Prevention of intrauterine infection by hepatitis B virus with hepatitis B immune globulin: efficacy and mechanism

Objective　To evaluate the efficacy of hepatitis B immune globulin (HBIG) in preventing intrauterine infection by hepatitis B virus (HBV) and to investigate its mechanism. Methods　Forty-eight pregnant women positive for hepatitis B surface antigen (HBsAg) were randomly divided into 2 groups. The 34 women in the study group were injected with HBIG during pregnancy; the other 14 women were controls. Maternal blood samples were taken before HBIG injection and at delivery. Neonatal blood samples were taken within 24 hours after birth before HBIG and hepatitis B vaccine were given. HBsAg and antibody to HBsAg (anti-HBs) were tested by radioimmunoassay. Results　None of the 35 newborns (including 2 twins) in the study group was positive for HBsAg, but 3 (21%) in the control group were positive (P=0.02). The HBsAg titers in the women in the study group decreased after HBIG injection. Of the 35 newborns in the study group, 32 (91%) were positive for anti-HBs. Conclusion　Systematic injections of HBIG during pregnancy may prevent intrauterine HBV infection, the mechanism of which may be reduction of maternal HBV viremia and production of fetal passive immunity.     

Prevention of hepatitis B in China: achievements and challenges

Hepatitis B virus （HBV） infection has been an .important public health problem in China.According to the Chinese Health Statistical Digest published by the Ministry of Health of the People＇s Republic of China, the morbidity and mortality of viral hepatitis are the highest among the infectious diseases compulsorily reported to the authorities of public health. The average incidence rate of viral hepatitis is 50-100 per 100 000, i.e. 0.6-1.2 million acute viral hepatitis cases occur every year in the country. Among them, 25% are hepatitis B. There are estimated 93 million of chronic HBV carriers among its 1.3 billion population,     

肝移植后乙型肝炎复发的预防与治疗

乙型肝炎病毒 (hepatitisBvirus,HBV)相关疾病 ,包括各种急、慢性肝炎、肝硬化及合并肝硬化的肝癌是肝脏移植的主要适用证 ,但移植术后HBV再感染及肝炎复发影响着患者的生存率和生活质量。近年来 ,随着各种新的治疗药物与方案的应用 ,此类患者的预后有了明显的改善。本文将就此     

Prevention and treatment of hepatitis B relapse after liver transplantation

Objectives　To investigate the effect of orthotopic liver transplantation (OLT) on hepatitis B(HB)-related diseases and the efficiency of prevention and treatment with lamivudine on recurrence of hepatitis B posttransplant in China.
Methods　Orthotopic liver transplantation (OLT) under veno-venous bypass was performed in 10, of whom 9 males had hepatitis B and 1 female had hepatocellular cancer (HCC) without HB pretransplant. Eight of the 9 males had fulminant hepatitis B (FHB) and they all had preoperative serious jaundice, ascites and coagulopathy. Six had encephalopathy; 1 was associaled with acute renal failure, and 1 with gastro-intestinal hemorrhage. Seven of the 10 patients had lamivudine to prevent reinfection with hepatitis B.
Results　Of the 8 patients who have survived for 2-12 months, 7 have survived for 6-12 months. Two died, one of recurrent FHB and the other from multi-organ failure (MOF). Seven preoperative HB patients of the 8 survivors have excellent liver function though 1 has positive HBsAg 6 months after OLT. One of the 8 survivors, the female with HCC pretransplant, suffered hepatitis B 6 months after OLT and her hepatic function has been gradually improving with lamivudine therapy.
Conclusions　OLT is an effective therapy for certain cases of FHB and HCC and lamivudine may prevent recurrence of hepatitis B after OLT.     

肝移植术后乙肝复发的预防和治疗

目的 探讨预防乙型肝炎病毒(HBV)相关性终末期肝病肝移植术后HBV再感染和复发的有效方法.方法 对近5年来资料完整,术前存在HBV感染,术后存活超过6个月的183例成人肝移植患者的临床资料进行回顾性研究,按照用药方法,分为单纯使用拉米呋啶(LAM)组(单纯组)106例与联合使用小剂量乙型肝炎免疫球蛋白(HBIG)和LAM组(联合组)77例,全部得到随访.结果 平均随访14.6个月,单纯组106例患者,移植后1周内HBsAg转阴率为82.1%(87/106),其中18例发现有HBV再感染,再感染率为16.98%(18/106),乙肝复发率为11.3%(12/106),9例检测到YMDD变异,变异率为8.49%.联合组77例患者移植后HBsAg转阴率为94.81%(73/77),HBV再感率为6.49%(5/77),HBV复发率为2.60%(2/77),1例检测到YMDD变异株,变异率为1.30%.移植后1周内HBsAg转阴率、HBV再感染率、复发率、YMDD变异率在两组间的差异均有统计学意义(P＜0.05).对于出现YMDD变异株的患者加用阿德福韦(ADF)治疗取得了较好的效果.结论 (1)小剂量HBIG和LAM联合应用较单纯使用LAM预防肝移植后HBV再感染和复发疗效确切,和国外大剂量静脉使用HBIG和LAM效果相当(x2=0.306),且具有价格低廉,易于被国人接受的优点;(2)对于小剂量HBIG和LAM联合应用过程中出现YMDD变异引起LAM耐药的患者,应该加用ADF治疗.但是对于此类患者病例数较少,相关经验少,有待于临床进一步观察.     

Prevention and treatment of hepatitis B relapse after liver transplantation

Ｏｒｔｈｏｔｏｐｉｃｌｉｖｅｒｔｒａｎｓｐｌａｎｔａｔｉｏｎ (ＯＬＴ)ｈａｓｂｅｅｎｔｈｅｍｏｓｔｅｆｆｅｃｔｉｖｅｍｅｔｈｏｄｆｏｒｅｎｄｓｔａｇｅｈｅｐａｔｉｃｄｉｓｅａｓｅ ＨｅｐａｔｉｔｉｓＢ(ＨＢ)ｒｅｌａｔｅｄｌｉｖｅｒｄｉｓｅａｓｅｓｈａｖｅｂｅｅｎｔｈｅｍａｉｎｉｎｄｉｃａｔｉｏｎｏｆＯＬＴｂｕｔｔｈｅＨＢｒｅｃｕｒｒｅｎｃｅｒａｔｅａｆｔｅｒＯＬＴｒｅａｃｈｅｓ 80 %ｏｒｍｏｒｅ,ｌｅａｄｉｎｇｔｏｈｅｐａｔｉｃｆａｉｌｕｒｅ ,ｒｅｔｒａｎｓｐｌａｎｔａｔｉｏｎｏｒｅｖｅｎｄｅａｔｈ…     

肝移植后乙肝复发的预防和治疗

目的　探讨原位肝移植治疗乙型肝炎相关疾病的效果及Lamivudine在防治肝移植后乙肝复发中的作用。方法　 10例患者接受了原位肝移植 ,其中 9例男性为乙肝患者 ,1例女性为肝癌患者 ,术前无乙肝感染。 9例乙肝患者中 ,6例并有不同程度的肝性脑病 ,1例并肝肾综合征 ,1例并上消化道大出血。 9例乙肝中 ,7例服用Lamivudine预防术后乙肝复发。结果　 8例存活 2 - 12个月 ,2例死亡。存活的 8例中 ,7例为乙肝患者 ,仅 1例术后 6个月出现HBsAg( ) ,但全部均肝功能良好 ;另 1例为肝癌患者 ,术后 6个月出现乙肝。死亡的 2例中 ,1例为术后乙肝复发暴发性肝功能衰竭所致 ,另 1例死于术后多器官功能衰竭。结论　原位肝移植加Lamivudine是治疗乙肝和肝细胞癌病例的有效方法。Lamivudine在观察期内可预防乙肝移植后乙肝复发。     

乙型病毒性肝炎相关失代偿肝硬化的抗病毒治疗进展

Objective: To review the development, mechanism, necessity and limitation of antiviral therapy in decompensated hepatitis B virus-related cirrhosis. Data sources: A literature search (Pubmed 2000 to 2011) was performed using the key words “antiviral and decompensated hepatitis B virus-related cirrhosis” mainly. Relevant book chapters were also reviewed. Study selection: Well-controlled, prospective landmark studies and review articles on antiviral therapy in decompesated hepatitis B virus-related cirrhosis were selected. Results: Specific antiviral agents which not only control viral replication, therefore permitting liver transplantation, but also improve liver function so significantly that patients could be removed from the transplant waiting list. However, the emergence of drug-resistant mutants can result in treatment failure. Combination therapy is a save-strategy in drug-resistant. Conclusions: Although the treatment of end-stage liver disease is still a challenge in worldwide, antiviral therapy has altered the natural history of hepatitis B virus patients with decompensated cirrhosis. The approval of the new generation of antivirals is opening new perspectives for finding the optimal antiviral treatment for patients with decompensated cirrhosis and preventing antiviral resistance. A combination of antivirals may be one of the future strategies for fulfilling these goals.     

慢性乙型肝炎抗病毒治疗的研究现状

由病毒高复制引起的活动性肝炎是慢性乙型肝炎病毒感染不良结局，如失代偿性肝硬化和肝细胞癌的一个主要危险因素。慢性乙型肝炎的治疗目标应当是清除病毒或抑制病毒复制。慢性乙型肝炎抗病毒治疗的主要指征是血清ALT大于2倍常参考值上限且HBV DNA大于10^5 copies/mL的病人，与核苷类抗病毒药物相比，干扰素-α抑制病毒复制的作用较弱，但具有潜在的免疫清除效应；聚乙二醇化干扰素-α治疗慢性乙型肝炎可能比普通干扰素-α更有潜力。前C区变异株能更有效地逃避干扰素-α诱导的免疫清除。药物抵抗是拉米夫定长期应用的主要限制。阿德福韦对拉米夫定抵抗的变异株有效，长期使用也可产生药物抵抗，但发生率非常低。联合治疗的有效性和安全性需要进一步的研究支持。     

Antiviral therapy of decompensated hepatitis B virus-related cirrhosis

Objective  To review the development, mechanism, necessity and limitation of antiviral therapy in decompensated hepatitis B virus-related cirrhosis.

Data sources  Most information was pulled from a literature search (Pubmed 2000 to 2011) using the keywords of antiviral and decompensated hepatitis B virus-related cirrhosis. Relevant book chapters were also reviewed.

Study selection  Well-controlled, prospective landmark studies and review articles on antiviral therapy in decompesated hepatitis B virus-related cirrhosis were selected.

Results  Specific antiviral agents not only control viral replication, which permits liver transplantation, but also improve liver function so significantly that patients could be removed from the transplant waiting list. However, the emergence of drug-resistant mutants can result in treatment failure. Combination therapy is a save-strategy in drug-resistant.

Conclusions  Although the treatment of end-stage liver disease is still a challenge worldwide, antiviral therapy has altered the natural history of hepatitis B patients with decompensated cirrhosis. The approval of the new generation of antivirals is opening new perspectives for finding the optimal antiviral treatment for patients with decompensated cirrhosis and preventing antiviral resistance. A combination of antivirals may be one of the future strategies for fulfilling these goals.

     

潘南金注射液治疗慢性乙型肝炎疗效观察

潘南金注射液是无水门冬氨酸钾和无水门冬氨酸镁的混合物．目前临床常用于病毒性急慢性肝炎、早期肝硬化、脂肪肝、中毒性肝炎以及心血管疾病等的治疗。为了解临床治疗效果，我们做了有关病例观察，报道如下。     

潘南金注射液治疗慢性乙型肝炎疗效观察

潘南金注射液是无水门冬氨酸钾和无水门冬氨酸镁的混合物,目前临床常用于病毒性急慢性肝炎、早期肝硬化、脂肪肝、中毒性肝炎以及心血管疾病等的治疗.为了解临床治疗效果,我们做了有关病例观察,报道如下.     

乙型肝炎病毒核苷类似物耐药性监测和预防及其处理

有关细菌耐药已广为熟知,然而病毒耐药机理及临床监控的研究在我国尚属起步阶段,这一领域可能会成为临床医学和基础病毒学科交叉的新生长点。以乙型肝炎病毒（HBV）为例,我国有1．3亿慢性HBV感染者,随着近期多种抗HBV核苷类似物的临床应用,如何监控HBV核苷类似物耐药性的产生以减少医疗经济损失,如何组织和发展核苷类似物HBV耐药性监测计划,并指导各级医院和国家的抗HBV药物管理。这些问题已成为临床医师关注的焦点,研究HBV耐药性对治疗效果的影响可能有重要的临床价值。一、HBV核苷类似物耐药性现状研究HBV变异现象已近…     

慢性乙型肝炎抗病毒治疗若干进展

乙型肝炎全球分布广泛,估计有3.5亿人呈乙型肝炎病毒(HBV)慢性感染。年龄愈小,愈容易发展为慢性感染,新生儿HBV感染者中90%可发展     

联合抗过敏疗法对急性乙型肝炎病人的疗效观察

[目的 ]阐明Ⅰ型变态反应与急性乙型肝炎关系 .[方法 ]将 42例急性乙型肝炎病人随机分为治疗组和对照组 ,并观察了联合抗过敏疗法对急性乙型肝炎的疗效 .[结果 ]治疗组行联合抗过敏疗法后血清内谷丙转氨酶和总胆红素均比治疗前明显降低 ,而对照组治疗前后无明显变化 ;治疗组谷丙转氨酶及总胆红素复常天数明显短于对照组 .[结论 ]联合抗过敏疗法对急性乙型肝炎疗效显著 ,从而间接证明了免疫球蛋白E及其介导的Ⅰ型变态反应在急性乙型肝炎发病机理中的致病作用 .