HCV在肝病患者中的感染模式及其免疫状况研究

对４１６例病毒性肝炎患者进行了抗－ＨＣＶ及其它血清标志物检测，结果共发现５２例抗－ＨＣＶ阳性患者，其中单独抗－ＨＣＶ阳性占２３．０％，与ＨＢＶ感染占４０．４％，与ＨＢＶ、ＨＤＶ感染占９．６％。抗－ＨＣＶ在慢性活动型肝炎、肝硬化中的阳性率分别为３０．４％和２２．７％，明显高于急性肝炎和非甲非乙型肝炎中的阳性率（２．８％、１３．０％），提示ＨＣＶ在促使肝病慢性化及加重病情方面有重要作用。对抗－ＨＣＶ阳性患者外周血Ｔ淋巴细胞分型结果显示：各型丙肝息者ＣＤ＿３、ＣＤ＿４比例均下降，而ＣＤ＿８比例上升，表现为Ｔｈ细胞功能下降，Ｔｓ细胞功能增强，提示细胞免疫功能紊乱是丙肝患者高慢性化率的免疫学基础。     

高频喷射通气结合胸壁挤压对组胺致肺损伤犬呼吸循环功能的影响

以高频喷射通气结合胸壁挤压（ＨＦＪＶ＋ＣＷＣ）为通气模式，观察其对组胺致肺损伤犬呼吸循环功能的影响，并与单纯高频喷射通气（ＨＦＪＶ）进行比较。结果表明：与ＨＦＪＶ相比，ＨＦＪＶ＋ＣＷＣ时的功能残气量（ＦＲＣ）、ＰａＣＯ＿２和ＰＣＯ＿２均显著降低（Ｐ＜０．０１），肺泡通气量（Ｖ＿Ａ）和二氧化碳排出量（ＣＯ＿２）均显著增高（Ｐ＜０．０１），每分呼出气量（Ｖ＿Ｅ）、ＰａＯ＿２、ＰＣＯ＿２、吸气峰压（ＰＩＰ）、平均气道压（Ｐａｗ）、呼气末压（ＥＥＰ）、ＨＲ、平均动脉压（ＭＡＰ）、肺动脉压（ＰＡＰ）和肺毛细血管楔压（ＰＣＷＰ）均无显著变化（Ｐ＞０．０５）。提示：ＨＦＪＶ＋ＣＷＣ除保留单纯ＨＦＪＶ时气道开放、气道低压、良好的血液氧合、不影响循环功能等特点外，还具有增加呼气动力，改善肺泡通气，显著促进ＣＯ＿２排除等优点。     

应用超声多普勒探测肝中静脉血流频谱及参数对肝弥漫性病变的诊断价值

本研究通过应用超声多普勒探测７０例肝弥漫性病变患者及２１例肝炎病毒携带者肝中静脉血流频谱形态及参数，对照５６例正常人，筛选诊断肝弥漫性病变较为敏感及特异性指标。结果表明：（１）肝硬化及脂肪肝肝中静脉血流频谱异常（ＨＶ１或ＨＶ２型）为多数，约占８２．６％；（２）对照正常组，肝弥漫性病变及肝炎病毒携带者肝中静脉内径变细、血流速度加快、充盈指数减小；（３）以充盈指数（ＣＩ）≤０．０３诊断肝弥漫性病变及肝炎病毒携带者的敏感性、特异性和准确性分别为８７．９％、９１．１％及８９．１％，可作为临床早期诊断肝弥漫性病变的参考指标。     

肝病患者和供血员血清中抗-HGV的检测及其意义

目的探讨肝病患者和供血员血清中抗 ＨＧＶ检测的意义。方法采用北京医科大学肝病研究所生产的试剂盒，对２２６例肝病患者和１８７例献血员血清中抗 ＨＧＶ进行检测。结果急性肝炎、慢性活动性肝炎、慢性迁延性肝炎、肝硬化、重型肝炎病人抗 ＨＧＶ阳性检出率分别为６．９％（３／４３），１７．９％（１９／１０６），１４．２％（５／３５），３３．３％（３／９）和９．１％（３．３３）。肝硬化患者血清中抗 ＨＧＶ的检出阳性率明显高于其它各型肝炎（Ｐ＜０．０５）。１８７例献血人员中检出抗 ＨＧＶ４例（２．１％）。结论作者认为在供血人员中对ＨＧＶ进行筛选，以避免和减少输血后肝炎的发生。     

男性急性乙醇中毒患者血清性激素含量的研究

测定了２３例男性急性乙醇中毒患者的性激素含量，结果表明：中毒组雌二醇（Ｅ＿２）、卵泡刺激素（ＦＳＨ）、血清泌乳素（ＰＲＬ）及黄体生成素（ＬＨ）高于正常对照组（Ｐ＜０．０１）；睾酮（Ｔ）水平在乙醇中毒第２期高于第１、３期，Ｅ＿２水平随病情加重呈直线上升；Ｅ＿２及Ｅ＿２／Ｔ水平与谷草转氨酶（ＧＰＴ）呈正相关，提示两者对急性乙醇中毒合并肝损伤程度的判断有一定帮助。     

124例海洛因依赖者乙肝病毒感染情况分析

为了解海洛因滥用人群中乙肝病毒（ＨＢＶ）感染情况。方法：采用ＥＬＩＳＡ法对１２４例海洛因滥用者和３００例正常人群的（ＨＢＶ）感染情况进行对照分析。结果：海洛因滥用组（ＨＢＶ）的感染率为１６．１３％，显著高于正常对照组（８．０％），Ｐ〈０．０５。结论：海洛因滥用可能是导致（ＨＢＶ）感染率高的重要原因。     

海洛因依赖者对医护人员的危害因素及防护

对１９９７ 年２ ～１１ 月自愿戒毒的１０００ 例海洛因依赖者（ 观察组） 和同期入院的１１００ 例其他科室患者（ 对照组）常规取血查 Ｈ Ｂｓ Ａｇ、抗 Ｈ Ｃ Ｖ、抗 Ｈ Ｉ Ｖ。结果显示：观察组的 Ｈ Ｂｓ Ａｇ 、抗 Ｈ Ｃ Ｖ、抗 Ｈ Ｉ Ｖ 阳性率分别为３５８ ％ 、４２０ ％ 、０６ ％ ；对照组的 Ｈ Ｂｓ Ａｇ 、抗 Ｈ Ｃ Ｖ、抗 Ｈ Ｉ Ｖ 阳性率分别为１３９１ ％ 、０６４ ％ 、０ ％ 。经统计学处理，观察组的乙型肝炎、丙型肝炎、艾滋病感染率均显著高于对照组，两组具有显著性差异（ Ｐ＜ ０００５ 或 Ｐ＜ ００５） 。为保护医护人员免受海洛因依赖者的危害，提出了相应的防护措施：加强防护意识，增强身体素质，严格执行卫生制度；采取体液、血液隔离。     

聚合酶链反应检测再生障碍性贫血血清中乙型和丙型肝炎病毒

应用聚合酶链反应（ＰＣＲ）检测了３７例非肝炎相关再生障碍性贫血（ＮＨＡＡ）和１８例肝炎相关再生障碍性贫血（ＨＡＡ）血清中的乙型肝炎病毒ＤＮＡ（ＨＢＶＤＮＡ）、丙型肝炎病毒ＲＮＡ（ＨＣＶＲＮＡ）。结果显示：ＮＨＡＡ的ＨＢＶＤＮＡ检出率为１３．５％（５／３７），ＨＡＡ为２２．２％（４／１８），两者比较Ｐ＞０．０５。ＮＨＡＡ的ＨＣＶＲＮＡ检出率为２．７％（１／３７），ＨＡＡ为３８．９％（７／１８），两者比较Ｐ＜０．０１。丙型肝炎相关再生障碍性贫血的预后较差。提示：ＨＣＶ感染与ＨＡＡ关系密切。     

血清β_2微球蛋白与肝炎临床病理的关系

目的为探讨血清β＿２－微球蛋白（β＿２－Ｍ）与肝炎组织学变化的关系，对肝炎患者血清β＿２－Ｍ含量与肝炎组织学变化进行对比分析。方法甲ＲＩＡ法测定各型肝炎１６７例血清β＿２－Ｍ含量，其中１１０例同时做肝活检，按照Ｋｎｏｄｅｌｌ肝组织炎症活动指数标准记分。结果与正常人比较，各型肝炎患者血清β＿２－Ｍ均明显升高，以ＡＨ、ＣＡＨ及ＰＨＬＣ更为显著（Ｐ＜０．０５～０．０１）。血清β＿２－Ｍ水平与肝细胞坏死及门管区炎症程度密切相关，而与肝纤维化程度无相关性。结论血清β＿２－Ｍ是反映肝实质炎症性质有价值的血清学指标。     

高频双向喷射通气对组胺犬气体交换及呼吸力学的影响

本实验比较了不同通气频率时高频双向喷射通气（ＨＦＴＪＶ）与高频喷射通气（ＨＦＪＶ）对组胺致肺损伤犬气体交换、氧运输功能、呼吸力学及血流动力学的影响。结果表明，在组胺持续滴注时，当通气频率分别为６０及１００次／ｍｉｎ时，ＨＦＴＪＶ时的ＰａＣＯ＿２较ＨＦＪＶ时均显著降低（Ｐ＜０．０、１），ｐＨ均显著升高（Ｐ＜０．０１），而ＰａＣＯ＿２、氧耗量、氧运输量、心输出量、肺动脉压、气道压、肺及时吸系统阻力、顺应性等均无明显改变。提示：ＨＦＴＪＶ能够显著增强组胺致肺损伤大的ＣＯ＿２排除，而对氧运输功能、呼吸力学及血流动力学均无明显影响。     

肝静脉频谱波形分析对脂肪肝诊断的临床价值研究

目的利用脉冲多普勒评估肝静脉（HV）频谱波形对脂肪肝临床应用中的价值。方法利用脉冲多普勒超声评估50例正常人和93例不同程度脂肪肝患者HV频谱波形（HV0型、HVⅠ型、HVⅡ型）。结果随着脂肪肝程度的加重．HVⅠ型和HVⅡ型明显增多。脂肪肝各组的HVⅠ＋HVⅡ比例均高于对照组,差异均有统计学意义（矿分别=10．59、30．80、24．91,P均〈0．05）,且中度、重度脂肪肝组的HVⅠ＋HVⅡ比例高于轻度脂肪肝组,差异也均有统计学意义（x^2分别=7.39、5．23,P均〈0．05）,但重度和中度脂肪肝组之间比较,差异无统计学意义（X^2=0．27,P〉0．05）。结论脉冲多普勒超声HV频谱波形分析有助于脂肪肝的诊断和分级。     

超声量化指标与肝静脉波形分型在评价乙肝患者肝纤维化程度中的临床意义

目的探讨超声量化指标与肝静脉波形分型在评价乙肝患者肝纤维化程度中的临床意义。方法回顾性分析本院110例乙肝患者的临床资料,作为研究组;选取同期到本院体检的25例健康人,作为对照组。研究组入院确诊时、对照组体检时均分别行超声检查,评估超声量化指标、肝静脉波形分型。以肝穿刺病理结果为金标准,判断超声量化指标、肝静脉波形分型对肝纤维化程度诊断价值。结果研究组S1、S2、S3、S4期患者超声量化指标评分高于对照组(P<0.05);随着肝纤维化分期增加,研究组超声量化指标评分呈增高趋势(P<0.05);研究组S4期HVⅠ型+HVⅡ型率高于S0、S1、S2期及对照组,S3期HVⅠ型+HVⅡ型率高于S0、S1、S2期及对照组(P<0.05);ROC曲线显示肝静脉波形分型灵敏度、特异度较超声量化指标评分高。结论乙肝患者肝纤维化程度评估中超声量化指标与肝静脉波形分型均具有一定价值,且后者灵敏度、特异度更高。     

慢性肝炎肝静脉彩色多普勒超声频谱改变与肝纤维化分期相关性的研究

目的 探讨慢性肝炎肝静脉频谱改变与病理肝纤维化分期的相关性。方法 应用彩色多普勒超声检测了602例慢性肝炎患者的肝静脉，全部病例均经超声引导下肝组织活检病理证实，将其频谱改变与肝纤维化病理分期进行对照分析。结果 慢性肝炎的肝静脉频谱波型表现为双向、单向和连续平坦（门静脉样）三种类型；按纤维化程度分为轻度（S0-S1）、中度（S2～S3）和重度（S4），轻度和重度差异有统计学意义，中度和重度差异无统计学意义。将双向波型定为正常波形，单向、连续平坦波型定为异常波形；在正常与异常波形之间，各相邻纤维化分期之间无明显差异，仅S1与S4差异有统计学意义；无纤维化（S0）为对照组，有纤维化（S1～S4）为病变组，异常波形对肝纤维化诊断的敏感性17．3％（97／559），特异性90．7％（39／43），诊断准确性为34．2％（136／602），假阳性4例（9．3％），假阴性462例（82．6％）。S波峰值流速在单向与双向之间差异无统计学意义；a波峰值流速在S0、S1、S2、S3分别与S4之间差异有统计学意义，S0～S3各期之间差异无统计学意义，通过ROC分析，a波峰值流速以8cm／S为界值，诊断S4的敏感性为40．6％，特异度为51．3％。结论 单向频谱峰值流速不一定降低。肝静脉频谱形态及a波峰值流速对肝纤维化分期S3及以下各期无明确诊断意义，对S4期的诊断有较大的价值，a波峰值流速的敏感性明显高于频谱形态，诊断中应重视a波峰值流速的变化。在慢性肝病中，超声检测肝静脉频谱变化对肝纤维化的诊断具有一定的价值．     

A Novel Non-invasive Method for Predicting Liver Fibrosis by Quantifying the Hepatic Vein Waveform

The hepatic vein (HV) waveform by Doppler ultrasound reflects the severity of liver fibrosis. We conducted a proof-of-concept study of a new method for quantifying the HV waveform. We calculated the coefficient of variation (CV) of the HV flow velocity and created a new index “q-HV” (quantified HV) and analyzed its performance for predicting histologic liver fibrosis in 114 patients with chronic liver disease. The CV of the HV flow velocity was well associated with flattening of the waveform and the q-HV significantly increased with the progression of liver fibrosis. The areas under the curve for the prediction of fibrosis stage were 0.732 for F2, 0.772 for F3 and 0.805 for F4. Combined q-HV and FIB-4 index (widely used liver fibrosis score) increased the diagnostic accuracy for liver fibrosis. The q-HV showed good accuracy for predicting liver fibrosis; thus, q-HV is feasible and acceptable as a non-invasive tool for predicting liver fibrosis.     

Hepatic vein Doppler waveform changes in early stage (Child-Pugh A) chronic parenchymal liver disease

Doppler waveform changes can be found in chronic parenchymal liver disease, especially in the late stages. We investigated the contribution of Doppler ultrasound in diagnosing early-stage chronic parenchymal liver disease. In this prospective study, 30 patients who had been diagnosed with chronic liver disease (Child-Pugh class A) and 30 healthy subjects were studied. The diagnosis was confirmed with histopathologic examinations of biopsy specimens in 17 patients. The Doppler US examination of hepatic veins was performed in all the patients and healthy subjects. The Doppler US pattern was classified into three groups according to the Doppler signal characteristics: (1) type 0, triphasic waveform, the presence of a short phase of reversed flow, (2) type I, decreased amplitude of the phasic oscillations without the short phase of reversed flow, and (3) type II, complete flat waveform. Normal hepatic vein waveforms (type 0) were found in 8 patients (26.66%) and abnormal hepatic waveforms (type I + type II) in 22 patients (73.33%). The results of Doppler ultrasonography were correlated with the diagnosis of early-stage chronic parenchymal liver disease (Child-Pugh class A). In all the subjects of the control group, the Doppler waveform of hepatic veins showed the triphasic pattern (type 0). In the statistical evaluation using Fisher's exact test we observed that there was a significant difference (p < 0.05) between the control group and the patient group with respect to the presence of abnormal (type I + type II) Doppler waveform. The diagnostic accuracy in the patients who had biopsy was 76.47% and that in the patients who did not was 69.23%. © 1997 John Wiley & Sons, Inc.     

Reproducibility of derived central arterial waveforms in patients with chronic renal failure

Arterial stiffness potently predicts mortality in dialysis patients. Pulse-wave analysis permits the non-invasive assessment of indices of arterial stiffness and the central pressure waveform by applanation tonometry. The aim of this study was to assess the reproducibility of pulse-wave analysis in patients with chronic renal failure. A total of 188 subjects (23 healthy controls, along with 71 pre-dialysis, 67 dialysis and 27 transplant patients) took part. Duplicate measurements were recorded of brachial blood pressure using the semi-automated Omron 705 device and of the radial artery pressure waveform using applanation tonometry. The central pressure aortic waveform was then obtained by application of a transfer function incorporated into the SphygmoCor software. Central aortic mean blood pressure (MBP), indices of arterial stiffness [augmentation index (AIx) and time to reflection (TR)] and the subendocardial viability ratio (SEVR) were analysed for intra-observer, inter-observer and long-term reproducibility using Bland-Altman plots. The mean (+/-S.D.) intra-observer difference was 0+/-4% for AIx, 0+/-20 ms for TR, 0+/-3 mmHg for aortic MBP and 0+/-18% for the SEVR. Inter-observer mean differences were 0+/-3% for AIx, 1+/-7 ms for TR, 1+/-4 mmHg for aortic MBP and 1+/-9% for the SEVR. For the long-term study, the mean differences were -1+/-9% for AIx, -2+/-13 mmHg for aortic MBP, -2+/-12 ms for TR and 1+/-29% for the SEVR. Pulse-wave analysis showed excellent reproducibility in all the studies, and is therefore suitable for use in all patients with chronic renal failure. Further prospective and interventional studies are now required to assess whether AIx and TR are important prognostic indices of cardiovascular events, and therefore relevant surrogate indices of arterial stiffness in this susceptible population.     

Safety and immunogenicity of the COVID-19 vaccine BNT162b2 in patients undergoing chemotherapy for solid cancer

BackgroundAlthough COVID-19 severity in cancer patients is high, the safety and immunogenicity of the BNT162b2 mRNA COVID-19 vaccine in patients undergoing chemotherapy for solid cancers in Japan have not been reported.MethodsWe investigated the safety and immunogenicity of BNT162b2 in 41 patients undergoing chemotherapy for solid cancers and in healthy volunteers who received 2 doses of BNT162b2. We evaluated serum IgG antibody titers for S1 protein by ELISA at pre-vaccination, prior to the second dose and 14 days after the second vaccination in 24 cancer patients undergoing cytotoxic chemotherapy (CC group), 17 cancer patients undergoing immune checkpoint inhibitor therapy (ICI group) and 12 age-matched healthy volunteers (HV group). Additionally, inflammatory cytokine levels were compared between the HV and ICI groups at pre and the next day of each vaccination.ResultsAnti-S1 antibody levels were significantly lower in the ICI and CC groups than in the HV group after the second dose (median optimal density: 0.241 [0.063–1.205] and 0.161 [0.07–0.857] vs 0.644 [0.259–1.498], p = 0.0024 and p < 0.0001, respectively). Adverse effect profile did not differ among the three groups, and no serious adverse event occurred. There were no differences in vaccine-induced inflammatory cytokines between the HV and ICI groups.ConclusionAlthough there were no significant differences in adverse events in three groups, antibody titers were significantly lower in the ICI and CC groups than in the HV group. Further protection strategies should be considered in cancer patients undergoing CC or ICI.     

Potential of chemotherapy–herb interactions in adult cancer patients

Goals of work The purpose of this study was to examine the specific herbs or vitamins (HV) used by patients receiving chemotherapy. Specifically, the following aspects were investigated: (1) HV use among adult cancer patients receiving chemotherapy, (2) the frequency of potential chemotherapy–HV interactions, (3) communication patterns between oncologists and their cancer patients taking HV, and (4) patients reactions to two hypothetical scenarios of chemotherapy–HV interactions.Patients and methods Adult cancer patients receiving chemotherapy at a university-based outpatient clinic over a 1-month period were sent a validated eight-page questionnaire regarding the use of complementary/alternative medicine, focusing on HV use. A total of 76 patients participated; relevant medical information was obtained from study participants charts. The chemotherapy received was compared with HV use to assess for potentially detrimental chemotherapy–HV interactions.Results HV use in patients receiving chemotherapy was common (78%), with 27% of the study participants being at risk of a detrimental chemotherapy–HV interaction. Most patients (>85%) would discontinue their HV or ask their medical oncologist for advice if a detrimental chemotherapy–HV interaction was suspected. Although most patients discussed HV use with their oncologist, the majority also relied on their friends and naturopathic physician for information regarding HV.Conclusions Considerable potential exists for detrimental chemotherapy–HV interactions. Methods to improve communication of HV use between cancer patients receiving chemotherapy and health-care practitioners are necessary to identify and minimize the risk of these interactions.This work was supported by University of Washington Undergraduate Research Training and University of Washington School of Pharmacy.     

正常人右胸头胸导联心电图特征

目的评价一种新的右胸导联心电图：头胸（ＨＣ）导联心电图的应用价值。方法对６４例正常人描记同时间、同部位的Ｗｉｌｓｏｎ导联（Ｖ３Ｒ～Ｖ７Ｒ）和ＨＣ导联（Ｈｖ３Ｒ～Ｈｖ７Ｒ）图形。结果两种导联方法心电图均无ＳＴ段抬高；ＨＶ５Ｒ～ＨＶ７Ｒ直立Ｐ波多于Ｖ５Ｒ～ｖ７Ｒ（Ｐ均（０．０５）；病理Ｑ波（Ｑ≥１／４Ｒ，ｔ＞０．０４秒）或Ｑｒ型波在Ｖ４Ｒ为６％，Ｖ５Ｒ为５６％，Ｖ６Ｒ为６２％，Ｖ７Ｒ为６５％，Ｔ波直立者仅１２％，然而ＨＣ导联均为Ｒ型或石型，Ｔ波直立者达８８％。Ｑ波出现率在Ｖ５Ｒ和ＨＶ５Ｒ、Ｖ６Ｒ和ＨＶ６Ｒ、Ｖ７Ｒ和ＨＶ７Ｒ间呈显著差异（Ｐ均＜０．００１），直立Ｔ波出现率在Ｖ３Ｒ～Ｖ７Ｒ和ＨＶ３Ｒ～ＨＶ７Ｒ间亦有明显差异（Ｐ波＜０．０１）。根据图形特征，ＨＣ导联右胸图形可分为３型：（１）ＨＶ３Ｒ～ＨＶ７Ｒ呈Ｒ型伴Ｔ波直立者占５５％；（２）ＨＶ３Ｒ～ＨＶ５Ｒ为ｒＳ型，ＨＶ６Ｒ和ＨＶ７ＲＲ型伴Ｔ彼直立者占３３％；（３）ＨＶ３Ｒ～ＨＶ７Ｒ均呈ｒＳ型伴Ｔ波平坦者占１２％。结论由于ＨＣ导联右胸心电图在健康人群中表现为正常的Ｐ－ＱＲＳ－Ｔ波群，故有益于右室疾病的诊断。     

Co-activation differences in lower limb muscles between asymptomatic controls and those with varying degrees of knee osteoarthritis during walking

Background

Increased muscle co-activation during gait has been identified as a neuromuscular alteration associated with knee osteoarthritis, however levels of co-activation among different osteoarthritis severity have not been established. The purpose of this study was to determine if differences in co-activation could be detected among asymptomatic controls, those with moderate and those with severe osteoarthritis using a co-activation index and a pattern recognition technique.

Methods

Surface electromyograms from vastus lateralis and medialis, lateral and medial hamstring and gastrocnemius pairs were recorded from 63 asymptomatic, 59 moderate and 48 severe osteoarthritic subjects during self-selected walking. A co-activation index was calculated over the initial stance for four medial and lateral muscle pairs. The four co-activation indices were tested among groups using a one factor ANOVA (α = 0.05). Gait waveform pattern recognition procedures were applied to yield a principal pattern, scored for each muscle site and subject. A mixed model ANOVA (group-muscle) tested for principal pattern score differences.

Findings

A significant group effect was found (P < 0.05) for all four co-activation indices. Principal pattern one captured the amplitude and general shape of activity throughout the entire stance phase. ANOVA revealed a significant (P < 0.05) group by muscle interaction for the principal pattern scores. Significant differences were found among all three groups and between the two osteoarthritic groups for both measures.

Interpretation

The co-activation indices and principal patterns identified that lateral site differences occurred among all three groups with medial site differences between the two osteoarthritic groups. These findings suggest that measures of muscle co-activity provide additional information related to knee osteoarthritis severity.