2 group was 1.12±0.20, P3:3.67±1.96, P4:1.30±0.25 and control group 0.40±0.19 μg/L(P<0.01). The mean of IFN-γ in P2 group was 360±20, P3:486±15, P4:259±19 and control group: 16±2 ng/L (P<0.01).Judged by ANOV and Newman-Keuls, the mean concentrations of sIL-2R, TNF-α and IFN-γ had a significant difference among groups. Except for P2group, the mean sIL-2R between other groups of AE patients had a significant difference (P<0.05). The mean of TNF-α concentration in P3 group was the highest (P<0.01). The mean of IFN-γ concentration in all patients was higher than that in control group (P<0.01),but there was no difference between AE groups (P>0.05).CONCLUSION: Low sIL-2R level indicates an early stage of AE or stable status, per contra, a progression stage. Higher level of TNF-α might be related to the lesion of liver. The role of single IFN-γ is limited in immunological defense against AE and it can not fully block pathological progression.     

IL-1β and TNF-α produced by peripheral blood mononuclear cells before and during interferon therapy in patients with chronic hepatitis C

We investigated the spontaneous and phytohemagglutinin-stimulated production of interleukin-1 (IL-1) and tumor necrosis factor- (TNF-) by peripheral blood mononuclear cells in patients with chronic hepatitis C during treatment with interferon- (IFN-). Spontaneous productions of these were significantly higher in patients with chronic hepatitis C than in healthy subjects. For patients prescribed interferon, stimulated production of TNF- was significantly higher in complete responders than in partial responders, but the differences were small between the other cytokine levels and outcome of IFN treatment. Spontaneous production of these cytokines was higher in patients with genotype III with complete response than in genotype III patients with a partial response, but this was not the case in patients with genotype II. There was a negative correlation between these cytokines and histological activity index. Spontaneous production of cytokines was decreased only in complete responders after the administration of interferon. These data suggest that the elevated production of cytokines in patients with chronic hepatitis C may be due to host response to the virus, and monitoring cytokines along with alanine aminotransferase and hepatitis C virus RNA during treatment may provide more precise information of the effectiveness of therapy.     

Expression of interferon-alpha／beta receptor protein in liver of patients with hepatitis C virus-related chronic liver disease

ABM: To study the expression of interferon-alpha/beta (IFN-α/β) receptor protein in liver of patients with hepatitis C virus (HCV)-related chronic liver disease and its clinical significance. METHODS: A total of 181 patients with HCV-related chronic liver disease included 56 with HCV-related liver cirrhosis (LC) and 125 with chronic hepatitis C (CHC). CHC patients were treated with five megaunits of interferon-α1b six times weekly for the first 2 weeks and then every other day for 22 wk. The patients were divided into interferon (IFN) treatment-responsive and non-responsive groups, but 36 patients lost follow-up shortly after receiving the treatment. The expression of IFN-α/β receptor (IFN-α/βR) protein in liver of all patients was determined with immunofluorescence. RESULTS: In liver of patients with HCV-related chronic liver disease, the expression of IFN-α/βR protein in liver cell membrane was stronger than that in cytoplasm and more obvious in the surroundings of portal vein than in the surroundings of central vein. Moreover, it was poorly distributed in hepatic lobules. The weak positive, positive and strong positive expression of IFN-α/βR were 40% (50/125), 28% (35/125), 32% (40/125), respectively in CHC group, and 91.1% (51/56), 5.35% (3/56), and 3.56% (2/56), respectively in LC group. The positive and strong positive rates were higher in CHC group than in LC group (P<0.01). In IFN treatment responsive group, 27.8% (10/36) showed weak positive expression; 72.2% (26/36) showed positive or strong positive expression. In the non-responsive group, 71.7% (38/53) showed weak positive expression; 28.3% (15/53) showed positive or strong positive expression. The expression of IFN-α/βR protein in liver was more obvious in IFN treatment responsive group than in non-responsive group. CONCLUSION: Expression of IFN-α/βR protein in liver of patients with HCV-related chronic liver disease is likely involved in the response to IFN treatment.     

Hepatitis C virus RNA detection in serum and peripheral blood mononuclear cells of patients with hepatitis C

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Expression of ICAM-1, HLA-DR, and CD80 on peripheral circulating CD_1αDCs induced in vivo by IFN-αin patients with chronic hepatitis B

AIM: To explore the effects of interferon-α(IFN-α) application on peripheral circulating CD1αdendritic cells (DCs) in patients with chronic hepatitis B, and the expression of HLA-DR, CD80, and ICAM-1 on CD1αDCs in order to explore the mechanism of immune modulation of IFN-α. METHODS: By flow cytometry technique, changes of CD1αDCs were monitored in 22 patients with chronic hepatitis B treated with IFN-αand in 16 such patients not treated with IFN-αwithin three months. Meanwhile, the expression of HLA-DR, CD80, and ICAM-1 on CD1αDCs was detected. RESULTS: In the group of IFN-αtreatment, the percentage of CD1αDCs in peripheral blood mono-nuclear cells was increased after three months of therapy. In patients who became negative for HBV-DNA after IFN-αtreatment, the increase of DCs was more prominent, while in control, these changes were not observed. Increased expression of HLA-DR, CD80, and ICAM-1 on CD1αDCs was also observed. CONCLUSION: CD1αDCs can be induced by IFN-αin vivo, and the immune related molecules such as HLA-DR, CD80, and ICAM-1 are up-regulated to some degree. This might be an important immune related mechanism of IFN-αtreatment for chronic hepatitis B.     

Expression of ICAM-1, HLA-DR, and CD80 on peripheral circulating CD1 α DCs induced in vivo by IFN-α in patients with chronic hepatitis B

AIM: To explore the effects of interferon-alpha (IFN-alpha) application on peripheral circulating CD1alpha dendritic cells (DCs)in patients with chronic hepatitis B, and the expression of HLA-DR, CD80, and ICAM-1 on CD1alpha DCs in order to explore the mechanism of immune modulation of IFN-alpha. METHODS: By flow cytometry technique, changes of CD1alpha DCs were monitored in 22 patients with chronic hepatitis B treated with IFN-alpha and in 16 such patients not treated with IFN-alpha within three months. Meanwhile, the expression of HLA-DR, CD80, and ICAM-1 on CD1alpha DCs was detected. RESULTS: In the group of IFN-alpha treatment, the percentage of CD1alpha DCs in peripheral blood mononuclear cells was increased after three months of therapy. In patients who became negative for HBV-DNA after IFN-alpha treatment, the increase of DCs was more prominent, while in control, these changes were not observed. Increased expression of HLA-DR, CD80,and ICAM-1 on CD1alpha DCs was also observed. CONCLUSION: CD1alpha DCs can be induced by IFN-alpha in vivo, and the immune related molecules such as HLA-DR, CD80,and ICAM-1 are up-regulated to some degree. This might be an important immune related mechanism of IFN-alpha treatment for chronic hepatitis B.     

Μanagement of patients with hepatitis B and C before and after liver and kidney transplantation

New nucleos(t)ide analogues(NAs) with high genetic barrier to hepatitis B virus(HBV) resistance(such as entecavir, tenofovir) have improved the prognosis of patients with HBV decompensated cirrhosis and have prevented HBV recurrence after liver transplantation(LT). NAs are considered the most proper approach for HBV infection in patients under renal replacement therapy but their doses should be adjusted according to the patient's creatinine clearance. In addition, physi-cians should be aware of the potential nephrotoxicity. However, patients with chronic hepatitis C and decom-pensated cirrhosis can receive only one therapeutic option before LT, as well as for Hepatitis C virus(HCV) recurrence after LT, which is the combination of sub-cutaneous Peg-IFN and ribavirin. Generally, therapy for HCV after renal transplantation should be avoided. Although the optimal antiviral therapy for HCV infec-tion has not been established, attention has turned to a new, oral direct acting antiviral treatment which marks a promising strategy in prognosis and in amelioration of these diseases.     

Effects of selenium on peripheral blood mononuclear cell membrane fluidity,interleukin-2 production and interleukin-2 receptor expression in patients with chronic hepatitis

AIM:To study the effect of selenium on peripheral bloodmononuclear cell(PBMC)membrane fluidity and immunefunction in patients with chronic hepatitis.METHODS:PBMCs were pretreated with selenium(1.156×10~(-7)mol/L)for 6 h in v/boor extracted directly frompatients after administration of selenium-yeast continuouslyfor 8-12 wk(200 μg/d),and then exposed to Con-A for48 h.The membrane fluidity,interleukJn-2(IL-2)productionand interleukin-2 receptor(IL-2R)expression in PBMCs andmalondialdehyde(MDA)concentration in medium and lipidperoxide(LPO)in plasma were determined.RESULTS:The PBMC membrane fluidity,IL-2 productionand IL-2R expression in patients with chronic hepatitis weresignificantly lower than those in healthy blood donators(particle adhesive degree R,0.17±0.01 vs 0.14±0.01,P<0.01;IL-2,40.26 9.55 vs72.96±11.36,P<0.01;IL-2R,31.05±5.09 vs 60.58±10.56,P<0.01),and the MDAconcentration in medium in patients with chronic hepatitiswas significantly higher than that in healthy blood donators(1.44±0.08 vs0.93±0.08,P<0.01).Both in vib-o and in vivoadministration of selenium could reverse the above parameters.CONCLUSION:Supplement of selenium can suppress lipidperoxidation,and improve PBMC membrane fluidity andimmune function in patients with chronic hepatitis.     

Effects of interferon-α therapy on serum and liver HBV DNA in patients with chronic hepatitis B

The aim of this study was to evaluate the effect of interferon- therapy on serum and liver HBV DNA in 20 patients with chronic hepatitis B and to correlate the presence or absence of HBV DNA with the clinical response. There were 11 responders and all lost HBV DNA from the serum. Ten of the 11 were followed for 36 months following IFN treatment and remained well with absence of HB_eAg and HBV DNA from the serum and with normal ALT. Five also lost HB_sAg. HBV DNA became undetectable in the liver of nine of 10 of these patients in whom liver tissue was available for study. HBV DNA persisted in the liver of seven of nine nonresponders and was not detected in two in spite of the presence of HBV DNA and HB_eAg in the serum of these two patients. We conclude that IFN may induce long remissions in patients with chronic hepatitis B with loss of HBV DNA from the serum and that occasionally HBV DNA may persist in the liver of such patients.This work was supported in part by Health and Welfare Canada Grant 6606-2435-52.     

Intraocular complications of IFN-α and ribavirin therapy in patients with chronic viral hepatitis C

We report a panel of severe inflammatory and vascular intraocular disorders occurring during interferon-alpha (IFN-α) treatment in eight hepatitis C virus (HCV)-infected patients. These events include three cases of Vogt-Koyanagi-Harada like (VKH) disease (an association of panuveitis, retinal detachment, ear and meningeal detachment and skin and hair changes), two cases of central retinal vein occlusion, one case of central retinal artery occlusion, one case of severe hypertensive retinopathy and one case of bilateral ischemic optic neuropathy with severe visual impairment. Rare as they are, such severe ophthalmological complications require a close follow-up of HCV-infected patients under IFN-α treatment with ophthalmological monitoring if any ocular manifestation occurs.     

Kinetics of phytohemaglutinin-induced IFN-γand TNF-α expression in peripheral blood mononuclear cells from patients with chronic hepatitis B after liver transplantation

AIM: To study the association between host immunity and hepatitis B virus (HBV) recurrence after liver transplantation.METHODS: Peripheral blood mononuclear cells (PBMC) were isolated from 40 patients with hepatitis B and underwent orthotopic liver transplantation (OLT) before and 2, 4, 8 wk after surgery. After being cultured in vitro for 72 h, the levels of INF-γ and TNF-α in culture supernatants were detected with ELISA. At the same time, the quantities of HBV DNA in serum and PBMCs were measured by real time PCR.RESULTS: The levels of INF-γ and TNF-α in PBMC culture supernatants decreased before and 2, 4 wk after surgery in turns (INF-γ 155.52±72.32 ng/L vs14.76±9.88 ng/L vs 13.22±10.35 ng/L, F= 6.946, P = 0.027＜0.05; TNF-α80.839±46.75 ng/L vs 18.59±17.29 ng/L vs9.758±7.96 ng/L,F= 22.61, P= 0.0001＜0.05). The levels of INF-γ and TNF-α were higher in groups with phytohemagglutinin (PHA) than in those without PHA before surgery. However,the difference disappeared following OLT. Furthermore,INF-γ and TNF-α could not be detected in most patients at wk 4 and none at wk 8 after OLT. The HBV detection rate and virus load in PBMlC before and 2, 4 wk after surgery were fluctuated (HBV detected rate: 51.4%, 13.3%, 50% respectively; HBV DNA: 3.55±0.674 log(10) copies/mL vs 3.00±0.329 log(10) copies/mL vs 4.608±1.344 log(10) copies/mL, F= 7.582, P= 0.002＜0.05). HBV DNA in serum was 4.48±1.463 log(10) copies/mL before surgery and ＜103 copies/mL after OLT except for one with 5.72×106 copies/mL 4 wk after OLT who was diagnosed as HBV recurrence.The levels of INF-γ, and TNF-α were lower in patients with a high HBV load than in those with a low HBV load (HBV DNA detected/undetected in PBMCs: IFN-γ 138.08±72.44 ng/L vs 164.24±72.07 ng/L, t = 1.065, P = 0.297＞0.05, TNF-α 80.75±47.30 ng/L vs74.10±49.70 ng/L, t= 0.407, P= 0.686＞0.05; HBV DNA positive/negative: IFN-γ 136.77±70.04 ng/L vs 175.27±71.50 ng/L, t= 1.702, P= 0.097＞0.05; TNF-α 75.37±43.02 ng/L vs 81.53±52.46 ng/L, t = 0.402,P = 0.690＞0.05).CONCLUSION: The yielding of INF-γ and TNF-α from PBMCs is inhibited significantly by immunosuppressive agents following OLT with HBV load increased, indicating that the impaired immunity of host is associated with HBV recurrence after OLT.     

肝移植后乙型肝炎复发的危险因素及预后分析

目的探讨乙型肝炎相关性肝移植患者术后在核苷(酸)类似物联合小剂量乙型肝炎免疫球蛋白的预防下乙型肝炎复发的危险因素及预后。方法 253例乙型肝炎相关性肝移植患者术前即开始给予核苷(酸)类似物预防,术中和术后均给予核苷(酸)类似物联合乙型肝炎免疫球蛋白处理。结果在253例肝移植患者中,死亡29例(11.5%);术前基础病为HBV相关性肝癌患者的病死率为21.2%,显著高于非肝癌患者的5.2%(P=0.000);乙型肝炎复发16例(6.3%);复发后均停用乙型肝炎免疫球蛋白,并调整核苷(酸)类似物,结果患者HBV DNA均<500IU/ml,肝功能稳定;Log-rank检验显示乙型肝炎复发后及时治疗对患者生存无明显影响;经Logistic多因素回归分析表明,术前HBeAg阳性、HBV DNA≥105IU/ml、HCC和HBV/YMDD变异是乙型肝炎复发的危险因素。结论肝移植能够有效治疗乙型肝炎相关性终末期肝病,在核苷(酸)类似物联合乙型肝炎免疫球蛋白预防后,仍有乙型肝炎复发,其对生存率的影响有待于观察。     

乙肝病毒相关肝病肝脏移植术后乙肝复发的预防和治疗

在我国施行肝移植的患者中,绝大多数是乙肝病毒相关性终末性肝病患者,术前病毒复制程度、个体免疫状态和病毒类型与移植术后易感复发密切相关。联合应用乙肝免疫球蛋白与核苷类似物可用于肝脏移植术后抗病毒治疗,近年来报道乙肝疫苗也可有效预防移植术后乙肝复发。本文重点介绍肝脏移植术后乙肝复发的机制及影响因素,探讨预防乙肝复发的各种方案的优劣。     

肝移植后乙型肝炎复发的临床表现与预后

目的 研究肝移植后乙型肝炎复发的临床特点、治疗和预后.方法 回顾性分析25例因终末期乙肝肝病行肝移植的患者术后乙型肝炎复发的临床类型、乙肝病毒指标的变化、对抗病毒再治疗的反应以及预后.结果 肝移植后乙型肝炎复发的高峰时间是在第1年;YMDD变异在拉米夫定失效患者中占61%;本组病例肝移植后乙型肝炎复发呈现3种临床类型:①纤维淤胆型肝炎,占8%(2/25),病情凶险,病死率高.②亚急性重型肝炎,占12%(3/25),恢复期后表现为肝硬化.③慢性肝炎,占80%(20/25),其中包括活动型和轻型.病情呈活动型者占48%(12/25),其中病情进展较快者可在4-5年内进展为肝硬化.预后与肝病活动程度关系密切,需要与排异反应及药物中毒相鉴别.病情呈轻型占32%(8/25),表现为一过性肝功能异常,预后较好.25例乙型肝炎复发患者.死亡2例,死亡原因均为纤维淤胆型肝炎.结论 肝移植后乙型肝炎复发的临床表现类型与抗病毒治疗是否及时有效密切相关.应用核苷类似物联合乙肝免疫球蛋白治疗,能有效地预防及治疗肝移植术后乙型肝炎复发.早期发现乙型肝炎复发并及时调整治疗,能显著改善患者的预后.     

肝移植术后乙型肝炎病毒再感染的病因与预后

目的了解肝移植后乙肝复发的原因及对预后影响。方法对终末期肝病患者肝移植前后的HBVDNA水平、HBV变异情况和HBV变异前后肝功能变化进行随访检测;术后肝功能和HBVDNA水平出现异常变化时,做肝脏组织活检。所有患者常规术后拉米夫定和乙肝免疫球蛋白治疗。结果2004年4月-2005年12月20例终末期肝病患者在我院进行了肝移植治疗,其中12例为乙肝肝硬化,8例为乙肝慢重肝合并急性肝衰,术后3例死于移植肝无功能,3例失访,14例随访了60-84个月不等,术后1年内,有6例患者出现乙肝病毒变异,其中3例病理证实乙肝复发,且均为乙肝慢重肝合并急性肝衰患者,2例术前HBVDNA分别为〉10^2copies／mL、〉10^6 copies／mL,另外3例乙肝肝硬化仅仅表现乙肝病毒变异,无肝炎复发。结论肝移植术后接受拉米夫定和乙肝免疫球蛋白治疗者,病毒变异是乙肝复发的主要原因,慢重肝合并急性肝衰、术前HBVDNA阳性的病人,随访时应该特别注意术后乙肝的复发。     

Association between TRAIL expression on peripheral blood lymphocytes and liver damage in chronic hepatitis B

AIM: To explore a novel mechanism for tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), upregulation of CD4+ and CD8+T lymphocytes participating in the patho-physiological process of chronic hepatitis B (CHB). METHODS: The levels of serum soluble TRAIL (sTRAIL), serum IFN-γ and membrane-bound TRAIL expression on peripheral leucocytes from 58 CHB patients were examined by ELISA and flow cytometry respectively. The levels of TRAIL were compared with the baseline levels of 17 healthy controls, and correlation analysis was performed between ALT, TBIL, PT, morphological change in hepatic tissues, and serum IFN-γ. RESULTS: The results showed that TRAIL levels on membranes of CD4+, CD8+ T cells in CHB patients were much higher than those in healthy controls (P<0.001), and were correlated with serum TBIL (r=0.354, P= 0.008 for CD4+ and r= 0.522, P= 0.000 for CD8+, respectively), ALT (r= 0.393, P= 0.003 for CD8+), PT (r = 0.385, P = 0.004 for CD8+) and serum IFN-y level (r = 0.302, P= 0.011 for CD4+ and r= 0.307, P= 0.009 for CD8+). On the contrary to membrane-bound TRAIL expression, serum level of sTRAIL was not correlated with that of TBIL and PT, though it was higher than that of the normal population and was positively correlated with serum HBeAg expression (r= 0.695, P = 0.001). CONCLUSION: The expression level of TRAIL on the membrane of lymphocytes was upregulated and associated with the liver injury in CHB patients. These findings suggest that upregulation of TRAIL expression may be induced by virus antigen and inflammatory cytokine IFN-γ.     

Management of hepatitis B virus infection after liver transplantation

Chronic hepatitis B virus(HBV) infection is responsible for up to 30% of cases of liver cirrhosis and up to 53% of cases of hepatocellular carcinoma. Liver transplantation(LT) is the best therapeutic option for patients with end-stage liver failure caused by HBV. The success of transplantation, though, depends on receiving prophylactic treatment against post-transplant viral reactivation. In the absence of prophylaxis, liver transplantation due to chronic hepatitis B(CHB) is associated with high rates of viral recurrence and poor survival. The introduction of treatment with hepatitis B immunoglobulins(HBIG) during the 1990 s and later the incorporation of oral antiviral drugs have improved the prognosis of these patients. Thus, LT for CHB is now a universally accepted option, with an estimated 5 years survival of around 85% vs the 45% survival seen prior to the introduction of HBIG. The combination of lamivudine plus HBIG has for many years been the most widely used prophylactic regimen. However, with the appearance of new more potent oral antiviral agents associated with less resistance(e.g., entecavir and tenofovir) for the treatment of CHB, new prophylactic strategies are being designed, either in combination with HBIG or alone as a monotherapy. These advances have allowed for more personalized prophylaxis based on the individual risk profile of a given patient. In addition, the small pool of donors has required the use of anti-HBc-positive donors(with the resulting possibility of transmitting HBV from these organs), which has been made possible by suitable prophylactic regimens.     

肝移植患者外周血单个核细胞中HBV DNA检测及临床意义

目的研究乙型肝炎肝硬化终末期患者肝移植后外周血单个核细胞(PBMC)HBV DNA状态及临床意义.方法应用荧光PCR技术检测乙型肝炎肝硬化终末期肝移植术后30例患者血清及PBMC标本HBV DNA,并用细胞计数法和管家基因β-actin标定PBMC HBV DNA,观察PBMC HBV DNA与血清HBV DNA定量关系;观察患者肝移植术后不同时间PBMC HBV DNA水平.30例对照组为肝炎肝硬化失代偿期患者.结果移植后患者19份(63%)PBMC标本HBVDNA阳性,低于对照组(87%,26/30).以Ct值为定量参数,移植后患者PBMC HBV DNA水平显著低于对照组(P=0.02);肝移植术后患者PBMC HBV DNA长期维持于103～104拷贝/106细胞水平,与肝移植后时间无明显关系.移植后患者血清HBV DNA均阴性,而对照组血清阳性率为48%.结论乙型肝炎肝硬化终末期患者肝移植术后,经有效预防HBV再感染治疗后,虽然血清中不能测出HBV DNA,但PBMC中HBV DNA阳性,这可能成为肝外"病毒池",导致供肝再感染;对移植后患者监测PBMC HBV DNA,可能有助于早期诊断HBV再感染或复发.     

非肝病及慢性乙型肝炎患者肝组织中巨细胞病毒的检测

目的：探讨巨细胞病毒（CMV）在非肝病患者及慢性乙型肝炎患者肝组织中的表达、分布特点及相关关系。方法：采用免疫组化方法以抗－CMV单克隆抗体对31例非肝病及76例慢性乙型肝炎肝组织进行检测,用抗－HBcAg多克隆抗体和抗－CMV单克隆抗体双标记技术在部分慢性乙型肝炎患者同一张肝组织切片上显示两种病毒分布特点。结果：31例非肝病肝组织中检出CMV Ag7例（22．6％）,明显低于慢性乙型肝炎患者（43／76,56．6％）,P＜0．01。在两组标本中CMV Ag均在肝细胞胞浆内表达。非肝病患者肝组织中阳性细胞数量较慢性乙型肝炎患者少,后者阳性细胞多近汇管区分布,数量多时,也可在肝小叶内弥漫分布。轻度和重度慢性乙型肝炎患者中CMV的检出率比较,差异无显著性,但慢性乙肝炎患者中CMV表达阳性细胞明显多于轻度慢性乙型肝炎（P＜0．05）。双标记染色显蒜CMV Ag和HBcAg多数可表达于肝小叶内同一区域肝细胞甚至同一肝细胞内,也可见于肝小叶中不同部位。结论：非肝病患者中CMV感染并不少见,慢性乙肝炎患者更易重叠CMV感染,并且其感染程度与肝组织的活动性病变密切相关。     

肝移植术后丙型肝炎复发受者肝组织病理学特征分析

目的：探讨肝移植术后丙型肝炎复发时受者肝组织病理学特征。方法收集28例明确诊断为肝移植术后丙型肝炎复发患者的54份肝组织病理学资料,回顾性分析丙型肝炎复发时肝组织病理学特点。结果肝移植术后丙型肝炎复发的主要病理学特点是：肝细胞变性和坏死,汇管区以淋巴细胞为主的炎性细胞聚集,以及较早出现的肝纤维化,同时部分病例合并有排斥反应和药物性肝损伤的组织学特点;移植术后远期（大于12 m）丙型肝炎复发者肝纤维化程度较近期（小于12 m）复发者严重[肝纤维化计分为（1.82±1.12）对（1.13±1.08）,P＜0.05;不同丙型肝炎病毒基因型导致的丙型肝炎在病理学表现上的差异无统计学意义;合并排斥反应及药物性肝损害患者肝炎活动度评分分别为（2.32±0.64）和（2.33±0.88）,显著高于无合并组患者（1.64±0.59）,（P＜0.05）。结论肝移植术后丙型肝炎复发时有特征性的肝脏病理学改变,肝组织病理学检查对移植术后丙型肝炎复发的病情判断具有重要的价值。