儿童急性病毒性肝炎的病原学调查

目的 了解近年来山东省枣庄地区儿童急性病毒性肝炎的病原学状况。方法 1994年1月～2004年12月收治的1210例儿童病毒性肝炎进行了血清病原学调查。结果 甲型肝炎759例（62．7％），急性乙型肝炎424例（35.0％），戊型肝炎2例（0．2％），急性丙型肝炎3例（0．2％），病原不明者22例（1．8％）。其中双重感染58例，（4．8％），均为甲乙型肝炎病毒双重感染。结论 儿童急性病毒性肝炎的病原学仍以甲型肝炎为主、乙型肝炎次之。     

原位杂交法检测非甲─非庚型肝炎患者肝组积中新型肝炎病毒DNA

目的证实在非甲-非庚型病毒性肝炎患者肝组织中一种新型肝炎病毒（transfusion－transmittedvirus，TTV）的存在．方法采用地高辛素标记TTVDNA探针以原位杂交技术对51例血清学病毒标记非甲-非戊型、免疫组化检测肝组织中HGVNSS阴性的病毒性肝炎患者石蜡包埋肝组织进行了检测．结果各型病毒性肝炎肝组织中TTV基因的总检出率为27．5％，其中急性轻型肝炎的检出率为30．8％（4／13），急性重型肝炎（1／8，12．5％），亚急性重型肝炎（3／7，42．9％），慢性肝炎（2／6，33．3％），活动性肝硬变（2／9，22．2％），慢性重型肝炎（1／4，25％），原发性肝癌（1／4，25％）TTVDNA表达于肝细胞核或胞浆内，以核型多见．在急性肝炎，TTV阳性细胞弥漫分布于肝小叶内，慢性肝炎于汇管区附近较为密集，而在肝硬变病例，阳性细胞在假小叶内多呈片簇状不规则分布结论在不明原因病毒性肝炎患者血清及肝组织中TTVDNA的检出表明TTV为一种新型的肝炎病毒，TTV为一种嗜肝性病毒，在我国存在着TTV感染     

血清学阴笥病毒性肝炎的临床特点及免疫组化分析

目的 对60例血清学阴性（非甲0非庚型）的病毒性肝炎患者进行临床特点及肝组织免疫组化分析。方法 用Menghini法穿刺取肝组织，10％福尔马林固定标本，石蜡包埋，切片。采用生物素标记的第二抗体及链霉菌抗生物素连接的过氧化物酶及底物色素（S－P法）测定肝组织HBsAg、HBcAg、HCVAg。结果 HBVAg阳性30例，HCVAg阳性5例，HBV、HCV重叠感染6例，全阴性19例。结论 HBV、HCV为血清学全部了有性肝炎的主要病原，对血清学病原阴性病毒性肝炎应重视肝组织病理学及病原学的检查。     

鞍钢职工急性散发性病毒性肝炎病原学分析

为明确鞍钢职工急性散发性病毒性肝炎(诊断全部符合2000年的病毒性肝炎防治方案)的主要类型及病原体,我们从2001年1月-2003年12月对本单位住院的职工患者245例进行全方位病原调查。采取的主要方法是用酶联免疫吸附试验检测抗HAV IgM、乙型肝炎血清学5项标志,抗HCV、抗HCV IgM、抗HEV IgM、抗HEV IgG。结果为：245例急性散发性病毒性肝炎是经血清学检测确诊的。其中：甲型肝炎病毒感染101例,占41．22％;乙型肝炎病毒感染36例,     

祖传验方治疗病毒性肝炎121例

目的观察祖传验方辨证加减对病毒性肝炎的治疗效果，方法121例病毒性肝炎患者，应用祖传验方辨证加减进行治疗，其中急性黄疸型肝炎15例占12．4％；无黄疸型病毒性肝炎85例占70．2％；慢性肝炎21例占17．3％；男59例，女62例．病程7d～35d；年龄18岁～52岁，在治疗过程中观察患者的临床症状及肝功能的变化情况．结果经过用祖传验方辨证加减治疗后，患者临床症状消失，肝功能及B超检查均在正常范围内，为治愈，103例占85．1％，其中急性黄疸型肝炎11例，无黄疸型病毒性肝炎76例，慢性肝炎16例；治疗后自觉症状消失，肝功能及B超检查轻度异常为好转，8例占6．6％，其中急性黄疸型肝炎2例，无黄疸型病毒性肝炎4例，慢性肝炎2例；用药治疗后自觉症状未完全消失，肝功能及B超检查未达正常范围为显效，7例占5．8％，其中急性黄疸型肝炎1例，无黄疸型病毒性肝炎4例，慢性肝炎2例；用药治疗后，自觉症状未消失，肝功能及B超检查仍异常为无效，3例占2．5％，其中急性黄疸型肝炎，无黄疸型病毒性肝炎，慢性肝炎各1例．总有效率达97．5％，治愈率达85．1％．结论运用祖传验方辨证加减治疗病毒性肝炎疗效显著．     

各型肝炎病毒单纯及重叠感染的研究

目的 探讨病毒性肝炎患者甲～戊，庚型肝炎病毒(HAV-HEV，HGV)单纯感染及重叠感染情况。方法 采用EIA法检测病毒性肝炎患者血清抗-HAV IgM，HBV标志物、抗-HCV IgM、抗-HDV IgM、抗-HEV IgM、抗-HGV IgM。结果 共检测210例病毒性肝炎患者HAV-HEV、HGV血清标志物，20例未检出(9．5％)，190例患者检出标志物阳性(90．5％)。HBV感染率89，5％(188／210，其中有34例为既往感染，占16．2％，现症感染154例，占73．3％)；HAV感染率29．0％(61／210)，HCV、HDV感染率均为8．1％(17／210)、HEV、HGV感染率依次为10．0％(21／210)、7．1％(15／210)。各临床类型中单纯感染占61．4％(129／210)，二重感染占32．4％(68／210)，以HAV HBV、HBV HDV、HBV HEV感染模式最常见，三重感染占6．2％(13／210)，以HAV HBV HDV感染模式最常见；临床上以肝炎肝硬化、重型肝炎重叠感染常见，急性肝炎最少见。结论 病毒性肝炎中HBV感染最常见，其次为HAV感染；单纯感染、二重感染多见，三重感染少见；重叠感染发生率随病情加重而增加。     

拉萨甲乙型病毒性肝炎的双重感梁

为了解西藏甲乙型病毒性肝炎双重感染的情况,我们对245例确诊为病毒性肝炎的病人进行了血清学病原标志物和临床观察,报道如下。观察对象为1987年3月至1988年1月自治区人民医院门诊和住院病人。由人民医院和自治区防疫站各派专人负责,经临床,血清学和B超检查,按南宁会议标准进行确诊。发现双重感染者11例。     

急性病毒性肝炎患者中庚型肝炎病毒RNA检测研究

为观察庚型肝炎病毒在急性病毒性肝炎中感染情况,对239例急性肝炎患者的血清,采用两步法筛选进行HGV RNA的检测,并经HGV RNA确证试验,结果显示:HGV RNA阳性者9例,其中合并乙肝1例,合并丙肝3例,合并戊肝1例,非甲-戊型肝炎中占4例。提示:①HGV与其它型肝炎病毒重叠感染较多。②6例患者无输血史,而HGV RNA仍为阳性,提示HGV的输血外传播。③NA-E急性肝炎患者中,HGV的阳性率为23.5％,证实HGV为其病原之一,同时提示还可能存在其它的致病因子。     

肝炎病毒重叠感染70例临床分析

目的 探讨病毒性肝炎患者肝炎病毒重叠感染的发病率和影响预后的相关因素。方法 采用ELISA对我院1320例病毒性肝炎患者进行甲、乙、丙、丁型肝炎病毒血清学检测。结果 1320例病毒性肝炎患者肝炎病毒重叠感染70例，重叠感染率为5．3％。结论 肝炎病毒的重叠感染乙、丁型感染率最高。其次是甲、乙型重叠感染。由于病原类型不同，其临床表现及转归亦不相同。     

重型病毒性肝炎病原学与预后的关系

重型病毒性肝炎最常见为乙型肝炎病毒( HBV )、丙型肝炎病毒 ( HCV)和丁型肝炎病毒( HDV)感染 ,而且主要是 HBV和 HCV、HDV混合感染所致[1] 。笔者回顾性分析 1 2 1例重型病毒性肝炎的 HAV、HBV、HCV和 HDV病原血清学标志 ,以分析影响重型病毒性肝炎预后的因素。1　资料与方法1 .1　研究对象　选择 1 995～ 2 0 0 0年来我中心查体的重型病毒性肝炎患者 1 2 1例 ,男 87例 ,女 34例 ,年龄 1 2～ 68岁。其中急性重型 2例 ,亚急性重型 1 5例 ,慢性重型 1 0 4例。均符合 1 990年全国肝炎会议修订方案的诊断标准 ,治疗前采取患者血样…     

Spectrum of viral hepatitis in thalassemic children receiving multiple blood transfusions.

AIM: To investigate the prevalence of infection with hepatitis viruses in children with thalassemia receiving multiple blood transfusions. METHODS: Sera from 50 children with thalassemia aged 5-15 years (30 boys), who had each received over 80 units of blood, were evaluated for the presence of markers for hepatitis A virus (HAV; IgG and IgM anti-HAV), hepatitis B virus (HBV; HBsAg, and IgG and IgM anti-HBc), hepatitis C virus (HCV; IgG and IgM anti-HCV, and HCV RNA) and hepatitis E virus (HEV; IgG and IgM anti-HEV). IgM anti-hepatitis D virus (HDV) was looked for only in HBsAg or IgM anti-HBc positive sera. RESULTS: No child had evidence of recent HAV or HDV infection. IgG anti-HAV was positive in 12 children. One patient had acute HBV infection. Nine patients were HBsAg-positive. HCV infection was present in 15 cases; six of them were HCV RNA positive, and three had superinfection with hepatitis B. Recent HEV infection was present in 5 cases. CONCLUSION: Thalassemic patients receiving multiple blood transfusions often acquire hepatitis B (20%) and C (30%) infections. Recent hepatitis E infection was documented in 10% in this one-point study.     

Determination of hepatitis delta virus RNA by polymerase chain reaction in acute and chronic delta infection

The objective of this study was to evaluate the usefulness of hepatitis delta virus (HDV) RNA detection by polymerase chain reaction (PCR) in acute and chronic D hepatitis and to correlate with HDV-RNA detection by dot blot and hepatic delta antigen. Serum samples from 33 patients with acute hepatitis B surface antigen (HBsAg)-positive hepatitis (15 with hepatitis B and D coinfection, 8 with HDV superinfection, and 10 with acute hepatitis B), 85 patients with chronic HBsAg-positive hepatitis (73 with chronic D hepatitis and 12 with chronic B hepatitis), and consecutive serum samples from nine patients with chronic D hepatitis treated with interferon alfa-2b were studied. HDV-RNA was detected by PCR in 93% of the patients with hepatitis B and D coinfection, in 100% of the patients with hepatitis D superinfection, and in 1 of the 10 patients with acute hepatitis B who subsequently seroconverted to total antibody to hepatitis delta antigen (HDAg), whereas HDV-RNA was found by dot blot technique in 60% of the hepatitis B and D coinfection cases, in 62.5% of the patients with hepatitis D superinfection, and in none of the acute hepatitis B cases. In chronic D hepatitis, HDV-RNA tested positive by PCR assay in 97% of patients with intrahepatic HDAg, in one patient with undetectable hepatic HDAg, and in none of the patients with chronic hepatitis B. In the treated patients, HDV-RNA was observed to become negative by PCR only in the three patients who had a persistent response to interferon. The results of this study show that HDV-RNA determination by PCR assay is a reliable tool for the diagnosis of delta infection and a clear improvement over other methods for the evaluation of HDV replication and response to antiviral therapy.     

The etiology of acute hepatitis superimposed upon previously unrecognized asymptomatic HBsAg carriers

To study the etiology of acute hepatitis superimposed upon previously unrecognized asymptomatic HBsAg carriers, paired sera were collected in acute and convalescence phases for measurement of HBeAg, anti-HBe, hepatitis B virus DNA and anti-delta from 76 adult patients with acute hepatitis who were HBsAg positive but IgM anti-HBc negative or positive only at low titer. None of them were IgM anti-hepatitis A virus positive on admission. Of the 34 patients who were HBeAg positive initially, two (5.9%) were diagnosed as having delta superinfection, and another two (5.9%) were suspected to have non-A, non-B virus superinfection because of a transient decrease of serum hepatitis B virus DNA. The remaining 30 (88.2%) cases were hepatitis B virus DNA negative with or without anti-HBe seroconversion on follow-up. The episodes of acute hepatitis in these cases may represent "immune clearance of HBeAg" or "immune clearance of hepatitis B virus with delayed anti-HBe seroconversion," respectively, in the natural course of chronic hepatitis B virus infection. Of the patients who were anti-HBe positive initially, 23 (54.8%) were diagnosed as having delta superinfection, including eight with de novo seroconversion of anti-delta and 15 with a rising titer of anti-delta; 10 (23.8%) were positive for hepatitis B virus DNA and were considered as reactivation of hepatitis B virus, and the other nine (21.4%) were suspected as having non-A, non-B virus superinfection.(ABSTRACT TRUNCATED AT 250 WORDS)     

Hepatitis B virus replication in acute hepatitis B, acute hepatitis B virus-hepatitis delta virus coinfection and acute hepatitis delta superinfection

To evaluate the effect of hepatitis delta virus on the level of replication of hepatitis B virus and to assess the clinical significance that such an effect might have on the final outcome of the infection, the serological profile of hepatitis B virus DNA was investigated in 153 patients with acute or chronic hepatitis B virus infection with or without associated delta infection. Serum hepatitis B virus DNA was detected in 57% of patients with acute hepatitis B, 67% of those with acute hepatitis B virus-hepatitis delta virus coinfection and 25% of HBsAg carriers with hepatitis delta virus superinfection during the first week after the onset of symptoms. Patients with acute hepatitis B and those with acute hepatitis B virus-hepatitis delta virus coinfection did not differ significantly with respect to the serological profile of hepatitis B virus DNA and final clinical outcome. Within the group of HBsAg carriers with hepatitis delta virus superinfection, all patients who were initially negative for hepatitis B virus DNA developed chronic hepatitis delta virus infection, whereas 3 of the 4 patients with active hepatitis B virus infection at the time of superinfection showed transient inhibition of hepatitis B virus replication followed by termination of hepatitis delta virus infection in two patients. Therefore, although delta virus may inhibit the replication of hepatitis B virus among chronic HBsAg carriers, this effect is not readily apparent among patients with hepatitis B virus-hepatitis delta virus coinfection.     

Clinical significance of two forms of IgM antibody to hepatitis delta virus

Separation of 7-8 S and 19 S forms of serum IgM antibodies to the hepatitis delta virus by rate-zonal centrifugation was carried out on serum from 24 patients with hepatitis delta virus infection: 4 patients with acute, self-limited hepatitis; 5 patients with hepatitis delta virus superinfection progressing to chronicity; and 15 patients with chronic hepatitis delta virus. The high molecular weight IgM form (19 S) was predominantly detected in acute hepatitis delta virus cases, whereas the low molecular weight (7 S) form was found in chronic hepatitis delta virus cases. The serological profile of these two forms of IgM antibody to hepatitis delta virus was investigated in serial samples from five patients with acute hepatitis delta virus superinfection that evolved to chronic hepatitis delta virus. We found that, in the acute stage of the disease, the 19 S form was predominant, whereas 6 mo later a predominance of 7-8 S IgM was observed. These results suggest that IgM antibody to hepatitis delta virus antibody forms are different in acute and chronic hepatitis delta virus infection and that their detection only helps in differentiating an acute infection from a chronic infection but not a hepatitis delta virus-hepatitis B virus-HBV coinfection from hepatitis delta virus superinfection in the acute stage of the disease.     

Hepatitis E infection is an under recognized cause of acute decompensation in patients with chronic liver disease

Background/aims

We aimed to assess characteristics of patients with a positive hepatitis E virus serology with emphasis on acute on chronic liver disease.

Methods

This was a retrospective audit performed at a large teaching hospital.

Results

Of the 164 patients tested, 15(9.1%) had a positive serology (hepatitis E virus IgG and or IgM) of whom two also had a positive hepatitis E virus RNA. Six (42.8%) had underlying chronic liver disease and presented with deteriorating liver tests ± decompensation. In one patient (16%) acute hepatitis E virus infection was the aetiology for the decompensation and in three the positive hepatitis E virus IgG was a reflection of prior subclinical infection. However, in two of the six patients with unexplained decompensation there was delay (150–270 days) in obtaining a hepatitis E virus serology, which may have resulted in a negative hepatitis E virus IgM at time of testing.

Conclusions

9.1% of patients presenting with abnormal liver tests at a large teaching hospital in south east England have a positive hepatitis E virus serology of whom 42.8% have acute on chronic liver disease. In 16% hepatitis E virus infection is the aetiology for the acute decompensation. This may be an under representation as in >30% of patients with unexplained decompensation there is considerable delay in requesting a hepatitis E virus serology.     

Chronic active hepatitis with superinfection of delta virus and hepatitis B virus: treatment with Chinese traditional medicine

Among the 136 patients of HBsAg positive chronic hepatitis admitted from November 1986 to June 1988, 110 patients gave consent to have liver biopsy and out of the 110 liver biopsies 86 were confirmed histologically to be chronic active hepatitis. After screening the 86 patients twice with ELISA (ABBOTT ANTI-DELTA EIA), 26 (30.23%) showed positive results twice. Though it was reported that the incidence of delta hepatitis infection is very low in the HBsAg carriers in Beijing area, the incidence of superinfection of delta hepatitis on chronic active hepatitis B seems to be considerably high (30.23%) as shown in this study. Histological examination revealed that in the liver of patients with superinfection of delta hepatitis on chronic active hepatitis (26 cases) there were more severe changes and more eosinophilic degeneration than in the liver of patients without superinfection (58 cases). The patients were allocated to 3 groups at random. Eleven cases of chronic active hepatitis, with superinfection were treated with Chinese traditional medicine Xiao Chai Hu Tang (XCHT), 5 cases with biphenyl dimethyl dicarboxylate (BDD) and 10 cases with XCHT + BDD. It was noted that after 3 months of treatment, in the XCHT group, HBeAg became negative in 2/3, anti-HBe converted to positive in 2/8 and HBV-DNA converted to negative in 2/2. SGPT became normal in 8/8. XCHT showed a fairly good result and deserves further study.     

Hepatitis D virus (delta agent) superinfection in an endemic area of hepatitis B infection: immunopathologic and serologic findings

In 86 Chinese patients with histologically proven hepatitis B surface antigen (HBsAg) positive chronic hepatitis and serum alanine aminotransferase levels exceeding 200 U/l, antibody to hepatitis D antigen (HDAg) was detected more frequently in sera from hepatitis B e antigen (HBeAg) negative patients (11/35, 31.4%) than in HBeAg positive (4/51, 7.8%) patients (p less than 0.02). 10 liver biopsy specimens (76.9%) from 13 chronic hepatitis B patients with superimposed hepatitis D virus (HDV) infection, showed positive staining for HDAg in their hepatocytes. Neither HBsAg nor hepatitis B core antigen (HBcAg) was found in the liver in 12/13 patients with superimposed HDV infection. However, in liver biopsy specimens from 42 patients without HDV superinfection, HBsAg was stained positively in 41 patients (97.6%), and HBcAg in 24 patients (47.1%). Using dot blot hybridization technique, serum hepatitis B virus (HBV) DNA was detected in 62.1% (41/66) of patients without HDV superinfection, while it was detected only in 10.0% (1/10) of patients who had HDV superinfection. It is concluded that HDV superinfection plays a significant role in Taiwan in HBeAg negative chronic hepatitis B patients with clinical "exacerbation". The data show clear evidence of HDV interfering with the replication of HBV.     

庚型病毒性肝炎17例的临床和病原学分析

目的:对南京地区庚型病毒性肝炎的临床和病原学特点进行分析。方法:用反转录聚合酶链反应(RT-PCR)法检测血清HGV-RNA。从274例病毒性肝炎患者中检测出17例庚型病毒性肝炎,观察其临床表现及血清病原学标志,并分析庚型肝炎病毒(HGV)部分核酸序列。结果与结论:17例患者男性成年人多见,全年散发,经输血感染为重要传播途径。HGV可以单独感染,也可重叠(混合)其它肝炎病毒感染。少数为急性肝炎,多数为慢性肝炎或肝硬化,尤其在重叠(混合)感染。单纯HGV感染者症状轻,多隐匿发病,肝功能损害较轻。重叠(混合)感染者多有慢性肝炎的症状,与HBV重叠(混合)感染时有形成重型肝炎的趋势。核酸序列分析表明HGV南京株部分核苷酸序列与HGV美国株HGU 44402、HGU 45966、HGU 36380及HGV河北株在对应位置的核苷酸同源性从87.27%~93.94%,可能HGV有不同的基因型。     

Progression of the proportion of hepatitis B virus precore stop mutant following acute superinfection of hepatitis C

To examine the progression of the proportion of hepatitis B virus (HBV) precore stop mutant (codon 28 of precore sequence; TGG to TAG) in the viral population of patients with dual hepatitis virus (B and C) infection, a series of serum samples obtained from six cases with chronic hepatitis B with acute hepatitis C superinfection were analysed by the method of amplification-created restriction site. At the time of superinfection, all patients included in the study were negative for hepatitis B e antigen and positive for its antibody. During the follow up of 30-90 months, in five of the six patients, three different patterns were observed: (i) the proportion of precore stop mutant increased in the first 20 months after acute hepatitis C virus superinfection and then decreased progressively thereafter (two cases); (ii) the proportion of precore stop mutant decreased progressively after superinfection (two cases); and (iii) no precore stop mutant was found during the course (one case).The remaining patient showed a progressive increase in the proportion of precore stop mutant over a period of 9 months after superinfection. Rather than the progressive increase in the proportion of precore stop mutants during the natural course of chronic HBV infection alone, the results of the present study showed a reverse course of progression following acute hepatitis C virus superinfection. This observation raised the possibility of a preferential or accumulative suppression on precore stop mutant by hepatitis C virus in the later stage of dual infection.