直接检测并发丙型肝炎病毒感染的肾移植患者肝组织内丙型肝炎病毒RNA

我们对１例肾移植后９年１０个月并发丙型肝炎的患者直接测定肝组织内丙型肝炎病毒ＲＮＡ，早期明确了诊断，现报告如下。一、临床资料１．病史介绍：患者为男性，４２岁。于１９８５年１２月２９日因高血压性肾病、尿毒症在外院行同种异体肾移植术，术后移植肾功能恢复良...     

透析患者的血脂检测分析

测定３０例血液透析患者和１１例腹膜透析患者的血脂，并测定其中１１例ＨＤ患者的高密度脂蛋白亚组、脂蛋白及卵磷脂碍固醇酰基转移酶。结果透析组中仅低密度脂蛋白非常显著地升高，ＨＤＬ和载脂蛋白非常显著的下降。     

糖尿病患者血脂检测结果分析

目的:探讨糖尿病患者的血脂变化.方法:采用全自动生化分析仪测定80例糖尿病患者及148例健康体检合格者的血脂水平.结果:糖尿病患者均可引起血脂异常,但以2-糖尿病患者血脂增高更为显著.结论:糖尿病患者除了控制血糖水平外,应同时预防和控制血脂水平.     

维吾尔族和汉族丙型肝炎患者T淋巴细胞亚群对比分析

目的：探讨分析维吾尔族和汉族丙型肝炎患者外周血中T淋巴细胞亚群的表达及意义。方法对247例丙型肝炎患者外周血采用酶联免疫吸附法检测抗-HCV、荧光定量聚合酶链反应法检测丙型肝炎RNA和流式细胞仪法对T淋巴细胞亚群进行分析。结果维吾尔族丙型肝炎患者CD4＋T（31.23±17.16）%和CD4＋/CD8＋（0.65±0.37）%均低于汉族患者（41.25±16.13）%和（0.92±0.38）%,维吾尔族丙型肝炎患者CD8＋ T（60.25±26.36）%高于汉族患者（52.91±22.59）%,差异均有统计学意义（t =4.65、5.52、2.30,P =0.00、0.00、0.02）,但两民族患者间抗-HCV阳性率差异无统计学意义（χ2=2.57,P =0.11）。结论维吾尔族丙型肝炎患者与汉族患者免疫功能不同,CD4＋T淋巴细胞免疫功能降低,可能是HCV持续感染和免疫耐受的重要原因之一。HCV持续感染患者的T淋巴细胞亚群的变化,加重了丙型肝炎的慢性化,临床应加以重视。     

50例慢性肾衰竭患者血脂及载脂蛋白检测结果分析

为研究慢性肾衰竭(CRF)患者脂质代谢紊乱特点,我们对50例CRF患者血脂和载脂蛋白水平进行了检测,现报道如下. 资料与方法 1 研究对象实验组50例,经临床确诊为CRF,血清肌酐浓度均＞450 μmol/L,血清尿素氮浓度均＞10.5 mmol/L.男28例,女22例;年龄20岁～68岁,平均(47.2±12.2)岁.对照组50例均为健康者,男30例,女20例;年龄23岁～64岁,平均(48.2±11.2)岁.所有受试者均抽清晨空腹静脉血,抽血前48 h无高脂饮食. 2 检验方法总胆固醇(TC)、甘油三酯(TG)均用酶法,高密度脂蛋白胆固醇(HDL-c)、低密度脂蛋白胆固醇(LDL-c)为直接测定法,四种试剂为北京中生公司提供,载脂蛋白AI(Apo-AI)、载脂蛋白B(Apo-B)采用免疫透射比浊法.两种试剂为北京九强公司提供. 3 统计学方法实验数据以(±s)表示,计量资料比较采用t检验.     

120例糖尿病患者血脂血糖的监测与分析

目的 监测并分析糖尿病患者血脂血糖水平与健康人群的差异.方法 选择120例糖尿病患者进行血脂血糖监测,与同期进行健康体检的120名体检者的资料进行对比分析.结果 对照组中高脂血症发生率为20.83%,糖尿病组中高脂血症发生率为51.67%.结论 糖尿病患者群体中的高脂血症发生率显著高于健康人群.     

高效抗逆转录病毒治疗HIV/AIDS患者血脂水平与饮食习惯及血脂知识的研究

目的了解高效抗逆转录病毒治疗(HAART)的HIV/AIDS患者血脂水平与其饮食习惯及血脂知识情况,为制定针对性护理措施提供参考。方法对306例门诊HIV/AIDS患者采用自行设计的一般资料、饮食习惯及血脂知识调查表进行调查。结果 HAART治疗HIV/AIDS患者血脂异常发生率为40.52%;不同饮食习惯患者血脂异常发生率差异有统计学意义(均P0.01);血脂知识与总胆固醇、三酰甘油、低密度脂蛋白呈负相关(均P0.05)。结论 HAART治疗HIV/AIDS血脂异常发生率较高,与其饮食习惯及血脂知识有一定的关系。护理人员应提供针对性的健康指导,倡导健康的饮食习惯,提高其血脂知识,从而改善患者的血脂水平。     

血液透析患者低密度脂蛋白受体相关蛋白基因多态性与血脂水平检测

目的 探讨血液透析患者脂代谢紊乱的临床特征及低密度脂蛋白受体相关蛋白(LRP)基因多态性对脂代谢的影响。方法 生化方法检测血液透析血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDLC)、载脂蛋白(Apo)A1、ApoB、ApoE及脂蛋白(Lp)(a)水平，多聚合酶链反应-限制性片断长度(PCR-RFLP)方法检测LRP5′端四核苷酸重复序列及外显子3 RsaⅠ位点基因多态性。结果 血液透析患者脂代谢紊乱主要表现为血清TG水平显著增高，高于正常者33．0％，HDLC水平显著降低，低于正常者10．4％。偏相关回归分析显示，TG水平与血清ALB水平、透析时体外循环血流量显著相关；HDLC与KT／V显著相关。血液透析患者高血压的发生率为73．6％，心血管疾病发生率为25．0％。伴心血管疾病组TG水平显著高于无心血管疾病组，伴高血压组与无高血压组血脂水平无显著差异。LRP基因多态性分析显示，LRP 5′端基因型91／91、91／187与等位基因91bp频率较高，LRP外显子3基因型C/C与等位基因C发生频率较高，病例组与对照组间无显著差异。病例组LRP5′端四核苷酸重复序列与外显子3 RsaⅠ位点不同基因型间血脂水平无显著差异。结论 血液透析患者脂代谢紊乱主要表现为血清TG、ApoB水平显著增高，HDLC等指标显著降低。伴心血管并发症的患者TG水平明显高于无并发症的患者。TG水平与血清ALB水平、透析时体外循环血流量显著相关；HDLC与KT／V显著相关。LRP5′端四核苷酸重复序列与外显子3 RsaⅠ位点基因多态性，对血液透析患者血脂水平无显著影响。     

脑梗死患者血清雌激素水平与血脂、梗死面积的相关分析

目的：观察脑梗死（CI）患者急性期血清雌激素水平的变化与血清脂质、CT面积之间的相关性。方法：采用时间分辨荧光免疫法测定老年急性 CI207例及正常老人对照组89例的性激素水平。结果：急性CI组男性及女性的血清雌二醇（E2）、甘油三酯（TG）、低密度脂蛋白（LDL）水平均比正常老年对照组明显增高（P＜0．05）。女性CI组的高密度脂蛋白（HDL）水平较正常老年对照组明显降低（P＜0．05），同时在多灶型CI中，血清E2与HDL呈正相关，与TG、LDL、梗死面积呈负相关，单灶型CI的面积与血清胆固醇水平相关（P＜0．01）。结论：CI患者性激素E2的升高不仅是一种应激反应，而且可能通过影响血脂代谢的机制，缩小梗死的面积，血脂代谢与CI的梗死类型相关。     

徐州地区丙型肝炎病毒基因分型研究

目的：了解徐州地区丙型肝炎病毒（HCV）的基因型构成状况,分析HCV不同基因型感染患者之间肝功能以及病毒载量是否存在差异。方法对116例抗-HCV及HCV RNA阳性的患者,采用实时荧光PCR产物测序法检测HCV基因分型;同时检测血清肝功能的丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）和总胆红素（TBil）,采用荧光定量PCR方法检测血清HCV RNA水平。结果116例患者共检测出8种基因型,主要为1型63例（54.31%）,其中1a型1例,1b型61例,1c型1例;2型48例（41.38%）,其中2a型40例,2i型8例;3型（3a）1例（0.86%）;6型4例（3.45%）,6a型1例,6h型3例。1型、2型和6型患者之间的肝功能以及病毒载量,显示各型之间差异无统计学意义（P均＞0.05）。结论徐州地区HCV感染以基因1、2型为主,也存在一定数量的6型和3型;不同基因型HCV感染者肝功能及病毒载量差异无统计学意义。     

Travel-associated acquisition of hepatitis C virus infection in patients receiving haemodialysis.

BACKGROUND: It has been proposed that hepatitis C virus (HCV)-infected patients with end-stage renal disease undergoing maintenance haemodialysis may lack HCV antibody (anti-HCV) despite chronic HCV viraemia. This carries important implications for the design of surveillance policies. METHODS: To characterize the prevalence of antibody-negative/RNA-positive HCV infection, patients attending seven haemodialysis units underwent anti-HCV testing using a third-generation assay and HCV RNA testing using real-time PCR. RESULTS: At screening, anti-HCV prevalence was 12/360 (3.3%; 95% CI 1.7-5.8%); 7/12 (58.3%) anti-HCV positive samples were HCV RNA positive. Among anti-HCV-negative samples, 2/348 (0.6%; 95% CI 0.2-2.1%) tested HCV RNA positive (genotype 1a). Retrospective testing of stored sera dated the infections to a period of holiday in the Indian subcontinent. The two infections were unrelated by HCV-NS5B sequencing. Only one of the two newly infected persons showed raised transaminases. Both developed anti-HCV within 8-13 weeks of follow-up. Prospective surveillance of travellers to resource-limited countries returning to the units showed a HCV incidence of 4/153 travel episodes (2.6%; 95% CI 0.7-6.6%) among 131 persons (3.1%; 95% CI 0.8-7.6%). CONCLUSIONS: Among haemodialysis patients in the United Kingdom, antibody-negative/RNA-positive HCV status is associated with newly acquired infection, rather than lack of antibody responses in chronic HCV infection. There is a significant risk of HCV infection associated with travel to resource-limited countries. Given that transaminase levels may be normal, HCV RNA testing is recommended in patients re-entering a dialysis unit following haemodialysis in settings where suboptimal infection control policies pose a risk of exposure to blood-borne viruses.     

Prevention of hepatitis C infection in haemodialysis units. A prospective study

A prospective study was begun in our haemodialysis unit afterfour previously negative patients were found to be anti-HCVpositive. A dedicated area and dedicated dialysis equipment(but not a separate room) were assigned to anti-HCV-positivepatients and testing for HCV antibodies was performed every3 months. A total of 131 patients were treated during the studyperiod of 18 months. Of these, 50 patients were dialysed duringthe entire 18 months, and 21 were available to be tested sixor more months after having left the centre. During the first6 weeks after implementing the precautions two more anti-HCV-positivepatients were detected. However, during the rest of the studyperiod no further newly infected patients were found. It isconcluded that the spread of HCV infection in a haemodialysisenvironment can be prevented by limited isolation procedures.     

丙肝病毒基因在肝门部胆管癌组织中的表达及其意义

目的 探讨丙肝病毒核糖核酸（ＨＣＶ ＲＮＡ）及蛋白在肝门部胆管癌组织中的表达及其生物学意义。方法 应用套式逆转录、多聚酶链反应（ｎｅｓｔｅｄ ＲＴ－ＰＣＲ）和免疫组织化学技术检测３６例肝门部胆管癌患者癌组织和癌旁组织中ＨＣＶ ＲＮＡ、非结构蛋白（ＮＳＳ）蛋白水平的表达。结果 ３６例肝门部这癌患者癌组织和癌旁组织中ＨＣＶ ＲＮＡ和ＮＳ５蛋白阳性表达率为８３．３％（３０／３６）４７．２％（１７／３６）     

Sperm ultrastructure and meiotic segregation in a group of patients with chronic hepatitis B and C

Little is known about the effect of chronic hepatitis B and hepatitis C on sperm quality. In this study, we analysed sperm quality from selected patients with chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections. Semen samples were examined by light and transmission electron microscopy (TEM). TEM data were elaborated with a mathematical formula able to indicate a fertility index and the presence of the three main sperm pathologies: apoptosis, immaturity and necrosis. Meiotic chromosome segregation was investigated by fluorescence in situ hybridisation carried out on sperm nuclei, using probes for chromosomes 18, X and Y. Despite normal sperm concentration, we observed reduced motility. TEM analysis highlighted that 35.7% of patients showed generally good semen quality. However, significantly higher values of apoptosis and necrosis, compared with controls, were observed, demonstrating spermatogenetic alterations. Regarding meiotic segregation, we found an incidence of disomies similar to that observed in control samples, whereas diploidy resulted higher in HCV patients, without reaching statistical significance. In conclusion, sperm quality in the studied group was not impaired; however, apoptosis and necrosis resulted out of normal range and the fertility index was significantly lower in HCV- and HBV-infected patients versus controls.     

Prevalence of antibodies to hepatitis C in dialysis patients and transplant recipients with possible routes of transmission.

The prevalence of hepatitis C infection and possible predisposing factors was assessed in a renal unit. Of 343 patients at our renal dialysis centre, 37 (10.8%) were anti-HCV positive by a 1st-generation assay (ELISA, Ortho/Chiron) and confirmed positive in 35 (10.2%) with a 2nd-generation test (UBI, New York). Anti-HCV positivity was significantly associated with: duration of renal replacement therapy (P < 0.0001); quantity of blood transfused (P < 0.002); duration of hospital haemodialysis (P = 0.0001); duration with a functional renal transplant (P = 0.039); and aspartate aminotransferase (P < 0.0001). Logistic regression determined the following variables to be independent risk factors: duration of renal replacement therapy with a relative risk of 34.3 for 5-9 years and 87.4 when the duration was in excess of 10 years; renal transplant for less than 1 year (relative risk of 5.0); transfusion in excess of 50 units of blood (relative risk of 11.6). Clinical assessment of anti-HCV-positive patients revealed peripheral signs of chronic liver disease in 40%, hepatomegaly in 34%, and splenomegaly in 9%. This prevalence of hepatitis C infection is similar to other European and North American centres, but contrasts with low prevalence rates reported from dialysis populations in the UK. It adds further support for routine screening of blood and possibly organ donors and implementation of further infection control measures in dialysis centres.     

Detection and differentiation of lactate and lipids by single-voxel proton MR spectroscopy

The signals of lactate and lipids partially overlap in single-voxel proton MR spectroscopy (¹HMRS), sometimes making them difficult to differentiate in clinical settings. Our aim in this study was to identify lactate and lipids by varying the echo time (TE). We expect that the accurate detection of lactate and lipids will have high diagnostic value in the diagnosis of brain tumors. Following our protocol, we obtained meaningful ¹HMRS spectra from 213 patients, including 163 patients with brain tumors, between August 1999 and February 2004. ¹HMRS was performed with a TE of 144 ms followed by a TE of 30 ms and/or a TE of 288 ms, if necessary. For the 213 patients, lactate level was negative in 47 patients, positive in 131 patients, and strongly positive in 35 patients. The lipid level was negative in 90 patients, positive in 56 patients, and strongly positive in 67 patients. Based on logistic discriminant analyses of neuro-epithelial tumor WHO grade and lactate and lipid levels, lactate and lipid levels were significant between WHO grades 2 and 3 (P=0.0239) and between grades 3 and 4 (P=0.0347). Lipids are a more significant factor for the discrimination between WHO grades 2 and 3 (P=0.0073) and between grades 3 and 4 (P=0.0048). With our method of varying the TE, it is possible accurately and efficiently to detect lactate and lipids in the brain. We found a significant correlation between lactate and lipid expression and WHO grade of neuro-epithelial tumors.These data were presented at the 22nd Annual Meeting of the Japan Society for Neuro-Oncology, 17–19 October 2004 in Miyagi, Japan.     

Liver transplantation and hepatitis C

End-stage liver disease caused by chronic hepatitis C viral infection is one of the major indications for liver transplantation. However, evidence for ongoing viral replication can already be found days after surgery and may lead sequentially to lobular hepatitis, chronic active hepatitis, fibrosis and liver cirrhosis. In some patients, this evolution is remarkably fast, most probably enhanced by the immunosuppressive therapy. A minority of patients develop a clinical picture of progressive cholestatic liver disease with histological signs of chronic rejection, which may necessitate retransplantation. While the 1- and 5-year survival rates for all patients transplanted because of hepatitis C virus (HCV)-induced liver cirrhosis are satisfactory, severe complications of disease recurrence are nonetheless expected during the first and second decade after liver transplantation. Larger and preferably randomized studies are needed to investigate whether combination therapy with interferon and ribavirin, preferably initiated as soon as possible after liver transplantation, prevents the fast evolution to cirrhosis without the appearance of chronic rejection and the expected complications of recurrent end-stage HCV-induced liver disease. The final goal should be the inhibition of viral replication even before liver transplantation, but other antiviral strategies should probably be used to attain this goal in patients with decompensated cirrhosis. Although the recurrence of a hepatitis C infection and concomitant disease in the liver graft may cause substantial morbidity, end-stage liver disease and liver failure caused by a chronic hepatitis C infection remain good indications for liver transplantation.     

Genotype distribution and transmission of hepatitis C virus (HCV) in French haemodialysed patients

BACKGROUND: HCV genotyping was performed to identify the source of HCV infectionin haemodialysed patients. METHODS: Specimens from 48 HCV-infected patients treated in the samedialysis unit were genotyped by line probe assay (LiPA). RESULTS: Thirty-seven patients (77 %) were infected by genotype lb. Onlyfour of the 48 patients were never transfused and three of themhad genotype lb. In two of the three genotype lb-infected patients,seroconver-sion was observed during the follow-up, suggestinga nosocomial HCV infection. Ten of the 44 transfused patientswere infected with genotypes other than lb. Blood products werevery probably the source of infection in these patients. The34 other patients (77.3%) were infected with genotype lb andretrospective analysis failed to identify nosocomial and transfusionalorigin. Eight of the 11 patients with genotypes different from lb werefound in the 16 patients who were more than 55 years old. Onlythree of the eight originated from France. CONCLUSIONS: Blood transfusions and nosocomial infections were the main causesof HCV transmission in haemodialysed patients. Both screeningof blood donors and aseptic measures in haemodialysis unitsmay prevent HCV transmission.