婴儿时期乙肝感染2例分析

最近1 a来,笔者接触到2例因母亲是乙肝携带者,而且生育两胞胎,在双胞胎中只有其中一个婴儿被感染乙肝,分析如下。1病历摘要例1：1985年出生,于2008-02生育双胞胎女孩,由于非婚生育,其生育过程无家人照顾,其怀胎过程中也未做过产前检查,直到腹痛见红才到正规医院生育,在产前检查中被查出乙肝大三阳,期间医护人员小心翼翼为其接生,顺利产下头胎女婴后15 m in又产下一女婴,     

乙肝血清5项指标部分模式HBsAg复检探讨

乙肝病毒表面抗原及其抗体 (HBs Ag、抗 - HBs)、乙肝病毒核心抗体 (抗 - HBc)、乙肝病毒 e抗原及其抗体 (HBe Ag、抗 -HBe) 5项指标 (也称乙肝两对半 )检测对乙肝病毒 (HBV)的感染诊断和在机体内复制程度、传染性强弱判定以及机体对 HBV的免疫力、乙肝疫苗免疫接种效果具有重要意义 ,已列为实验室最常规的乙肝指标检测组合。随着免疫学方法的发展 ,酶联免疫吸附试验 (EL ISA)一步法检测因其快速、简便等已被大多数实验室所采用 ,随之带来乙肝两对半检测模式中 HBs Ag阴性模式增加。为了观察 HBs Ag结果的准确性 ,我们对 5 4份 …     

2005年天津市报告乙型病毒性肝炎病例构成的调查

目的 掌握乙型病毒性肝炎(乙肝)临床谱构成,使用调查结果推算临床谱发病率及修正乙肝报告发病率.方法 根据2005年疫情网络报告乙肝病例数,每月初按上月地区发病不等比例分层随机抽样调查,调查病例统一填写天津市乙型病毒性肝炎流行病学调查表,用Excel软件输机并运用SPSS11.5统计.结果 急性乙肝构成为36.51%,重型肝炎为4.33%,慢性肝炎为48.81%,淤胆型肝炎0.08%,乙肝肝硬化10.27%;修正急性肝炎发病率为19.05/10万.结论 修正急性乙肝发病率远低于疫情报告发病率;乙肝临床谱构成仍以慢性病例为主;建议加强医疗机构乙肝的急、慢性病例分类报告.     

乙肝两对半定量检测的临床意义

乙型肝炎是乙型肝炎病毒(hepatitis B virus,HBV)引起的全球性传染病,我国是HBV流行地区,HBV携带者占总人口的10％以上.传统两对半定性酶标测定(ELISA)对乙肝疾病的诊断起到了一定的作用,但因ELISA方法学的局限,易造成HBV的漏诊,而乙肝两对半的定量检测可对乙肝的病程、治疗、预后起一个动态监测的作用,能够让医生对病情疗效作出合理的解释并提供依据,指导治疗,弥补了定性检测的不足.本文用了两种不同的方法对500例患者检测乙肝两对半,其结果分析如下.     

时间分辨荧光免疫分析法检测乙肝标志物的应用价值

【目的】探讨时间分辨免疫分析法(TRFIA)检测乙肝标志物的应用价值。【方法】应用TRFIA和ELISA同时检测218例传染科住院及门诊患者,并进行比较。【结果】两种方法检测乙肝标志物的符合率很高,达94.9%以上,经配对资料χ2检验,两测定方法所得结果无显著性差异。TRFIA检测出现了两种ELISA未检测到的两种血清学模式。【结论】TRFIA具有灵敏度高,可定量的优势,可准确测定患者血清标志物的含量为动态观察病情、指导治疗提供了可能性。     

乙肝两对半、前S抗原、抗体及HBV-DNA的相关性探讨

目的 探讨前S抗原、抗体及HBV-DNA与乙肝常规检查（两对半）的相关性。方法 采用ELISA法对136份血清标本分别进行两对半、pre-S1抗原、pre-S2抗原、pre-S1抗体、pre-S2抗体及HBV-DNA检测，并对结果进行分析。结果 pre-S1抗原、pre-S2抗原在HBV-DNA（＋）组中检出率为62．5％和58．3％，在HBV-DNA（-）组的检出率为22．2％和27．7％，两者之间差异显著（PS1〈0．05，PS2〈0．05），pre-S1抗原、pre-S2抗原在HBeAg（＋）组的检出率为100％和87．5％，在HBeAg（-）组的检出率为36％和38％，两者之间差异显著（PS1〈0．01；PS2〈0．01）。结论 乙肝病毒标志物（HBVM）、前S抗原、HBV-DNA在判断乙肝的复制情况中各有优势，要综合多方面结果得出全面准确的结论。     

医保参保人员19129例乙肝五项结果调查

目的调查衡水市乙肝感染状况。方法采用ELISA法检测乙肝五项。结果乙肝五项结果出现阳性模式13种,表面抗原总阳性率3.21%,大、小三阳阳性率年龄分布:20~29岁0.82%、30~39岁1.58%、40~49岁2.95%、50~59岁3.12%、60~69岁2.86%、≥70岁2.78%。乙肝患病率在男女之间危险比为:1.68。结论本市乙肝患病率40~69岁发病率较高。     

云南省保山市不同等级医院乙肝病例报告及血清学检测结果分析

目的 分析不同级别和类型医院乙型病毒性肝炎（乙肝）病例分类报告及血清学检测结果,探讨病例报告中可能存在的问题。 方法 从中国疾病预防控制信息系统中下载保山市2016年报告的乙肝病例（含外地报告但现住址在保山市）资料,包括人口学资料、病例报告资料以及谷丙转氨酶（ALT）、乙肝核心抗体-IgM（HBcAb-IgM）等血清学监测数据。 使用Excel软件建立数据库,应用SPSS 19.0软件包进行数据统计分析。 结果 一级医院和二级医院报告的HBsAg携带者、未分型、ALT异常、ALT＞P₇₅和未检测HBcAb-IgM的病例数高于其他级别的医院,差异有统计学意义（χ2值分别为884.623、885.244、489.321、560.361、1 124.17,均P＜0.01）。 对于上述比较的各项指标,卫生院和综合医院报告的病例数高于其他类型的医院,差异有统计学意义（χ2值分别为316.875、309.754、359.044、473.882、332.055,均P＜0.01）。 结论 二级医院和一级医院报告的乙肝病例较多,但错误报告的病例也较多。县级综合医院和卫生院是病例核查的重点。      

不典型乙型脑炎一例报告

1　临床资料患儿男,5岁6个月,因发热 3 d入我院。3 d前无明显诱因出现发热, T39℃,畏寒,无头痛及呕吐,无抽搐,无咳嗽。在当地诊断为“上呼吸道感染”,先后给予口服“阿莫西林”及退热药,静脉点滴“头孢拉啶”等治疗,效果不佳,体温呈持续上升趋势;辅检:外周血白细胞 28.6×109/L,中性粒细胞95%。入院后查体:T39.3℃,神清,精神差,皮肤粘膜无黄染、无出血点及皮疹,浅表淋巴结无肿大,咽红,扁桃体Ⅰ度,无化脓。颈软,双肺呼吸音粗,未闻及罗音,心脏无异常,神经系统病理反射阴性。今年接种乙脑疫苗。血常规:白细胞 32.1×109/L,中性粒细胞 83%,血…     

接种乙肝疫苗后乙肝标志物的变化

目的体检和门诊及住院患者检查乙肝两对半，5项全部阴性162例，男84例，女78例，年龄4～55岁，平均27．3岁。方法分别按使用说明书注射3针国产抗乙肝疫苗（0、1、6个月）。并于第3针抗乙肝疫苗注射后的3～6个月复检。结果ELISA法17例HBsAb阴性（10．49％），即不产生保护性抗体，其余4项阴性；145例HBsAb阳性（89．51％），其中28例HBsAb、HBcAb均阳性（17．28％），其余3项阴性；11例只有HBcAb阳性，其余4项阴性（6．79oA）。结论注射抗乙肝疫苗后，24．07％HBcAb阳性是否为乙肝疫苗制备时纯度不够，或是部分人对乙肝疫苗免疫应答差异所致及运输保存等问题。     

Argon-helium cryoablation for thoracic vertebrae with metastasis of hepatocellular carcinoma-related hepatitis B: A case report

BACKGROUND Spinal metastasis of hepatocellular carcinoma(HCC) is rare, with an extremely poor prognosis and results in severe pain. Argon-helium cryotherapy is a local ablation method for HCC.CASE SUMMARY A 54-year-old man was diagnosed with HCC related to hepatitis B one year ago and underwent surgical tumor resection and tenofovir antiviral treatment.However, a new lesion developed on the right liver after 1 mo. Transarterial chemoembolization was performed four times. One month ago, the patient developed back pain, and metastasis on the 11 th thoracic vertebra was detected.Argon-helium cryoablation was performed to treat the right occupancy and metastatic lesion, which immediately alleviated the pain and prolonged survival.CONCLUSION The use of argon-helium cryoablation for thoracic vertebrae with metastasis of HCC achieved favorable results.     

Hepatitis B virus-related liver cirrhosis complicated with dermatomyositis: A case report

BACKGROUND Twenty percent of patients infected with hepatitis B virus(HBV)develop extrahepatic manifestations with HBV detected in the lymph nodes,spleen,bone marrow,kidneys,and skin.HBV infection has been associated with some autoimmune disorders.Dermatomyositis(DM)is an idiopathic inflammatory myopathy,which involves a viral infection,and DM has been identified in patients infected with HBV,but there is no direct histological evidence for an association between HBV and DM.CASE SUMMARY We describe a familial HBV-infected patient admitted with liver function abnormality,rashes,a movement disorder,and an elevated level of creatine kinase(CK).A computed tomography scan of the lung showed pulmonary fibrosis,and a liver biopsy identified nodular cirrhosis.An electromyogram revealed myogenic damage,and a muscle biopsy showed nuclear migration in local sarcolemma and infiltration of chronic inflammatory cells.Immunohistochemical staining showed negative results for HBsAg and HBcAg.Fluorescence in situ hybridization showed a negative result for HBV DNA.The patient was diagnosed with HBV-related liver cirrhosis complicated with DM and was treated with methylprednisolone,mycophenolate mofetil,and lamivudine.Eight months later,the patient was readmitted for anorexia and fatigue.The blood examination showed elevated levels of aminotransferases and HBV DNA,however,the CK level was within the normal range.The patient developed a virological breakthrough and lamivudine was replaced with tenofovir.CONCLUSION DM in chronic HBV-infected patients does not always associate with HBV.Antiviral and immunosuppressive drugs should be taken into consideration.     

Isolated hepatic tuberculosis associated with portal vein thrombosis and hepatitis B virus coinfection: A case report and review of the literature

BACKGROUNDWhile tuberculosis (TB) itself is a common disease, isolated TB of the liver is a rare entity. Tubercular involvement of the liver is more commonly a part of a disseminated disease of the hepatic parenchyma. In contrast, isolated hepatic TB spread through the portal vein from the gastrointestinal tract is seldom encountered in clinical practice, with only a few sporadic cases and short series available in the current literature. Vascular complications, such as portal vein thrombosis (PVT), have rarely been reported previously.CASE SUMMARYA 22-year-old man was hospitalized with complaints of a 3-mo history of fever and weight loss of approximately 10 kg. He had a 10-year hepatitis B virus (HBV) infection in his medical history. Contrast-enhanced computed tomography (CECT) confirmed hepatosplenomegaly, with hypodensity of the right lobe of the liver and 2.1 cm thrombosis of the right branch of the portal vein. A liver biopsy showed epithelioid granulomas with a background of caseating necrosis. Ziehl-Nelson staining showed acid-fast bacilli within the granulomas. The patient was diagnosed with isolated hepatic TB with PVT. Anti-TB therapy (ATT), including isoniazid, rifapentine, ethambutol, and pyrazinamide, was administered. Along with ATT, the patient was treated with entecavir as an antiviral medication against HBV and dabigatran as an anticoagulant. He remained asymptomatic, and follow-up sonography of the abdomen at 4 mo showed complete resolution of the PVT.CONCLUSIONUpon diagnosis of hepatic TB associated with PVT and HBV coinfection, ATT and anticoagulants should be initiated to prevent subsequent portal hypertension. Antiviral therapy against HBV should also be administered to prevent severe hepatic injury.     

Extremely high titer of hepatitis B surface antigen antibodies in a primary hepatocellular carcinoma patient: A case report

BACKGROUNDHepatocellular carcinoma (HCC) may be caused by hepatitis B virus (HBV) infection. Post-infection recovery-associated changes of HBV indicators include decreased hepatitis B surface antigen (HBsAg) level and increased anti-HBsAg antibody titer. Testing to detect HBV DNA is conducted rarely but could detect latent HBV infection persisting after acute infection and prompt administration of treatments to clear HBV and prevent subsequent HBV-induced HCC development. Here, we present an HCC case with an extremely high anti-HBsAg antibody titer and latent HBV infection.CASE SUMMARYA 57-year-old male patient with abdominal pain who was diagnosed with primary HCC presented with an extremely high level (over 2000 ng/mL) of serum alpha-fetoprotein. Abdominal B-ultrasonography and computed tomography scan results indicated focal liver lesion and mild splenomegaly. Assessments of serological markers revealed a high titer of antibodies against hepatitis B core antigen (anti-HBcAg antibodies), an extremely high titer (1000 mIU/mL) of hepatitis B surface antibodies (anti-HBsAg antibodies, anti-HBs) and absence of detectible HBsAg. Medical records indicated that the patient had reported no history of HBV vaccination, infection or hepatitis. Therefore, to rule out latent HBV infection in this patient, a serum sample was collected then tested to detect HBV DNA, yielding a positive result. Based on the aforementioned information, the final diagnosis was HCC associated with hepatitis B in a compensated stage of liver dysfunction and the patient was hospitalized for surgical treatment.CONCLUSIONA rare HCC case with high serum anti-HBsAg antibody titer and detectable HBV DNA resulted from untreated latent HBV infection.     

Successful treatment of infantile hepatitis B with lamivudine: A case report

BACKGROUNDHow to treat infantile hepatitis B virus (HBV) infection remains a controversial issue. The nucleoside analogue lamivudine (LAM) has been approved to treat children (2 to 17 years old) with chronic hepatitis B. Here, we aimed to investigate the benefit of LAM treatment in infantile hepatitis B.CASE SUMMARYA 4-mo-old infant born to a hepatitis B surface antigen (HBsAg)-positive woman was found to be infected by HBV during a health checkup. Liver chemistry and HBV seromarker tests showed alanine aminotransferase of 106 U/L, HBsAg of 685.2 cut-off index, hepatitis B “e” antigen of 1454.0 cut-off index, and HBV DNA of > 1.0 × 10⁹ IU/mL. LAM treatment (20 mg/d) was initiated, and after 19 mo, serum HBsAg was entirely cleared and hepatitis B surface antibody was present. The patient received LAM treatment for 2 years in total and has been followed for 3 years. During this period, serum hepatitis B surface antibody has been persistently positive, and serum HBV DNA was undetectable.CONCLUSIONEarly treatment of infantile hepatitis B with LAM could be safe and effective.     

乙肝免疫球蛋白阻断乙肝病毒母婴垂直传播的临床观察

目的探讨用乙肝免疫球蛋白阻断乙肝病毒母婴垂直传播感染的临床疗效。方法将100例血清乙型肝炎表面抗原(HBsAg)阳性的孕妇随机分为两组:乙肝免疫球蛋白(HBIG)组50例,分别在孕28、32、36周各肌肉注射乙肝免疫球蛋白200IU一次;对照组50例,未予用药。分娩后采集两组新生儿脐血,分离血清,用酶联免疫吸附(ELISA)法和荧光定量聚合酶链反应(PCR)法检测乙肝表面抗原HBsAg、乙肝e抗原(HBeAg)。结果乙肝免疫球蛋白(HBIG)组和对照组宫内感染率分别为10%、23.7%,差异有统计学意义(P<0.05)。结论对乙肝表面抗原HBsAg阳性的孕妇产前多次肌内注射HBIG可以有效降低HBV宫内感染率。