Chronic hepatitis B virus infection

Many factors are involved in the pathogenesis of chronic hepatitis B virus infection (HBV), such as, for example, characteristics of the virus, ethanol intake, coinfection with other viruses (HCV, HIV, HDV), and therapeutic interventions such as the use of cytotoxic drugs or immunosuppressors, or specific antiviral agents. The clinical, pathological and serological characteristics of chronic hepatitis B virus infection are besides very heterogeneous. Chronic HBV infection can be recognised facing persistence of the Australia antigen (HBsAg) for more than six months. The presence of HBeAg is usually associated with active viral replication and can be measured by the quantity of DNA-HBV present in the serum or by the hepatic expression of HBcAg. The hepatic damage that is produced in chronic hepatitis due to HBV is not so much due to the effect of the virus on the hepatocytes as to the immune reaction that it provokes in the host. For this reason a certain inversely proportionate correlation can be observed between the intensity of viral replication and the degree of hepatic inflammation. The presence of active chronic hepatitis in the initial biopsy has not been associated with the development of cirrhosis, nor does the histological diagnosis of persistent chronic hepatitis guarantee that cirrhosis will be developed in the future.     

母体孕期乙型肝炎病毒感染与早产关联队列研究

目的 研究母体乙型肝炎病毒(HBV)感染与早产的关联.方法 将2011年1月-2014年12月期间在安徽医科大学第一附属医院分娩的12 186对母亲-单胎配对资料纳入本次研究,回顾性分析母体孕期HBV感染与早产的关联.结果 该队列人群包括对照11 550例(94.78％),HBV感染乙肝e抗原阴性者[HBeAg(-)]...     

乙型肝炎病毒感染对健康影响的队列研究

目的:探讨乙型肝炎病毒(HBV)感染对健康的影响。方法:在原发性肝癌(HCC)高发区江苏省海门市建立前瞻性研究队列人群,对研究对象进行流行病学调查,采集外周静脉血检测HBsAg及其他相关指标,每年随访队列成员的生命状况及死因。以HBsAg作为HBV感染指标,比较HBsAg暴露和阴性组人群的死亡密度。并应用COX风险模型探讨HBV感染在原发性肝细胞癌(HCC)发生中的风险率比(HR)。结果:HBsAg暴露组人群的死亡密度为1482.35/10万人年,是对照组的3.42倍。HCC是研究组的首位死因,占全部死亡的52.28%,与对照组相比RR=15.63,AR=93.60%。男性HR=22.3,95%CI 18.7~26.6,女性HR=37.2,95%CI=19.1~72.5。结论:感染HBV对机体健康有明显影响。     

Neighbourhood environments and mortality in an elderly cohort: results from the cardiovascular health study

BACKGROUND: It has been postulated that neighbourhood conditions are related to the health of the elderly population but longitudinal studies are rare and confounding by individual level variables remains a possibility. METHODS: Data were obtained from the cardiovascular health study, a population based study of adults aged 65 years and older. Census block groups were used as proxies for neighbourhoods. A summary score was used to characterise the neighbourhood socioeconomic environment. Information on personal socioeconomic indicators, cardiovascular disease prevalence, and cardiovascular risk factors was obtained from the baseline examination. Proportional hazards regression and propensity score matching were used to control for individual level variables. RESULTS: Over the eight year follow up there were 1346 deaths among the 5074 participants, of which 43% were attributable to cardiovascular disease. Among white participants, living in the most disadvantaged neighbourhood group was associated with higher rates of cardiovascular death, after adjustment for income, education, and occupation (hazard ratio (HR) 1.5, 95% confidence intervals (CI) 1.2 to 1.9). No neighbourhood differences were observed for non-cardiovascular deaths. Estimates for black participants were 1.3 (95% CI 0.7 to 2.3) for cardiovascular deaths and 1.4 (95% CI 0.8 to 2.4) for non-cardiovascular deaths, but sample size was small. In white participants, associations of neighbourhood characteristics with cardiovascular mortality persisted after adjustment for prevalent baseline disease and cardiovascular risk factors. The use of propensity score matching led to similar results (HR for the lowest compared with the highest neighbourhood score group: 1.6 95% CI 1.1 to 2.5, controlling for personal socioeconomic indicators). CONCLUSION: Neighbourhood disadvantage is related to rates of cardiovascular death in elderly white adults.     

乙型肝炎病毒基因型与感染临床表型的相关性研究

目的 调查乙型肝炎病毒(HBV)基因型分布,并探讨其与感染临床表型的相关性.方法 采用PCR扩增后测序的方法,对150例乙型肝炎病毒感染者进行HBV基因型的分析,应用x2检验和t检验法分析HBV基因型与临床表型的相关性.结果 150例样本中,B基因型90例占60.0％,C基因型60例占40.0％,不同性别之间HBV基因型分布,差异无统计学意义;B基因型患者年龄(29.4±10.2)岁显著低于C基因型患者(35.1±11.5)岁(P＜0.05);肝硬化和肝细胞癌组C基因型的比例,分别为59.1％和60.0％,显著高于慢性乙型肝炎患者(32.0％)和HBV无症状携带者(30.0％)(P＜0.05);C基因型HBeAg阳性率(71.7％)显著高于B基因型(55.6％)(P＜0.05);C基因型患者血清的HBV-DNA含量(5.98±0.76)log值显著高于B基因型组(5.62±0.92)log值,差异有统计学意义(P＜0.05).结论 HBV基因型与临床病情密切相关,C基因型患者平均年龄、病毒水平、HBeAg阳性率显著高于B基因型,可能是导致C基因型患者更易发展为肝硬化和肝癌的原因.     

乙型肝炎病毒X基因变异与隐匿性感染的关系

隐匿性HBV感染指患者血清HBsAg阴性,而血清和(或)肝组织HBV DNA阳性,其发生机制仍未明了.目前,对HBV基因变异的研究大多集中在S基因,而X基因是病毒复制的重要调节区,是转录、反转录和正链合成的起点,此处变异可能会影响到病毒的转录和复制,但由于X基因结构和功能的复杂性,目前对其变异与隐匿性HBV感染的关系研究相对较少.此文就HBV X基因变异对隐匿性HBV感染的发生和影响进行综述.     

Traffic air pollution and mortality from cardiovascular disease and all causes: a Danish cohort study

ABSTRACT: BACKGROUND: Traffic air pollution has been linked to cardiovascular mortality, which might be due to co-exposure to road traffic noise. Further, personal and lifestyle characteristics might modify any association. METHODS: We followed up 52 061 participants in a Danish cohort for mortality in the nationwide Register of Causes of Death, from enrollment in 1993-1997 through 2009, and traced their residential addresses from 1971 onwards in the Central Population Registry. We used dispersion-modelled concentration of nitrogen dioxide (NO2) since 1971 as indicator of traffic air pollution and used Cox regression models to estimate mortality rate ratios (MRRs) with adjustment for potential confounders. RESULTS: Mean levels of NO2 at the residence since 1971 were significantly associated with mortality from cardiovascular disease (MRR, 1.26; 95% confidence interval [CI], 1.06-1.51, per doubling of NO2 concentration) and all causes (MRR, 1.13; 95% CI, 1.04-1.23, per doubling of NO2 concentration) after adjustment for potential confounders. For participants who ate < 200 g of fruit and vegetables per day, the MRR was 1.45 (95% CI, 1.13-1.87) for mortality from cardiovascular disease and 1.25 (95% CI, 1.11-1.42) for mortality from all causes. CONCLUSIONS: Traffic air pollution is associated with mortality from cardiovascular diseases and all causes, after adjustment for traffic noise. The association was strongest for people with a low fruit and vegetable intake.     

猪源乙型肝炎病毒的分子流行病学调查

目的 了解猪HBV的感染情况,探讨猪作为乙型肝炎病毒感染动物模型的可行性.方法 采用酶联免疫吸附试验(ELISA)法对血清中的HBV血清标志物进行检测,分别用S区和C区引物对血清和白细胞中HBV-DNA进行聚合酶链式反应(PCR)以检测HBV的感染情况.结果 ①234份血清标本进行了HBV血清标志物的检测,HbsAg、HBsAb、HBcAb、HBeAg、HBeAb的阳性率分别为4.70％ (11/234)、29.06％ (68/234)、79.91％ (187/234)、2.99％ (7/234)、15.81％ (37/234),血清标记物全阴性16.67％ (39/234);②血清HBV-DNA的PCR扩增结果:S区引物扩增阳性率3.4％ (8/234),C区引物扩增阳性率20％ (47/234);③白细胞DNA PCR扩增,S区扩增阳性率10.9％ (17/156),C区扩增阳性率51.3％ (80/156);④白细胞中HBV-DNA的检出率高于血清HBV-DNA的检出率,二者差异有统计学意义(P＜0.001);⑤HBV-DNA的C区检出率高于S区检出率,二者差异有统计学意义.结论 ①HBV在屠宰生猪中有较高的感染率;②白细胞中HBV-DNA的检出率高于血清HBV-DNA的检出率;③HBV-DNA的C区检测比S区检测更为敏感.     

Seroepidemiology of infection with hepatitis A virus and hepatitis B virus in the Seychelles

A batch of 417 serum samples obtained from native-born subjects were tested for the presence of hepatitis B surface antigen (HBsAg) and corresponding antibody (anti-HBs), by enzyme-linked immunosorbent assay (ELISA); and antibodies to hepatitis B core antigen (anti-HBc), e-antigen (anti-HBe), and hepatitis A virus (anti-HAV), by radioimmunoassay (RIA). HBsAg was found in only two of the 417 subjects studied. Anti-HBs was detected in 112 samples (26.8%), anti-HBc in 114 (27.3%) and anti-HBe in 31 samples (7.4%). Serologic evidence of a previous or present infection by hepatitis B virus (HBV) was found in 34.5% of the samples studied. Males showed a greater prevalence of anti-HBs and anti-HBc, while anti-HBe was more common in females; however, these differences were not significant. With regard to age, a significantly higher prevalence of anti-HBs (p less than 0.05), anti-HBc (p less than 0.025) and anti-HBe (p less than 0.025) was found in the older age groups. Anti-HAV antibodies were present in 90% of the subjects studied, with no variation between the sexes. The anti-HAV rate in the group under 20 years was similar to that found in the older age groups. The total infection rate of hepatitis B virus in the Seychelles is lower than in other tropical areas, HBs antigen/antibody ratio approaching that in temperate areas. Elucidation of the reasons for the low prevalence of hepatitis B virus carriers among the Sevchelles population requires further investigation.     

Height and cancer mortality: results from the Glasgow University student cohort

The aim of the study was to examine the association between height and cancer mortality in a socially homogeneous group of subjects. The study was based on a cohort of students, 8397 men and 2329 women, aged 16-30 y, who attended the University of Glasgow between 1948 and 1968. Mean follow-up time was 40 y. Height was measured at a medical examination performed at the student health service. The outcome measures used in the study were all-cause mortality and mortality from: all cancers, smoking and non-smoking related cancers and cancers related to sex hormones. No substantial or statistically significant associations were seen between height and all-cause or all-cancer mortality in either sex. Neither were any significant associations found between height and any of the sub-types of cancer studied (ie those related to smoking, those not related to smoking, and those related to sex hormones). Previous observations which have shown positive associations between height and cancer mortality have generally been based on populations with diverse social origins, among whom the variation in height will reflect variation in health and nutrition in childhood. The relatively low level of such variation in the present study may account for the negative findings. Public Health (2000) 114, 451-455     

乙型肝炎病毒宫内感染危险因素研究

目的 研究乙型肝炎病毒(HBV)宫内感染的危险因素.方法 采用巢式病例对照研究的方法,进行HBV宫内感染危险因素的logistic回归分析.结果 HBV宫内感染危险因素的单因素分析显示在α=0.05水平上,孕妇DR3、婴儿DR3、母婴DR3同阳性、孕妇血清HBV DNA阳性、孕妇血清HBeAg阳性和胎盘感染在病例组和对照组差异均有统计学意义;是HBV官内感染的危险因素,OR值(95%CI)分别为4.71(1.62～13.66)、3.91(1.18～12.94)、5.96(1.14～31.15)、6.59(2.72～15.97)、4.53(1.93～10.64)和2.51(1.12～5.60);在α入=0.05,α出=0.10水平上,进行HBV宫内感染的多因素logistic回归分析,孕妇DR3(OR=4.65,1.44～15.05)、孕妇血清HBV DNA(OR=6.56,2.65～16.23)被引入回归方程,为HBV宫内感染的危险因素,且两因素间未显示交互作用;其他因素的暴露率在病例组和对照组未见明显差别.随着孕妇血清HBV DNA含量的增加,其发生宫内感染的危险性呈现增高趋势(χ2=16.74,P＜0.os).结论 HBV宫内感染的危险因素为孕妇HLA-DR3阳性和孕妇血清HBV DNA阳性,且两因素间未显示交互作用,HBV宫内感染率随孕妇血中HBVDNA含量增高呈增高趋势.     

大学新生4406例肝功能及乙型肝炎病毒感染检测结果

目的 了解广西玉林师范学院大学新生肝功能及乙型肝炎(乙肝)病毒(HBV)感染情况,为高校学生的疾病预防控制工作提供科学依据.方法 采集早晨空腹静脉血,应用全自动生化分析仪检测;采用连续监测速率法测定血清中丙氨酸转氨酸(ALT)、天冬氨酸转氨酶(AST)活力,采用酶联免疫吸附试验(ELISA)法进行乙肝表面抗原(HBsAg)检测.结果 4406例大学新生中肝功能异常者113例,占总数的2.56％,其中男生73例,占5.53％ (73/1 319);女生40例,占1.30％ (40/3 087).男生异常率明显高于女生,差异有统计学意义(x2=66.44,P＜0.01).对初查肝功能异常的新生在2周内进行复查并加测HBsAg项目,结果肝功能恢复正常者84人,占74.34％(84/113);仍然异常者29人,占25.66％(29/113),其中合并HBsAg阳性者20人,阳性率为68.97％ (20/29).结论 大学新生体检肝功能异常者男生明显高于女生;对初查肝功能异常者,必须复查并加测HBsAg项目,以便明确病因;复查肝功能仍然异常者多与乙型肝炎病毒(HBV)感染有关,对这些学生应加强监测并采取相应的预防控制措施.     

Chronic hepatitis B infection: a workshop consensus statement and algorithm

Here, presented with an evidence-based algorithm, are workshop consensus recommendations on whom to screen for hepatitis B and when to pursue further evaluation and management.     

我国育龄期妇女乙型肝炎病毒表面抗原及e抗原流行现状分析

持续性乙型肝炎病毒(hepatitis B virus,HBV)感染分为两类：乙型肝炎表面抗原(hepatitis B surface antigen,HBsAg)阳性(显性HBV感染)和阴性(隐匿性HBV感染,occult hepatitis B infection,OBI)。对显性感染的认识相对清楚,但对OBI的认识仍然有限。本文重点介绍OBI的危害及其流行情况,并分别阐述了母婴不同乙肝传播类型与乙肝疫苗免疫效果的关系。HBV以母婴传播为主,两类HBV感染在母婴传播上表现为四种类型：(Ⅰ)母亲HBV显性-子代HBV显性; (Ⅱ)母亲HBV显性-子代OBI; (Ⅲ)母亲OBI-子代OBI; (Ⅳ)母亲OBI-子代HBV显性。HBV疫苗免疫后时代可能以Ⅱ型传播为主。应加强对OBI的研究,重新评估现有HBV免疫策略对HBV母婴传播的影响。     

Body mass index and mortality from all causes and major causes in Japanese: results of a pooled analysis of 7 large-scale cohort studies

Background

We pooled data from 7 ongoing cohorts in Japan involving 353 422 adults (162 092 men and 191 330 women) to quantify the effect of body mass index (BMI) on total and cause-specific (cancer, heart disease, and cerebrovascular disease) mortality and identify optimal BMI ranges for middle-aged and elderly Japanese.

Methods

During a mean follow-up of 12.5 years, 41 260 deaths occurred. The Cox proportional hazards model was used to estimate hazard ratios (HRs) for each BMI category, after controlling for age, area of residence, smoking, drinking, history of hypertension, diabetes, and physical activity in each study. A random-effects model was used to obtain summary measures.

Results

A reverse-J pattern was seen for all-cause and cancer mortality (elevated risk only for high BMI in women) and a U- or J-shaped association was seen for heart disease and cerebrovascular disease mortality. For total mortality, as compared with a BMI of 23 to 25, the HR was 1.78 for 14 to 19, 1.27 for 19 to 21, 1.11 for 21 to 23, and 1.36 for 30 to 40 in men, and 1.61 for 14 to 19, 1.17 for 19 to 21, 1.08 for 27 to 30, and 1.37 for 30 to 40 in women. High BMI (≥27) accounted for 0.9% and 1.5% of total mortality in men and women, respectively.

Conclusions

The lowest risk of total mortality and mortality from major causes of disease was observed for a BMI of 21 to 27 kg/m² in middle-aged and elderly Japanese.Key words: body mass index, mortality, cancer, heart disease, cerebrovascular disease     

Perceived stress and cause-specific mortality among men and women: results from a prospective cohort study

The authors assessed the effect of psychological stress on total and cause-specific mortality among men and women. In 1981-1983, the 12,128 Danish participants in the Copenhagen City Heart Study were asked two questions on stress intensity and frequency and were followed in a nationwide registry until 2004, with <0.1% loss to follow-up. Sex differences were found in the relations between stress and mortality (p = 0.02). After adjustments, men with high stress versus low stress had higher all-cause mortality (hazard ratio (HR) = 1.32, 95% confidence interval (CI): 1.15, 1.52). This finding was most pronounced for deaths due to respiratory diseases (high vs. low stress: HR = 1.79, 95% CI: 1.10, 2.91), external causes (HR = 3.07, 95% CI: 1.65, 5.71), and suicide (HR = 5.91, 95% CI: 2.47, 14.16). High stress was related to a 2.59 (95% CI: 1.20, 5.61) higher risk of ischemic heart disease mortality for younger, but not older, men. In general, the effects of stress were most pronounced among younger and healthier men. No associations were found between stress and mortality among women, except among younger women with high stress, who experienced lower cancer mortality (HR = 0.51, 95% CI: 0.28, 0.92). Future preventive strategies may be targeted toward stress as a risk factor for premature death among middle-aged, presumably healthy men.     

社区人群中乙型肝炎病毒感染和代谢综合征的相关研究

目的:研究社区人群中乙型肝炎病毒(HBV)感染和代谢综合征(MS)的关系。方法:对参加2007-2009年间上海市普陀区各级医院的健康体检的常住人口进行调查,除了收集年龄、性别、腰围等数据外,还采集血清标本,检测其HBV携带情况以及空腹血糖、甘油三酯、高密度脂蛋白等MS相关指标,使用lo-gistic回归分析HBV感染和MS间的关系。结果:本次调查总数是9 414,乙型肝炎表面抗原阳性率是17.1%。乙型肝炎表面抗原在MS患病组中的阳性率为21.9%,明显比非MS患病组中的16.4%要高(P<0.000 1)。HBV感染和MS的联系粗的OR是1.561,95%可信区间是1.276～1.908,调整年龄和性别后,其调整OR为1.397,95%可信区间是1.139～1.714。结论:HBV感染和代谢综合征间存在一定的联系,研究结果表明HBV感染可能会增加研究人群代谢综合征的患病风险。     

2001—2013年海门市居民肺癌发病与死亡情况

目的分析2001—2013年海门市居民肺癌发病与死亡趋势,为制定肺癌预防和控制措施提供依据。方法根据肿瘤信息系统登记的肺癌发病与死亡资料统计分析海门市居民肺癌的发病率、死亡率、中国人口标化率（中标率）、世界人口标化率（世标率）、年龄别发病率和死亡率及发病死亡年平均增长速度等指标。结果男女合计肺癌发病率72.55/10万,中标率和世标率分别为56.55/10万和42.65/10万,占全部癌症新发病例的21.73%;位居各类癌症之首。肺癌发病率从2001年的57.13/10万上升至2013的92.37/10万,以年平均3.77%的速度上升,2013年比2001年上升了61.68%。男女合计肺癌死亡率为62.41/10万,中标率和世标率分别为47.21/10万和35.53/10万。肺癌死亡率位居各类癌症死亡的第1位。2013年肺癌死亡率为75.74/10万,较2001年的46.40/10万上升了63.25%,以年平均3.84%的速度上升。结论肺癌发病率、死亡率均位居海门市癌症发病与死亡的第1位,且呈逐年上升趋势,人口老龄化、环境污染、吸烟及个人不良生活习惯等是造就肺癌发病率和死亡率增高的重要因素,当务之急应加强肺癌预防与控制工作。     

2009—2010年咸阳市健康儿童乙型肝炎抗体水平监测结果

目的了解咸阳市健康儿童的乙型肝炎(乙肝)免疫水平,为今后如何有效开展基层乙肝疫苗接种提供科学依据。方法采用分层随机抽样和简单随机抽样的方法抽取258名0～8岁儿童的血样,用酶联免疫吸附试验(ELISA)检测抗-HBs。结果该市0～8岁儿童抗-HBs阳性率为57.36%,低年龄组儿童抗-HBs阳性率高于高年龄组,3和8岁为2个抗-HBs阳性率高峰。结论咸阳市1岁以下新生儿抗-HBs阳性率偏低;应全面开展0～8岁儿童的乙肝疫苗查漏补种工作,提高儿童抗-HBs水平。