Hepatitis C and the British Columbia experience with hepatitis A vaccination

The prevalence of hepatitis C virus (HCV) infection in British Columbia is approximately 1.5%. Experience in this province has revealed that groups at high risk of HCV infection are also prone to outbreaks of hepatitis A virus (HAV). As hepatitis A infection can be fatal in HCV-positive individuals, numerous strategies have been implemented to help minimize its spread. The importance of vaccinating individuals at high risk for hepatitis C infection against HAV has been recognized.     

Seroprevalences of hepatitis B virus and hepatitis C virus among participants of an Asian health fair in the Lower Mainland,British Columbia

BACKGROUND:

The seroprevalences of hepatitis B virus (HBV) and hepatitis C virus (HCV) are 0.4% and 0.8%, respectively, in Canada, but varying rates have been reported in different populations.

OBJECTIVES:

To determine the seroprevalences of HBV and HCV among attendees of an Asian health fair in the Lower Mainland, British Columbia, as well as to correlate questionnaire answers regarding vaccination status to serological profiles.

METHODS:

Attendees at an Asian health fair were invited to participate in the present study on a voluntary basis. They provided answers to a questionnaire including ethnicity and vaccination status. Blood was then drawn for HBV and HCV serology. Active HBV was defined as HBV surface antigen (HBsAg) positive while HCV seroprevalence was defined as HCV antibody reactive. Previous exposure to HBV was defined as HBV core antibody (anti-HBc) positive and HBsAg negative. Nonimmunity was defined as anti-HBc negative and HBV surface antibody negative. Only those with correct demographic information matched to serological results were included in the study.

RESULTS:

There were 192 consenting attendees of the fair, of whom 112 were included in the study. Of the participants, 91% were Chinese. Active HBV infection was found in three participants (2.7% [95% CI 0.6% to 7.6%]) and HCV infection was found in two participants (1.8% [95% CI 0.2% to 6.3%]). More than 40% of participants had been previously exposed to HBV (42% [95% CI 33% to 51%]). Almost 20% demonstrated nonimmunity to HBV (19% [95% CI 12% to 27%]). There was significant discordance when questionnaire answers regarding vaccination status were compared with serological profiles.

CONCLUSION:

The seroprevalences of HBV and HCV in this cohort were 2.7% and 1.8%, respectively – higher than nationally reported rates. Our results highlight that the lack of knowledge of HBV infection and vaccination status remains a significant clinical issue in the Asian community of British Columbia.     

慢性乙型肝炎重叠HAV与HEV感染的临床分析

目的研究慢性乙型肝炎患者重叠甲型肝炎与重叠戊型肝炎病毒的临床特点及其对病情转归的影响。方法采用ELISA法检测甲、乙、丙、戊型肝炎病毒血清标记物,选择慢性乙型肝炎重叠甲型肝炎52例与慢性乙型肝炎重叠戊型肝炎267例进行对比分析。结果慢性乙型肝炎重叠戊型肝炎患者较慢性乙型肝炎重叠甲型肝炎患者总胆红素水平高、重型肝炎发生率高、病死率高,两组白蛋白水平和平均住院日无明显差异。结论慢性乙型肝炎患者重叠戊型肝炎病毒感染较重叠甲型肝炎病毒感染病情更重、预后差。     

脂联素与慢性病毒性肝炎

脂联素是邮旨肪组织产生的一种脂肪因子,其主要作用为调节能量代谢,提高胰岛素的敏感性,抑制动脉粥样硬化等.近年来研究显示,脂联素与炎症及多种肝病具有密切关系,现就脂联素在慢性病毒性肝炎的表达和作用作一综述.     

慢性丙型肝炎的组织学特点和分类

目的研究慢性丙型肝炎的组织病理学特点和新的病变程度的分类，并与慢性乙型肝炎作比较。方法对４９例慢性丙型肝炎和４５例慢性乙型肝炎的肝组织标本，由三位病理科医师双盲读片，记录主要的组织学改变，并根据新老慢性肝炎分类评估。结果慢性丙型肝炎最为突出的组织学改变为肝脂肪变（６１％）、胆管损害（５７％）、肝窦内炎症细胞（４７％）和淋巴细胞聚集（４３％），均较慢性乙型肝炎多见，差异有显著性。本组病例按新的国际分级、分期与传统的慢活肝、慢迁肝的分类比较，二者之间有一定的相关性，但前者更能准确反映病变的程度。结论新的慢性肝炎的组织学分类法优于传统的分类法。值得推广。     

重叠乙型和丙型肝炎病毒感染的临床与病理分析

目的 观察HBV和HCV重叠感染的临床与病理,探讨HBV和HCV相互作用的特点.方法 收集226例慢性肝病患者的血清学指标,实时荧光定量PCR法测定HBV DNA和HCVRNA,ELISA检测HBV血清标志物、抗-HCV抗体.行肝穿刺活组织病理检查、免疫组织化学HBsAg、HBcAg和原位杂交HBV DNA、HCV RNA检测.计数资料比较采用X2检验或Fisher确切率检验.结果 HBV和HCV重叠感染的重度慢性肝炎患者比例为62.50%,高于HBV或HCV单独感染者的27.05%和30.56%(X2=14.70,P＜0.01).HBV感染组的血ALT、AST、TBil、DBil和Alb高于HBV和HCV重叠感染组和HCV感染组,差异均有统计学意义(X2=8.52,P＜0.05).重叠感染组和HBV感染组的血HBsAg与肝内HBsAg一致率比较,差异均有统计学意义(X2=15.60,P＜0.01).HBV和HCV重叠感染组血清HBV DNA阳性率为12.5%,低于HBV单独感染组的87.7%(X2=17.66,P＜0.01);而HBV和HCV重叠感染组HCV RNA阳性率为75.0%,低于HCV单独感染组的80.6%,差异无统计学意义(P＞0.05).结论 HBV和HCV重叠感染导致的肝损伤更明显.     

Rate,delay and predictors of hepatitis C treatment in British Columbia

BACKGROUND:

The current treatment rate for chronic hepatitis C virus (HCV) infection is suboptimal despite the availability of efficacious antiviral therapy.

OBJECTIVE:

To determine the rate, delay and predictors of treatment in patients with chronic HCV infection.

METHODS:

A retrospective chart review of chronic HCV patients who were being evaluated at a tertiary hepatology centre in Vancouver, British Columbia, was performed.

RESULTS:

One hundred sixty-four patients with chronic HCV infection who were assessed for treatment between February 2008 and January 2013 were reviewed. Treatment was initiated in 25.6% (42 of 164). In multivariate analyses, male sex (OR 7.90 [95% CI 1.35 to 46.15]) and elevated alanine aminotransferase (ALT) level (>1.5 times the upper limit of normal) (OR 3.10 [95% CI 1.32 to 7.27]) were positive predictors of treatment, whereas active smoking (OR 0.09 [95% CI 0.02 to 0.53]) and Charlson comorbidity index (per point increase) (OR 0.47 [95% CI 0.27 to 0.83]) were negative predictors of treatment. The most common reasons for treatment deferral were no or minimal liver fibrosis in 57.7% (n=30), persistently normal ALT levels in 57.7% (n=30) and patient unreadiness in 28.8% (n=15). The most common reasons for treatment noninitiation were patient refusal in 59.1% (n=26), medical comorbidities in 36.4% (n=16), psychiatric comorbidities in 9.1% (n=4) and decompensated cirrhosis in 9.1% (n=4). There was a statistically significant difference in the median time delay from HCV diagnosis to general practitioner referral between the treated and untreated patients (66.3 versus 119.5 months, respectively [P=0.033]). The median wait time from general practitioner referral to hepatologist consult was similar between the treated and untreated patients (1.7 months versus 1.5 months, respectively [P=0.768]). Among the treated patients, the median time delay was 6.8 months from hepatologist consult to treatment initiation.

CONCLUSIONS:

The current treatment rate for chronic HCV infection remains suboptimal. Medical and psychiatric comorbidities represent a major obstacle to HCV treatment. Minimal hepatic fibrosis may no longer be a major reason for treatment deferral as more efficacious and tolerable antiviral therapies become available in the future. Greater educational initiatives for primary care physicians would promote early referral of patients. More nursing support would alleviate the backlog of patients awaiting treatment.     

Relationship between hepatitis B virus DNA levels and liver histology in patients with chronic hepatitis B

AIM： To study the relationship between hepatitis B virus （HBV） DNA levels and liver histology in patients with chronic hepatitis B （CHB） and to determine the prevalence and characteristics of hepatitis B e antigen （HBeAg） negative patients.
METHODS： A total of 213 patients with CHB were studied, and serum HBV DNA levels were measured by the COBAS Amplicor HBV Monitor test. All patients were divided into two groups according to the HBeAg status.The correlation between serum HBV DNA levels and liver damage （liver histology and biochemistry） was explored.
RESULTS： Of the 213 patients with serum HBV DNA levels higher than 10^5 copies/mL, 178 （83.6%） were HBeAg positive, 35 （16.4%） were HBeAg negative. The serum HBV DNA levels were not correlated to the age,history of CHB, histological grade and stage of liver disease in either HBeAg negative or HBeAg positive patients. There was no correlation between serum levels of HBV DNA and alanine aminotransferanse （ALT）,aspartate aminotrans-ferase （AST） in HBeAg positive patients. In HBeAg negative patients, there was no correlation between serum levels of HBV DNA and AST,while serum DNA levels correlated with ALT （r = 0.351, P = 0.042）. The grade （G） of liver disease correlated with ALT and AST （P 〈 0.05, r = 0.205, 0.327 respectively）in HBeAg positive patients. In HBeAg negative patients,correlations were shown between ALT, AST and the G （P 〈 0.01, and r = 0.862, 0.802 respectively）. HBeAg negative patients were older （35 ± 9 years vs 30 ±9 years, P 〈 0.05 ） and had a longer history of HBV infection （8 ± 4 years vs 6 ± 4 years, P 〈 0.05） and a lower HBV DNA level than HBeAg positive patients （8.4± 1.7 Log HBV DNA vs 9.8 ± 1.3 Log HBV DNA, P 〈0.001）. There were no significant differences in sex ratio,ALT and AST levels and liver histology between the two groups.
CONCLUSION： Serum HBV DNA level is not correlated to histological grade or stage of liver disease in CHB patients with HBV DNA mor     

宿主遗传背景与乙型肝炎重症化

HBV慢性感染的临床转归包括慢性化和重症化,分别具有不同的疾病进展特性.HBV感染慢性化主要体现为慢性乙型肝炎、肝纤维化、肝硬化、肝癌等病理进程,进展时间较长.     

重视对慢性病毒性肝炎合并肝脂肪变的研究

慢性乙型肝炎是我国最常见的慢性传染病之一,资料显示,全球至少有20亿人感染过HBV,我国HBV携带率为9.75%,约有1.2亿人感染过HBV.丙型肝炎呈全球性流行,以往文献报道我国一般人群抗HCV阳性率为3.2%,感染者约为4100万,根据中国疾病预防控制中心提供的数据,我国每年的新发丙型肝炎已从2003年的2万多人发展为2005年的近6万人.     

拉米夫定治疗前后乙型肝炎病毒YMDD变异的相关因素分析

Objective To identify factors associated with YMDD mutation in patients with chronic hepatitis B before and after Iamivudine treatment in Zunyi region.Methods 53 patients with chronic hepatitis B were enrolled in this study,HBV DNA,HBV markers,ALT,AST,TBil,albumin in the serum were examined at 0,3,6,12,18 and 24 months after lamivudine treatment.HBV genotype and YMDD mutation were determined by sequencing before lamivudine treatment.YMDD mutation was checked again if serum HBV DNA rebound to more than 1×104 copies/ml after the initial decrease.Results HBV genotype in Zunyi region iS constitute of B.C and B+C genotype.YMDD mutation occurred in 18 cases after lamivudine treatment.the rate of YMDD mutation was 15.1%,and 34.0% after 1 year and 2 years treatment.There are four types of mutation:nL180M/M204V,rtL180M/M2041,rtM204I,nL180M.rtM204V mutation in C gene was always acompanied by rtL180M mutation (100%). The rate of rtL180M/M204V mutation in genotype C group was significantly higher than that in genotype B group (77.8% to 25.0%),the same was true for the rtL180M/M204I mutation (22.2% to 12.5%). There was no point mutation in genotype C group. The point mutation of rtM204I and rtL180M appeared only in genotype B group. Gender,nation,family history of hepatitis B and HBeAg were not associated with YMDD mutation (P ＞ 0.05),while the mutation rate was associated with the disease course and severity of disease. YMDD mutation did not occure in patients with low HBV DNA level (＜105 copies/ml). Conclusion YMDD mutation after lamivudine therapy is associated with HBV gnnotype and P gene mutation type,and prolonged treatment increases the the mutation rate. In order to reduce the incidence of YMDD mutation,patients with shorter disease course,lower HBV DNA level,more serious liver damage should be treated with iamivudine.     

米非司酮和米索前列醇用于HBV携带者和慢性丙型肝炎患者早孕药物流产安全性评价*

目的调查米非司酮配伍米索前列醇行药物流产在肝病患者中应用的安全性。方法270例HBV感染者、12例慢性丙型肝炎患者和181例非肝炎病毒感染者早期妊娠,给予米非司酮和米索前列醇口服行药物流产。常规检测血生化指标和血清病毒指标。结果HBV和HCV感染者排出胎囊大小为2.36±0.89 cm,对照组排出胎囊大小为2.37±0.79 cm;在270例HBV感染者中,流产成功率为90.5%,12例丙型肝炎患者流产成功率为90.7%,对照组流产成功率为90.6%,各组差异不具有统计学意义（P>0.05）;无论是HBV感染者、慢性丙型肝炎患者,还是非肝炎病毒感染者,在流产后肝功能无显著性变化,无肝损伤病例发生。结论HBV和HCV感染者行米非司酮联合米索前列醇药物流产是安全有效的。     

复方甘草酸苷联合苦参素治疗慢性肝炎患者对血清肝纤维化指标的影响

目的：观察复方甘草酸苷联合苦参素治疗慢性肝炎患者对血清肝纤维化指标的影响。方法将56例慢性乙型肝炎或慢性丙型肝炎患者随机分成对照组与治疗组,每组28例,分别应用苦参素或复方甘草酸苷联合苦参素治疗,疗程12周。结果在治疗结束后,联合组患者 ALT 为（34.9±18.4） U/L,HA 为（129.4±98.2） ng/ml,LN 为（130.7±71.2） ng/ml,PⅢNP 为（25.3±14.8） ng/ml,CⅣ为（100.5±34.2） ng/ml,均显著低于对照组[分别为（ALT58.4±37.7）U/L、（182.2±93.3） ng/ml、（176.6±91.6） ng/ml、（35.4±21.4） ng/ml 和（128.4±51.9） ng/ml,P＆lt;0.05]。结论复方甘草酸苷联合苦参素能明显降低慢性肝炎患者血清肝纤维化指标。     

Pancreatic involvement in chronic viral hepatitis

AIM:To elucidate the frequency and characteristics of pancreatic disorders in the course of chronic viral hepatitis. METHODS:We prospectively assessed the serum pancreatic enzyme levels and imaging findings in patients with chronic viral hepatitis and healthy control subjects. RESULTS: Serum amylase (t-Amy), salivary amylase (s-Amy), pancreatic amylase (p-Amy) and serum lipase levels were higher in hepatitis patients in comparison to control subjects. However, in asymptomatic viral carriers, only the serum t-Amy levels were higher than those of the controls. The levels of each enzyme rose with the progression of liver disease in patients with hepatitis B or C; whereas the levels of each enzyme within the same clinical stage of the disease did not differ between patients diagnosed with either hepatitis B or hepatitis C virus. Imaging findings demonstrated chronic pancreatitis in only 1 out of 202 patients (0.5%). CONCLUSION: Our data suggest that serum levels of pancreatic enzymes increase with the progression of liver disease in patients diagnosed with viral hepatitis. Pancreatic disease, asymptomatic in most cases, may represent an extrahepatic manifestation of chronic viral hepatitis.     

乙型肝炎重症化研究现状和发展趋势

在乙型肝炎的抗病毒治疗已取得长足进展的同时,重症乙型肝炎的发病率并未明显下降,且病死率仍居高不下.亚太肝病学会慢加急性肝功能衰竭(ACLF)专家组对ACLF的定义为:已确诊或未经诊断的慢性肝炎患者急性发作,表现为以黄疸和凝血障碍为主的肝损伤,4周内并发腹水和(或)肝性脑病~([1]).重症乙型肝炎的发病率及病死率仍居高不下,部分与HBV耐药变异、HBV再活化或合并感染等相关~([2-4]).     

慢性肝病者乙型和丙型肝炎病毒重叠感染的研究

对２１３例老年慢性肝病患者的乙型肝炎病毒（ＨＢＶ）和丙型肝炎病毒（ＨＣＶ）血清标志物检测发现：ＨＢＶ感染占７３．２４％、ＨＢＶ和ＨＣＶ重叠感染占重叠感染点１５．４９％、ＨＣＶ感染占７．０４％、其它占４．２６％；ＨＢＶ阴性者ＨＣＶ检出率高于ＨＢＶ阳性者，肝癌和肝硬化患者较慢性肝炎患者高；ＨＢＶ和ＨＣＶ重叠感染患者的血清血蛋白下降显著，γ－球蛋白升高明显，肝硬化并腹水和上消化道出血者了多。结果表明，老     

慢性丙型肝炎患者2型糖尿病并发率调查及其基因型特征分析

目的通过调查慢性丙型肝炎患者2型糖尿病并发率及其与所感染丙型肝炎病毒（HCV）基因型的关系。进一步探讨糖尿病是否为丙型肝炎的肝外表现之一。方法采用荧光定量聚合酶链反应和聚合酶链反应一微板核酸杂交酶联免疫技术对308例慢性丙型肝炎、305例慢性乙型肝炎患者进行乙型肝炎病毒、HCV定性．定量检测和HCV基因型分析并比较其与对照人群糖尿病并发率的差异。结果慢性丙型肝炎患者糖尿病并发率为32．79％，明显高于慢性乙型肝炎（9．84％）及对照组（8．39％）。合并糖尿病的慢性丙型肝炎患者血清丙氨酸氨基转移酶及总胆红素水平显著高于未合并糖尿病者，且以1b型HCV的感染率为最高，占40．59％，与未合并糖尿病者相比差异有统计学意义。结论慢性丙型肝炎患者糖尿病并发率高，以1b型多见，且病情相对较重。     

加强乙型肝炎重症化的基础和临床研究

<中华肝脏病杂志>2010年第2期和本期发表了宁琴、侯金林、王宇明、唐红、陈智和魏来等教授写的关于慢性乙型肝炎重症化的系列文章,包括乙型肝炎重症化研究现状和发展趋势,乙型肝炎病毒(HBV)变异、转录复制调控与乙型肝炎重症化,宿主遗传背景、免疫学应答与乙型肝炎重症化,现代诊断技术平台、细胞治疗与乙型肝炎重症化等,系统地综述了国内外关于慢性乙型肝炎重症化的基础和临床研究最新进展,主题突出,内容新颖,观点明确,证据充分;既有国内外最新的文献综述,又有作者自己的研究成果和临床经验,并展望了乙型肝炎重症化的基础和临床研究方向.     

六种治疗方案对1910例甲型肝炎和233例急性乙型肝炎患者疗效分析

目的 回顾性观察甘草酸二胺（5组）、单胺（6组）、山莨菪碱（2组）、门冬氨酸钾镁（3组）、山莨菪碱＋门冬氨酸钾镁注射液（4组）、茵黄片（1组）治疗甲型肝炎和急性乙型肝炎患者的疗效。方法 甘草酸二胺150mg、单胺40ml、山莨菪碱10mg、门冬氨酸钾镁20m1分别加入5％～10％葡萄糖注射液250ml中静脉滴注，口服茵黄片治疗甲型肝炎和急性乙型肝炎共2143例，治疗结束后进行疗效分析。结果 甲型肝炎、急性乙型肝炎患者的治愈率分别为96．3％、94．4％。甲型肝炎组中，甘草酸二胺、单胺可使患者平均住院日、纳差、乏力消失、丙氨酸氨基转移酶（ALT）、血清胆红素（SB）复常的时间较其他组分别缩短5～7、2～4、1～2、4～7、4～8天，差异有显著性（P〈0．02～0．001）。1组患者纳差、巩膜黄染、肝区叩痛消失时间较其他组分别延长1～4、1～8、2～5天，差异有显著性（P〈0．05～0．001）。急性乙型肝炎组中，5、6组患者的平均住院日、ALT、SB复常时间为36．2、35．1，23．7、23．9，19．1、19．0天，较其他组缩短7．11、4．6、5．7天，恶心、纳差消失时间为10．9、10．5，13．0、13．7天，较1组患者缩短2～3天，乏力消失时间为14．6、15．0天，较1、2组患者缩短3～5天（P〈0．05～0．01）。结论 在治疗甲型肝炎和急性乙型肝炎时，甘草酸二胺和单胺在改善患者临床症状和肝功能指标方面优于茵黄片、山莨菪碱和门冬氨酸钾镁等药物，甘草酸二胺、单胺在治疗甲型肝炎和急性乙型肝炎中疗效相当。口服茵黄片的疗效低于静脉应用药物。