急性散发性非甲非乙型肝炎的研究

急性非甲非乙型肝炎在国外占散发性病毒性肝炎的11～47%左右国内只有少数报告。我组总结了营口、沈阳、抚顺市传染病院收治的156例急性病毒性肝炎(以黄疸型肝炎为主),观察非甲非乙型肝炎(散发)的发病频度情况。     

在住院病人中,非甲非乙型肝炎和甲型、乙型肝炎相比较的发病数

为了确立甲型、乙型肝炎和非甲非乙型肝炎的相对发病率,在一所综合成人医院里,检查了9年以来所贮存的全部急性病毒性肝炎病例的血标本,用现在能提供的血清学方法加以分类。本研究包括了447名病例中的456次肝炎发作,结果分布如下:甲型肝炎114例(25％),乙型肝炎282例(62％),非甲非乙型肝炎60例(13％)。非甲非乙型肝炎在性别分布     

儿童病毒性肝炎PHSA受体、DNA聚合酶、抗HBc-IgM和抗HAV-IgM的临床研究

本文应用ELISA法测定了41例儿童病毒性肝炎患儿血清的PHSA受体、抗HBc-IgM和抗HBV-IgM,并用RIA法测其DNA聚合酶(DNA-P)的活性。按病原分型在32例急性黄疸肝炎中有6例为甲肝(18.7%),10例为乙肝(31.3%),10例为甲乙型肝炎混合感染(31.3%),6例为非甲非乙型肝炎(18.7%);5例急性无黄疸型肝炎中判为乙肝3例,非甲非乙型肝炎2例;4例慢性迁延型肝炎全系乙型肝炎。发现PHSA受体,DNA-P和抗HBc-IgM的检测对乙型病毒性肝炎近期感染的诊断,具有特异性和敏感性。     

53例急性病毒性肝炎血清学分型调查

本文报道医院收治的53例急性病毒性肝炎患者血清学分型调查,各型肝炎分布因年龄而异。本调查表明在17岁以下患者中,甲型肝炎占88.46％,乙型占23.08％,非甲非乙型肝炎占7.69％;而18～55岁成年人患者中,甲型占37.04％,乙型占62.96％,非甲非乙型占22.22％,说明甲型是儿童青少年所患肝炎的主要型别,乙肝多见于成人;甲、乙型混合感染、重叠感染及非甲非乙型肝炎在青少年与成人两组中亦分别占一定比例。     

急性起病的非甲非乙型病毒性肝炎的病原分析

对HBsAg(一)、IgM抗HAV(一)临床诊断为急性非甲非乙肝炎63例,进行了病原学鉴定。以聚合酶链反应(PCR)检测HBV DNA,HCV RNA,并检测了IgM抗HBc和抗HCV血清抗体。诊断为急性丙型肝炎15例(23.8％),急性乙型肝炎20例(31.7％),慢性HBV携带者急性活动19例(30.2％),乙、丙型混合肝炎2例(3.2％),病原不明7例(11.1％)。结果表明在临床所谓的急性非甲非乙肝炎中,急性和慢性乙型肝炎仍占多数。     

新西兰某市团体中散发的急性非甲非乙型肝炎

散发的急性非甲非乙型肝炎,第一次在新西兰报告。94名病人血清的肝炎生物化学检验证明,患急性乙型肝炎(HB)有26名(27％),患急性甲型肝炎(HA)22名(23％),患急性非甲非乙型肝炎(NANBH)25名(26％)。9名(10％)是伴有EB病毒(爱泼斯坦—贝尔病毒)的肝炎,1名(1％)是巨细胞病毒(CMV)肝炎。11名病人有混合感染:其     

人群中病毒性肝炎的型别研究

作者于1987年2月16日～1988年2月15日在四川五个点211 639人群中监测急性病毒性肝炎。其发病率为167.74/10万,其中甲型肝炎占24.51％;乙型肝炎占38.31％;非甲非乙型肝炎占24.51％,EB病毒和巨细胞病毒所致肝炎各占3.38％;混合感染占5.92％。病毒性肝炎中有14.93％重叠感染。发病高峰在春季。发病率,男:女=1.75:1。甲型肝炎20岁以下年龄组、乙型肝炎20～39岁年龄组的发病率明显高于其他年龄组,非甲非乙型较分散,5～19岁相对多一些,其他型别年龄组间无明显差异。355例急性病毒性肝炎患者中43.9％有接触史,36.6％有注射史。     

非甲非乙型肝炎病原的电子显微镜观察(初报)

非甲非乙型肝炎的存在虽已明确,然其病原的形态至今尚未肯定。本文初步报告我们应用电镜对非甲非乙型肝炎病原的研究。 原材料为超离心制备的非甲非乙型肝炎病人和非甲非乙型肝炎献血员的血清,以及个别死于急性非甲非乙型肝炎尸体的肝组织匀浆和肝超薄切片。 共观察33例标本,发现类似乙型肝炎Dane颗粒和表面抗原颗粒12份,其中3例献血员与输血后肝炎病人的血清出现免疫沉淀线;88～143nm的多形性类疱疹病毒颗粒3份;57nm明确的20面体病毒颗粒1份。     

非甲-戊型病毒性肝炎和乙、丙型肝炎病毒重叠感染相关性再障临床分析

目的了解非甲-戊型病毒性肝炎和乙、丙型肝炎病毒重叠感染与再生障碍性贫血的关系及其临床特点。方法根据有关诊断标准，对非甲-戊型病毒性肝炎和乙、丙型肝炎病毒重叠感染相关性再障患者从临床症状、血常规、肝功能及病毒学检测等多方面进行比较。结果36例肝炎相关性再障患者中非甲-戊型病毒性肝炎相关性再障10例(占28％)，乙、丙型肝炎病毒重叠感染相关性再障3例(占8％)。从感染肝炎病毒到发生再障的间隔时间为40～150d，这两种再障均为急性肝炎相关性再障，生存期5～64d。结论非甲-戊型病毒性肝炎和乙、丙型肝炎病毒重叠感染与再生障碍性贫血的发生密切相关。     

非甲非乙型肝炎

非甲非乙型肝炎属于病毒性肝炎之一,已被发现多年,并经临床、流行病学和动物实验所证实。国外对它的研究已取得了一定的进展,据报导在一些发达的国家里,百分之九十左右的输血后肝炎是由非甲非乙型肝炎的病原体所引起,而且发展成慢性肝炎的可能性大于乙型肝炎。非甲非乙型肝炎病毒携带者为乙型肝炎病毒携带者的3～5倍。从诊断学看,尚未发现有比较特异的诊断方法,只能从排除甲型肝炎病毒、乙型肝炎病毒、EB病毒和巨细胞病毒的基础上加以诊断。目前,我国已把病毒性肝炎列为国家攻关项目之一,非甲非乙型肝炎的研究已经提到重要议事日程上来了。为了对当前非甲非乙型肝炎的研究有个简要而概括的了解,现就有关问题综述如下。     

献血员和非甲非乙型肝炎病人的抗—HCV

用抗-HCV EIA法检测献血员和非甲非乙型肝炎病人的抗-HCV。ALT异常献血员抗-HCV阳性率(37.5%)明显高于ALT正常献血员(2.9%),抗-HCV与ALT异常密切相关,提示用ALT加上抗-HCV筛选献血员将大大减少输血后NANBH的危险性。HCV是输血后和慢性NANBH的主要原因,是散发性NANBH的重要原因。抗-HCV检出率随着病程的延长而升高,但抗-HCV出现时间较迟。     

351例各类肝病患者血清抗—HCV的调查

应用固相酶联免疫洲定方法(ELISA),检测351例不同类型肝病患者血清丙型肝炎病毒抗体(抗-HCV)。输血后非甲非乙型肝炎(NANBH)、散发性NANBH和非乙型肝硬化抗-HCV阳性率分别为86%、34.9%和76.2%;28例急性甲肝均阴性;乙肝患者为23.3%;原发性肝癌为16.0%。有输血史乙肝患者抗-HCV阳性率高于无输血史者。提示除甲肝外,各类肝病患者均为HCV高危人群。输血液制品是乙肝合并丙肝的主要原因。     

成人病毒性肝炎患者柯萨奇病毒感染研究

目的 :探讨成人病毒性肝炎患者中柯萨奇病毒B组 (CoxsackievirusB ,CVB)散发性感染状况。方法 :用ELISA法测定病毒性肝炎患者血清中抗CVB -IgM抗体 ,同时应用荧光定量PCR方法测定HBVDNA及HCVRNA含量。结果 :4 5 7例病毒性肝炎患者中抗CVB -IgM阳性 13例 ,其中CVB单独感染者 1例。CVB感染组与阴性对照组在临床表现、肝功能试验、HBVDNA含量等方面相比无明显差异。结论 :病毒性肝炎患者中CVB感染率为 2 .84 % ,其肝炎病原学意义有待进一步研究     

艾滋病合并乙、丙型病毒性肝炎96例分析

目的探讨艾滋病病毒重叠乙型肝炎病毒和或丙型肝炎病毒感染相互之间对疾病的进程的影响。方法对96例艾滋病合并乙、丙型病毒性肝炎的临床及实验室检查资料进行回顾性分析。结果96例艾滋病合并病毒性肝炎中，乙型病毒性肝炎17（17．7％）倒，丙型病毒性肝炎76（79．16％）例，乙肝重叠丙肝3（3．12％）例，均为静脉共用针头吸毒患者。96例艾滋病合并乙、丙型病毒性肝炎中，大部分为轻度或肝功能正常患者，肝硬化发生率低。从有性接触或静脉共用针头吸毒开始到发病住院时间均超过6年以上。结论艾滋病患者中，乙型肝炎病毒感染远低于丙型肝炎病毒，与丙型肝炎易慢性化有关；当人体同时感染了艾滋病病毒、乙型肝炎病毒、丙型肝炎病毒后，相互之间对疾病的进程无明显影响。     

延边地区庚型肝炎病毒感染的调查研究

[目的]探讨庚型肝炎病毒在延边地区不同人群中的感染状况。[方法]将278名肝脏疾病患，123名职业献血员以及93名健康人共494人为研究对象，采用酶联免疫吸附测定法检测庚型肝炎病毒。[结果]494例研究对象的庚型肝炎病毒感染率为6.48%(32/494)。存在性别，年龄别及民族别差异，一般人群庚型肝炎病毒感染率为2.15%(2/93)。肝脏疾病患感染率中慢性乙型重症肝炎患的感染率为13.36%(4/30)。为最高，献血员庚型肝炎病毒感染率为7.31%(9/123)。     

人类非嗜肝病毒所致肝炎患者临床特征的相关性分析

目的  探讨人类非嗜肝病毒所致肝炎的病因和临床特征。方法  对176例人类非嗜肝病毒性肝炎患者进行临床研究,用常规方法检测112例甲-戊型肝炎标志物,排除嗜肝病毒感染。检测单纯疱疹病毒（HSV）、EB病毒（EBV）、巨细胞病毒（CMV）、柯萨奇病毒（CoxV）等病毒的IgM、IgG型抗体和自身抗体（线粒体抗体和抗核抗体）,随访6个月,并将其临床症状体征、肝功能指标与同期急性病毒性肝炎比较。结果  非嗜肝病毒肝炎患者病原体以CMV感染最多（34.7%）,其次分别为EB病毒和轮状病毒感染（24.4%、9.6%）,非嗜肝病毒肝炎患者的乏力、纳差、厌油、恶心、肝肿大、皮肤黄染发生率较同期急性病毒性肝炎低,两者比较差异有统计学意义（P <0.01）,其脾肿大、淋巴结肿大的发生率较同期急性病毒性肝炎高,两者比较差异有统计学意义（P <0.01）;非嗜肝病毒肝炎患者肝功能的ALT、AST、TBIL值较同期的急性病毒性肝炎值低,两者比较差异有统计学意义（P <0.01）,清蛋白、凝血酶原时间值与急性病毒性肝炎比较,差异无统计学意义（P > 0.05）;非嗜肝病毒肝炎患者的单一感染的ALT、AST、TBIL较复合感染时间短,两者比较差异有统计学意义（P <0.01）。结论  巨细胞病毒、EB病毒等为非嗜肝病毒肝炎的常见病原体,临床表现为急性肝损伤,但较急性病毒性肝炎轻,单一感染较复合感染轻,预后较好。

     

干扰素阻断乙型肝炎病毒父婴传播临床研究

目的研究干扰素阻断父婴传播乙型肝炎病毒（HBV）的效果。方法选择2005年2月～2012年3月在惠州市第一人民医院及惠州市中心人民医院就诊的460例男性慢性HBV感染者及所生新生儿进行研究。研究组为230例接受干扰素治疗并停药的患者及半年后其与配偶自然受孕所生新生儿：对照组为230例不愿接受抗病毒治疗的患者与其配偶自然受孕所生新生儿。观察两组患者生育前HBV定量水平及两组所生新生儿HBV感染情况。结果HBV父婴传播高风险阈值为≥1．O×10^6 copies／mL。干扰素治疗后,父婴传播风险下降31．87％,而对于高病毒载量患者,父婴传播率无明显改变。结论HBV水平高者,其子代感染HBV可能性大;干扰素治疗后HBV垂直传播的风险明显下降。但对于过高病毒载量患者,干扰素疗效欠佳。     

Hepatitis C virus infection in different groups of children in Wuhan area

Summary To investigate the incidence of child’s HCV infection in our area, 637 children with different background, including 65 posttransfusion cases, 419 hepatitis patients (250 cases of acute hepatitis A, 156 cases of chronic hepatitis B and 13 cases of non-A, non-B hepatitis), 50 infantile hepatitis syndrome (1HS) infants and 103 healthy day-cared children were tested for serum anti-HCV antibody (EIA) and HCV RNA (nested PCR). It was found that posttransfusion children had significantly higher anti-HCV positive rate (30. 8%) and HCV infection incidence (43.1%) than hepatitis patients (4.3% and 5.3%), IHS infants (6.0% and 8.0%) and daycared children (2.9% and 2.9%). 25 of 33 cases with posttransfusion hepatitis (PTH) developed hepatitis C, which was the leading cause of PTH (75.8%) and NANB PTH (25/30, 83.3%). The incidence of HCV infection in NANBH patients was 23.1% (3/13) which was apparently higher than that in day-cared children (P <0. 02) and lower than that in PTH patients (P<0. 001), but not statistically different from that in AHA and CHB patients (P>0. 05). Mother-infant paired study in IHS group showed that 4 pairs of mother-infant had HCV infection, one boy aged 8 months and his mother were anti-HCV positive, and another 3 pairs possessed HCV RNA in sera. 3 of 103 healthy day-cared children were found to have inapparent HCV infection, who were anti-HCV and HCV RNA positive.     

Detection of hepatitis B virus DNA in mononuclear blood cells

The Southern transfer hybridisation technique was used to test mononuclear blood cells for hepatitis B virus DNA. Viral DNA sequences were detected in mononuclear cells of 10 out of 16 patients with hepatitis B virus infection and in none of 21 normal controls. Blood contamination was excluded by the absence of hepatitis B virus DNA in the corresponding serum samples in all cases. Free monomeric hepatitis B virus DNA was found in three patients positive for hepatitis Be antigen (HBeAg) and one positive for anti-HBe, and integrated hepatitis B virus DNA was present in four patients positive for anti-HBe. In two other patients the small size of the samples did not allow a distinction between free and integrated viral DNA. The state of the virus in the mononuclear cells seemed to correlate with the HBeAg or anti-HBe state, as has been noted in the liver. These results indicate that hepatitis B virus may infect mononuclear blood cells, thereby expanding the tissue specificity of this agent beyond the liver, as has been reported for pancreatic, kidney, and skin tissue. They also suggest that hepatitis B virus infection of mononuclear cells might be related to immunological abnormalities observed in carriers of the virus.     

An outbreak of hepatitis B associated with reusable subdermal electroencephalogram electrodes

BACKGROUND: In early 1996 an outbreak of hepatitis B was detected among patients who attended an electroencephalogram (EEG) clinic in Toronto operated by a neurologist. In this article we report the results of an investigation conducted to determine the extent and source of the outbreak. METHODS: Notifications were sent to 18 567 patients who had attended any of 6 EEG clinics operated by the neurologist between 1990 and 1996 asking them to see their physician to be tested for hepatitis B virus (HBV) infection; 2957 envelopes were returned. Of the remaining 15 610 patients, results of laboratory tests were available for 10 244 (65.6%). A detailed follow-up of patients with newly acquired hepatitis B and those with chronic infection (carriers) was conducted. Viral DNA sequencing was used to compare strains of available HBV isolates. RESULTS: A total of 75 patients were identified in whom hepatitis B developed between 1991 and 1996; all of them had had at least one EEG performed in which reusable subdermal electrodes had been used. No cases were detected among patients who participated only in sleep studies, for which disk electrodes had been used. The peak rate of HBV infection (18.2 cases per 1000 person-EEGs) occurred in 1995. One technician performed all of the EEGs at the clinics and was found to be positive for hepatitis B e antigen. DNA sequencing confirmed that the virus isolated from the technician was identical to the virus isolated in 4 cases of hepatitis B tested. Infection control procedures were found to be inadequate. INTERPRETATION: The hepatitis B outbreak was a result of a common source of infection, the technologist, and inadequate infection control practices. Reusable subdermal EEG electrodes were the likely vehicles of transmission. Health care workers should follow recommended infection control practices and be vaccinated against hepatitis B.