外周血单个核细胞感染乙型肝炎病毒对新生儿宫内感染的影响

目的探讨HBsAg、HBeAg阳性孕妇外周血单个核细胞(PBMC)内乙型肝炎病毒(HBV)DNA感染状况及其在宫内母婴垂直传播中的作用.方法对HBsAg/HBeAg双阳性共67对孕妇及其新生儿静脉血分离和提纯PBMC后,经抽提、纯化后的DNA进入PCR扩增反应,引物为HBV C区基因序列.结果67例HBsAg及HBeAg双阳性的孕妇中有35例(52.2%)PBMC中HBV DNA阳性,25例孕妇在血清及PBMC中均发现HBV DNA.67例新生儿有22例感染HBV DNA,感染率32.8%,其中血清HBV DNA阳性者10例,PBMC HBV DNA阳性者19例,二者均阳性者7例.结论母亲PBMC内HBV DNA阳性可能导致新生儿PBMC中HBV DNA阳性,PBMC内的HBV DNA可能是HBV母婴垂直传播的一条重要途径,同时,HBsAg及HBeAg阳性母亲若血清HBV DNA为阳性就极大增加了其新生儿感染HBV的危险性.     

乙肝孕妇分娩方式与新生儿HBV宫内感染关系

目的 探讨乙型肝炎孕妇分娩方式与新生儿乙型肝炎病毒(HBV)宫内感染的关系.方法采用问卷调查方式收集HBsAg阳性孕妇分娩方式等资料,用酶联免疫吸附试验检测孕妇和新生儿出生24h内外周血乙肝病毒标志物,实时荧光定量PCR检测母亲和新生儿外周血HBV DNA含量.结果新生儿HBsAg阳性者101例,HBVDNA阳性者30例,二者任一项阳性者113例,宫内感染率为9.5％(113/1 191);孕妇分娩时选择阴道产582例,剖宫产609例,2组宫内感染率差异有统计学意义(x2= 18.563,P=0.001);孕妇血清HBeAg和HBV DNA均阴性、HBeAg阳性而HBV DNA阴性、HBeAg和HBV DNA均阳性时,阴道分娩组和剖宫产组新生儿宫内感染率差异均有统计学意义(x2值分别为7.382、4.919、5.364,均P＜0.05);HBsAg阳性孕妇HBV DNA含量≤103和105 ～ 107 copies/mL时的分娩方式与宫内感染均有关(x2值分别为10.777、8.450,均P＜0.05).结论分娩方式与新生儿HBV宫内感染有关,HBsAg阳性孕妇选择剖宫产可能有利于降低HBV宫内感染率.     

母血HBV DNA含量与新生儿HBV感染关系

目的 探讨HBsAg阳性孕妇外周血乙型肝炎病毒(HBV)DNA含量及细胞转运与新生儿HBV感染的关系.方法 用荧光定量PCR方法定量检测HBsAg阳性孕妇血清HBV DNA;用等位基因特异性PCR及半巢式PCR技术扩增HBsAg阳性孕妇新生儿外周血中母亲DNA,通过检测谷胱甘肽-S-转移酶(GSTM1)、血管紧张素转换酶(ACE)等位基因确定母-胎细胞转运;用巢式PCR检测新生儿血清、外周血单个核细胞(PBMC)中HBV DNA.结果 随着孕妇血清HBV DNA含量的增加,新生儿HBV DNA阳性的危险性呈现增高趋势(X~2=13.16,P<0.05,趋势X~2=12.42,P<0.05),而孕妇血清HBV DNA含量与新生儿PBMC HBV DNA阳性无关(总X~2=2.41,P>0.05,趋势X~2=0.35,P>0.05);孕妇血清HBV DNA含量与母-胎细胞转运无关(总X~2=4.14,P>0.05,趋势X~2=0.001,P>0.05);母-胎细胞转运与新生儿外周血PBMC HBV DNA阳性有关(X~2=10.26,P<0.05),而与新生儿外周血HBV DNA阳性无关(X~2=0.49,P>0.05).结论 HBsAg阳性孕妇血清HBV DNA含量、母-胎细胞转运与新生儿HBV感染有关,分别是新生儿血清、PBMC HBV感染的重要危险因素.     

外周血单个核细胞感染乙型肝炎病毒对新生儿宫内感染的影响

目的 :探讨 HBs Ag、 HBe Ag阳性孕妇外周血单个核细胞 ( PBMC)内乙型肝炎病毒 ( HBV) DNA感染状况及其在宫内母婴垂直传播中的作用。方法 :对 HBs Ag/ HBe Ag双阳性共 6 7对孕妇及其新生儿静脉血分离和提纯 PBMC后 ,经抽提、纯化后的 DNA进入 PCR扩增反应 ,引物为 HBV C区基因序列。结果 :6 7例 HBs Ag及 HBe Ag双阳性的孕妇中有 35例 ( 5 2 .2 % )PBMC中 HBV DNA阳性 ,2 5例孕妇在血清及 PBMC中均发现 HBV DNA。6 7例新生儿有 2 2例感染 HBV DNA,感染率 32 .8% ,其中血清 HBV DNA阳性者 10例 ,PBMC HBV DNA阳性者 19例 ,二者均阳性者 7例。结论 :母亲 PBMC内 HBV DNA阳性可能导致新生儿 PBMC中 HBV DNA阳性 ,PBMC内的 HBV DNA可能是 HBV母婴垂直传播的一条重要途径 ,同时 ,HBs Ag及HBe Ag阳性母亲若血清 HBV DNA为阳性就极大增加了其新生儿感染 HBV的危险性     

HBsAg阳性孕妇的新生儿宫内HBV感染状况的研究

目的:探讨HBsAg阳性孕妇的新生儿宫内HBV感染率,为临床提供判断宫内HBV感染的实验指标。方法:应用酶联免疫吸附试验(ELISA)法分别检测88例孕妇及其新生儿的血清HBsAg、HBeAg。应用荧光定量PCR技术检测孕妇血清HBV-DNA,检测新生儿血清HBV-DNA和外周血单个核细胞内HBV-DNA。结果:①以新生儿HBsAg阳性作为判断指标、88例新生儿宫内感染率为6.82%(6/88);以新生儿血清BHV-DNA阳性作为判断指标,88例新生儿宫内感染率为13.64%(12/88);以新生儿PBMC内HBV-DNA阳性作为判断指标,88例新生儿宫内感染率为17.05%(15/88)。②孕妇HBsAg阳性,同时伴有HBeAg和HBV-DNA阳性的新生儿宫内感染率明显高于只有HBsAg阳性而HBeAg和HBV-DNA阴性的孕妇。结论:新生儿HBsAg检测,检测方法简便、易行,但作为判断宫内感染的指标,有漏检和低估的可能。必须结合血清和PBMC内的HBV-DNA检测才能正确判断。HBeAg阳性和HBV-DNA阳性的孕妇更有宫内传播HBV给胎儿的可能性。     

乙肝母亲HBV DNA含量及肝功能与其新生儿HBV宫内感染的关系

[目的]探讨乙型肝炎母亲血清HBV DNA含量及反映肝脏损伤的相关肝功能指标与新生儿HBV宫内感染的关系. [方法]连续收集2006年9月～2007年7月在太原市传染病医院产前检查及分娩的191例HBsAg阳性孕妇及其新生儿为研究对象,用荧光定量PCR(FQ-PCR)法检测母亲及其新生儿血清HBV DNA含量;用全自动生化仪检测肝功能;酶联免疫吸附试验(ELJSA)检测新生儿血清HBsAg.采用SPSS13.0统计软件进行统计分析. [结果]孕妇血清HBV DNA含量与HBV官内感染有关,且HBV DNA含量≥104 copy/ml以上与宫内感染显著相关;乙肝母亲丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)水平与HBV宫内感染无关联. [结论]孕妇血清HBV DNA含量是HBV宫内感染的危险因素,且HBV DNA含量≥104 copy/ml时,宫内感染发生率显著增加;乙肝母亲肝功能异常与HBV宫内感染无关.     

乙型肝炎病毒宫内感染的细胞分子机制

目的 :探讨HBV宫内传播的细胞分子机制及其对新生儿的影响。方法 :将 12 3例HBsAg阳性孕妇新生儿按发生和未发生HBV宫内感染进行分组。用巢式PCR和选择性PCR法分别对 12 3例HBsAg阳性孕妇及其新生儿血清、外周血单个核细胞 (PBMC)中HBVDNA进行检测。结果HBsAg阳性孕妇血清及外周血PBMC中HBVDNA阳性率分别为4 3 0 9%和 30 0 8% ,新生儿血清、PBMC中HBVDNA阳性率分别为 19 5 1%和 2 6 0 2 %。而且HBsAg阳性孕妇PBMCHBVDNA与血清HBVDNA无关联 (χ2 =1 4 7,P =0 2 3) ;新生儿PBMCHBVDNA与血清HBVDNA无关联 (χ2 =0 83,P =0 36 ) ;HBsAg阳性孕妇血清HBVDNA与新生儿血清HBVDNA有关联 (χ2 =4 5 8,P =0 0 3) ,而与新生儿PBMCHBVDNA无关联 (χ2 =0 2 5 ,P =0 6 2 ) ;HBsAg阳性孕妇PBMCHBVDNA与新生儿PBMCHBVDNA显著相关 (χ2 =2 1 6 1,P =0 0 1) ,也与新生儿HBV宫内感染显著相关 (χ2 =12 86 ,P <0 0 1)。结论 :HBV通过胎盘导致胎儿宫内感染的传播途径可通过血清直接传播 ,也可通过PBMC介导。PBMC介导的HBV宫内传播较隐匿 ,孕妇PBMCHBVDNA阳性也是HBV宫内感染的重要因素。     

剖析住院患者中的乙肝病毒携带状态

目的 剖析住院患者中的乙型肝炎病毒（HBV）携带状态,为制定护理人员HBV职业感染的防护方法提供依据.方法对992例连续入院的住院患者入院时取空腹静脉血3 ml,分离血清于-40℃保存备用.使用ELISA法检测每份血清的乙型肝炎病毒表面抗原（HBsAg）和乙型肝炎病毒e抗原（HBeAg）.使用套式聚合酶链反应（n-PCR）检测所有HBsAg阳性患者和100例连续入院的HBsAg阴性患者血液的HBV DNA.将n-PCR检测HBV DNA低限作为一个HBV感染剂量,使用n-PCR极量稀释法检出每份HBV DNA阳性血清所含的HBV感染剂量/ml,以此作为HBV传染性或病毒浓度的指标.结果 992例住院患者中156例HBsAg阳性（HBsAg阳性者）,依据HBeAg是否阳性将HBsAg阳性者分为HBeAg阳性和阴性2种类型,HBeAg阳性者31例（19.87%）,阴性者125例（80.13%）.73.7% 的HBsAg阳性者HBV DNA阳性,病毒浓度范围为0～109感染剂量/ml,26.3%的 HBsAg阳性者HBV DNA阴性,病毒浓度在n-PCR的检测阈值之下.9%的HBsAg阴性者HBV DNA阳性,病毒浓度范围在0～104感染剂量/ml,最大传染性较HBsAg阳性者小105感染剂量/ml.HBeAg阳性者的病毒浓度范围在102～109 感染剂量/ml,阴性者在0～106 感染剂量/ml;HBeAg阳性者的病毒浓度较阴性者高103倍.结论住院患者中存在隐匿性和HBsAg阳性2种HBV携带状态,两者的最大HBV浓度相差105感染剂量/ml;HBeAg阳性者是HBV携带者中传染性较强部分,病毒浓度较阴性者高103倍.这些特点可为制定护理人员HBV职业感染的防护方法提供依据.     

HBsAg阳性产妇血清、乳汁和新生儿血清中乙肝病毒DNA检测结果分析

目的:检测乙肝病毒血清学标志物阳性产妇血清、乳汁及其新生儿脐带血中HBV DNA含量,指导哺乳,减少母婴传播。方法:用荧光定量PCR法检测产妇血清、乳汁和新生儿脐带血中HBV DNA含量。结果:血清高病毒血症组(≥108copies/ml)产妇初乳和新生儿脐血HBV DNA阳性率明显高于其他组。同时与血清HBeAg存在显著相关,血清HBeAg阳性组中产妇自身HBV DNA阳性率明显高于HBeAg阴性组,在初乳和脐血中的HBV DNA也有差异。结论:乙肝病毒宫内感染的发生率与孕妇血清HBV DNA含量相关,孕晚期高病毒血症与宫内感染显著相关;产妇血清高HBV DNA含量,乳汁HBV DNA阳性不适宜母乳喂养,HBeAg阳性者应加强监测,在科学的指导下母乳喂养。     

HBsAg阳性孕妇新生儿HBV宫内感染的影响因素研究

目的探讨HBsAg阳性孕妇新生儿发生HBV宫内感染的相关影响因素。方法以太原市第三人民医院产前检查并分娩的HBsAg阳性孕妇及其新生儿为研究对象,收集HBsAg阳性孕妇一般情况(年龄、文化程度)、分娩前HBIG注射史、家人HBV感染史、乙肝病毒标志物以及新生儿出生24小时内的乙肝病毒标志物的资料。以新生儿是否发生HBV宫内感染将379例HBsAg阳性孕妇分为两组,HBV宫内感染组36例,非HBV宫内感染组343例,进而分析HBsAg阳性孕妇的一般情况、家人感染HBV史、HBV复制状态、HBV血清标志物阳性模式及HBIG注射史与新生儿HBV宫内感染的关系。结果 (1)单因素分析显示:HBV宫内感染组与非HBV宫内感染组的HBsAg阳性孕妇年龄、HBV复制状态、HBV血清标志物阳性模式的差异均有统计学意义(P<0.05),而两组间HBsAg阳性孕妇文化程度、家人HBV感染史和HBIG注射史的差异均无统计学意义(P>0.05)。(2)多因素Logistic回归分析显示:HBsAg阳性孕妇的年龄(OR=0.398,95%CI0.159～0.996)与HBeAg和HBV DNA双阳性(OR=2.539,95%CI 1.233～5.227)被引入回归方程。同时分析HBsAg阳性孕妇HBV DNA含量分级与HBV宫内感染关系的结果显示其差异有统计学意义(χ2=10.983,P=0.004),且进行趋势卡方分析后,显示HBV DNA拷贝数在>106时,HBV宫内感染率明显上升。结论 HBsAg阳性孕妇年龄(>30岁)是HBsAg阳性孕妇HBV宫内感染的保护因素,而血清HBeAg和HBV DNA均为阳性和HBVDNA拷贝数>106时,其发生HBV宫内感染的可能性较大。     

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.     

Acute infection by hepatitis B virus

The clinical spectrum of acute hepatitis B virus infection is very broad, with clinical manifestations that range from anicteric and sub-clinical hepatitis to severe acute icteric hepatitis and even, in some cases, to fulminant hepatitis. Diagnosis depends to a large extent on the degree of clinical suspicion of hepatitis, establishing the aetiological origin of the B virus through the study of serological markers and/or DNA in the blood. Although in the majority of cases there is a favourable evolution of acute hepatitis B virus infection, with spontaneous resolution of the clinical manifestations in 4-8 weeks, progression to chronic hepatitis is not unusual in certain cases, above all in infancy. No specific treatment exists for acute hepatitis B virus infection that would reduce its severity or prevent its evolution into chronic hepatitis. However, relative rest and the administration of an hypercaloric diet are recommended. In cases of severe acute hepatitis hospital admission should be recommended; in cases of fulminant hepatitis, admission to the intensive care unit for intensive monitoring and evaluation of a liver transplantation is recommended if spontaneous improvement does not occur. This paper reviews briefly the clinical manifestations, diagnosis, prognosis and treatment of acute hepatitis B virus infection.     

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.     

Occupational hepatitis B virus infection in sewage workers

In a cross-sectional study the employees of a Sewage Company were tested for hepatitis B virus (HBV) markers--HBsAg, anti-HBs, anti-HBc--to determine the prevalence of HBV infection and assess the risk of exposed sewage workers becoming infected, so as to evaluate the necessity for appropriate vaccination. The overall prevalence of HBV markers was 43.9% and 6.6% of the employees were HBsAg carriers. In the univariate analysis the prevalence of past and current infection was significantly associated with exposure to sewage (p < 0.001), age (p < 0.001) and with educational level (p < 0.001). However, the logistic regression analysis confirmed that only exposure to sewage was independently associated with positivity for HBV infection (p < 0.001). Workers exposed to sewage should therefore be considered for vaccination against hepatitis B virus.     

隐匿性HBV感染的研究

隐匿性HBV感染的存在和临床意义已经被许多研究所证实,且发现在单纯抗-HBc阳性者中发生率最高.此文就各类人群隐匿性HBV感染的若干研究作了综述.     

Treatment of chronic hepatitis B virus infection

The treatment of the patient with chronic hepatitis B virus infection (HBV) must be carried out with the knowledge that the percentage of patients infected with the B virus that develop chronic hepatitis remains between 5-10%. Of these, 10-30% will present chronic infection with active viral replication, necroinflammatory hepatic lesion, evolution to hepatic cirrhosis and the risk of developing hepatocarcinoma. For this reason, the aim of treatment is to achieve negativisation of the HBeAg, seroconversion to anti-HBe and a reduction of viral replication to undetectable values (estimated by level of DNA-HBV), for protracted periods of time. When a sustained loss of HBeAg and a reduction of viral replication are obtained, a biochemical, clinical and histological remission is achieved. Up until now the therapeutic alternatives in chronic infection by the B virus have been immunomodulation with Interferon alpha and the blocking of viral replication with lamivudine or adefovir dipivoxil. A difference must be drawn between the biochemical response, defined as a fall in the transaminases to normal values, and the virological response, which refers to a fall in the levels of DNA-HBV below 10(5) copies/ml. Finally, the complete response is defined as the virological and biochemical response with negativisation of the HBsAg. If a sustained response is obtained for several months, a histological response can be predicted with reduction in the intensity of the hepatic lesion and an absence or stabilisation in the process of fibrosis. The sustained response should last for no less than 6 to 12 months following the end of treatment.     

乙肝疫苗免疫人群乙肝病毒感染和发病状况研究

目的了解上海市儿童乙肝疫苗免疫后乙肝病毒感染和发病情况。方法采用多阶段随机抽样方法,于2000年和2006年共计抽取1 904份接种人群血液标本,用酶联免疫吸附试验（ELISA）检测HBsAg、抗-HBs和抗-HBc。结果新生儿乙肝疫苗接种率和及时率均保持较高水平。20岁以下人群乙肝发病率明显下降;HBsAg携带率降幅为78.34%。儿童乙肝患者中84.35%（124/147）未接种过乙肝疫苗;23例接种乙肝疫苗但患病的儿童中,12例患儿的母亲或父亲HB-sAg阳性。结论儿童接种乙肝疫苗是预防和降低乙肝感染的有效措施。需加强母（父）婴阻断和家庭内传播机制的研究。     

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.     

性传播疾病患者HBV感染状况

目的 了解５５５名性病门认及诊ＨＢＶ感染状况。方法 ＨＢｓＡｇ、抗ＨＢｓ、抗－ＨＢｃ、ＨＢｅＡｇ和抗ＨＢｅ的检测,采用ＥＬＩＳＡ法,性传播疾病的诊断与检测参照卫生《性病防治手册》。结果 性病患ＨＢｓＡｇ感染率（２２．５０％）高于对照组（１４．４％）,二差异有显性（Ｘ＾２＝５．１４,Ｐ〈０．０５）、梅毒患ＨＢｓＡｇ感染庞（２３．５１）高于对照组（４．８１％）,三差异有显性（Ｘ＾２＝５．