慢性乙型重型肝炎并发胆道感染35例临床分析

目的探讨慢性乙型重型肝炎并发胆道感染的临床特点及治疗效果。方法观察35例慢性乙型重型肝炎并发胆道感染患者的体温、右上腹痛、腹部压痛、血常规及腹部B超等临床表现。经验性用药主要选用针对革兰氏阴性杆菌的抗生素进行抗感染治疗,观察患者的预后。结果 35例慢性乙型重型肝炎并发胆道感染患者,85.7%、82.9%、62.9%分别出现发热、右上腹痛、右上腹压痛,68.6%白细胞总数〉10×109/L,B超检查均有胆囊和胆管壁增厚、毛糙等变化。经抗感染治疗后分别有71.4%和14.3%胆道感染治愈和好转,57.1%患者肝功能好转。结论大部分慢性乙型重型肝炎并发胆道感染患者有典型的胆道感染的表现,常以革兰氏阴性杆菌感染为主,早期发现以及有效地应用敏感抗生素治疗能改善预后。     

162例慢性乙型重型肝炎医院感染调查分析

目的 分析总结慢性乙型重型肝炎患者发生医院感染的特点,为加强医院感染的防控提供帮助.方法 调查分析我院2008年1月至2011年10月收治的慢性乙型重型肝炎患者162例发生医院感染的情况.结果 162例慢性乙型重型肝炎患者中发生医院感染35例,医院感染率为21.6％.感染部位以腹腔感染和呼吸道感染最多,其次为肠道感染.病原菌以大肠埃希茵和肺炎克雷伯杆菌常见.医院感染主要发生在住院时间15-30d,占72.09％.医院感染组治疗无效率(20％)显著高于非医院感染组(7.09％)(P＜0.05).结论 慢性乙型重型肝炎医院感染发生率高,应积极治疗原发病,改善肝功能,严格遵守消毒隔离制度,加强医院感染的防控,从而提高生存率.     

重型肝炎

151例亚急性重型肝炎患临床特征与预后分析；氟康唑胶囊联合大蒜素注射液治疗慢性乙型重型肝炎合并真菌感染的疗效分析；106例重型肝炎并发医院感染的危险因素分析；慢性乙型重型肝炎患外周血IL-18、IL-4、TFNY变化的研究；中药结肠透析治疗慢性重型肝炎的临床效果观察与护理；岩黄连联合灯盏花素注射液治疗慢性重型肝炎43例；     

重型病毒性肝炎病原学特点及转归

探讨重型病毒尾肝炎的病原学特点。收集各型重型病毒性肝炎418例，分析其病原学分型及乙型肝炎病毒不同病原学模式与重型肝炎预后的关系。急性重型肝炎以甲型、戊型及乙型病毒性肝炎为主，乙型肝炎病毒感染治愈后病毒阴转率较高。亚急性有慢性重型肝炎以乙型肝炎病毒毒感染居首，占92．8％。在乙型肝炎病毒感染的病原学模式中，以HBsAgHBeAbHBcAb阳性的重型肝炎发病及死亡率最高。乙型肝炎病毒与其他肝炎病毒重叠感染与单独感染比较，死亡率无显著差异。单纯TTV感染可导致重型肝炎。重型肝炎发病后HBVDNA可自然阴转，阴转率可达53．6％。重型肝炎仍以乙型肝炎病毒病毒感染为主。乙型肝炎病毒前C区发生基因突变可能较易发生重型肝炎。     

慢性乙型重型肝炎与血清血小板活化因子的相关性

目的:探讨血小板活化因子变化在慢性乙型重型肝炎预后评估中的临床价值.方法:将49例慢性乙型重型肝炎患者分为好转组(n=26)和死亡组(n=23),另选择20例健康体检者作为对照组.重型肝炎患者均采用综合治疗.分别检测治疗前和治疗后血清内毒素和人血小板活化因子值,统计慢性乙型重型肝炎患者死亡率.结果:49例慢性乙型重型肝炎患者内毒素血症发生率为85.71%(42/49),死亡组和好转组血清内毒素浓度均高于正常对照组(均P<0.01);好转组治疗后血清ET浓度明显低于治疗前(P<0.01);死亡组和好转组的血清PAF含量均高于正常对照组(均P<0.01);好转组治疗后血清PAF浓度明显低于治疗前(P<0.01);发生内毒素血症的患者PAF浓度明显高于未发生内毒素血症的患者(P<0.05);经Logistic回归分析,TBIL、ET、PAF与慢性乙型重型肝炎患者预后成正相关(P<0.05或0.01,OR=0.799、0.040、2.007),PTA与慢性乙型重型肝炎患者预后成负相关(P<0.05,OR=0.015),其中以PAF与预后的关系最为密切.结论:血小板活化因子下降与肝功能改善、临床表现好转有密切关系,慢性乙型重型肝炎患者血小板活化因子含量可作为评价重型肝炎预后的指标之一.     

肝硬化患者医院内感染的临床分析

３４６例肝硬化患者,其中代偿期７８例,失代偿２１４例,慢性重症肝炎５４例。８５例发生院内感染,院内感染率为２４６％。肝硬化失代偿期和慢性重型肝炎的院内感染发生率明显高于代偿组分别为２３８％,４２．６％和１４１％。肝硬化失代偿期和慢性重型肝炎感染部位以腹腔和消化道为主,肝硬化代偿期以呼吸道和消化道为主。医院内感染的病原菌在肝硬化代偿期以革兰氏阳性菌为主,在失代偿期和慢性重型肝炎则以革兰氏阴性杆菌为主。腹水、腔道出血、侵袭性操作、脾功能亢进是感染的主要危险因素。讨论：肝硬化患者机体免疫功能低下,必须…     

乙型肝炎病毒e抗原阴性慢性乙型重型肝炎85例临床特点

中国慢性乙型肝炎防治指南中,已参照欧美诊治指南将慢性乙型肝炎分为HBeAg阳性和阴性两类,两类肝炎的临床特点、疗效以及预后等均有所不同。现将HBeAg阴性与HBeAg阳性的慢性乙型重型肝炎进行比较,分析HBeAg阴性的慢性乙型重型肝炎临床特点与预后。一、资料与方法1.对象:2002年7月至2004年12月在北京地坛医院住院治疗、出院诊断为慢性乙型重型肝炎的204例患者,其中HBeAg阴性85例,HBeAg阳性119例;男169例,女35例;慢性乙型重型肝炎早期53例、中期65例、晚期86例。     

失代偿期肝硬化及慢性重型肝炎患者感染病原菌分布与耐药性研究

目的探究失代偿期肝硬化及慢性重型肝炎患者感染病原菌分布与耐药性。方法随机选取如皋市人民医院2014年1月-2015年1月收治的528例慢性重型肝炎与失代偿期肝硬化患者的临床资料,收集患者痰液、血液和咽拭子的标本进行细菌培养,使用K-B纸片扩散法对药敏试验进行检测。结果 20例慢性重型肝炎患者感染病原菌,感染率为18.5%;38例失代偿期肝硬化患者感染病原菌,感染率为9.0%;真菌(15.1%)、革兰阴性菌(60.4%)及革兰阳性菌(24.5%)为培养出的主要病原菌。结论研究慢性重型肝炎和失代偿期肝硬化患者感染病原菌的分布和耐药性有着重要的临床指导意义。     

漳州地区各种肝炎患者感染TTV的研究

了解和掌握漳州地区各种肝炎病人感染ＴＴＶ情况及输血与感染ＴＴＶ的关系。采用ＴＴＶ套式ＰＣＲ法对漳州地区病原分型为甲、乙、丙、戊、庚型肝炎病人和非甲～庚型肝炎病人 (包括有输血史和无输血史 )及临床分型为急性肝炎、慢性肝炎和重型肝炎病人的血清进行ＴＴＶＤＮＡ检测分析。结果表明 ,甲、乙、丙、戊、庚型肝炎和非甲～庚型肝炎病人ＴＴＶ感染率分别为 10 .3%、2 5.9%、2 5.0 %、32 .4 %、2 6.3%和 36.8% ,各型间感染率无显著差异 (Ｐ >0 .0 5)。急性肝炎、慢性肝炎和重型肝炎患者ＴＴＶ感染率分别为2 1.3%、2 5.4 %和 34 .4 % ,…     

386例重型肝炎医院感染调查分析

目的分析重型肝炎患者发生医院感染的特点,为有效预防医院感染的发生提供帮助。方法应用SPSS 13.0统计软件对2009年1月至2013年12月收治的386例重型肝炎中发生医院感染病例进行回顾性分析。结果 386例重型肝炎患者中发生医院感染71例,医院感染率为18.39%。感染部位以腹腔感染、呼吸道感染肠道感染为主。病原菌以肺炎克雷伯杆菌、大肠埃希菌和白假丝酵母菌最常见。医院感染发生与年龄、住院时间、侵入性操作和抗菌药物应用正相关(P0.05);医院感染以腹腔感染、呼吸道感染和胃肠感染为主,病死率为71.83%。结论重型肝炎医院感染发生率高,是医院感染的高危人群及导致死亡的危险因素。     

丙型肝炎病毒与甲乙型肝炎病毒重叠感染的研究

对485例病毒性肝炎患者进行了抗HCV、抗HAV-IgM、HBV-M检测.各型病毒性肝炎患者中抗HCV阳性率15.05％,慢性肝炎、肝硬变和重型肝炎阳性率高于急性肝炎;抗HCV阳性者中,27.40％有输血或血浆史;57.53％HBV-M阳性,其中HBsAg阳性占54.76％,抗HBc阳性达88.10％;既往有HBV感染者占33.33％.HBV与HCV重叠感染中慢性肝炎占58.06％,IAV与HCV重叠感染以急性肝炎多见(94.44％),HCV与甲乙型肝炎病毒三重感染可加速肝炎重症化的进程。     

Delta infection and hepatitis B virus replication in Danish patients with fulminant hepatitis B

The presence of hepatitis B virus and delta agent markers was investigated in 41 patients referred during the years 1970-1985 with fulminant hepatitis classified as type B or non-A non-B and compared to findings in patients with uncomplicated hepatitis B and chronic hepatitis B infection. 13 patients had no markers of hepatitis B and delta infection and were classified as non-A non-B hepatitis. The remaining 28 patients were all HBsAg and IgM anti-HBc positive and 14 (50%) had evidence of delta infection. In contrast, only 13/71 patients (18%) with acute benign hepatitis B had evidence of delta coinfection (p less than 0.005). This corresponds to an odds ratio of 4.5 for development of fulminant hepatitis among patients with hepatitis B and delta coinfection. In 100 chronic HBsAg carriers 29% were positive for delta markers. 12 of the delta infected patients with fulminant hepatitis were positive for total antibody to the delta antigen, and 2 were delta antigen positive. Three were HBeAg positive/anti-HBe negative. None had hepatitis B virus DNA. Among the 14 patients without delta infection, hepatitis B virus DNA was found in 2/4 HBeAg positive/anti-HBe negative patients and in 1/8 patients negative for both markers. The present data indicate that a high proportion of Danish patients with fulminant hepatitis B have hepatitis B and delta agent coinfection. Further, the findings suggest that hepatitis B and delta coinfection may be associated with an increased risk of development of fulminant hepatitis as compared to that of hepatitis B alone.     

重型肝炎合并革兰阴性菌感染的预后及影响因素

目的 探讨重型肝炎合并革兰阴性菌感染的预后及影响因素,为有效防治提供指导.方法 回顾性分析2004年1月-2006年6月我院住院的重型病毒性肝炎合并革兰阴性菌感染220例的预后,以及性别、年龄、肝炎型别、各种其他合并症、感染部位及细菌类型对预后的影响.结果 重型肝炎合并革兰阴性菌感染占总体细菌感染的79.1%,总病死率...     

Delta hepatitis in the Los Angeles area: a report of 126 cases

We describe the clinical course in 126 patients with delta hepatitis who have been evaluated in Los Angeles since 1967. In approximately two thirds of all patients, delta infection was associated with chronic hepatitis B. Most patients were members of two major risk groups: 65.9% were intravenous drug abusers, 11.9% were male homosexuals, and another 9.5% were both intravenous drug users and male homosexuals. The overall case fatality rate was 23%; fulminant hepatitis caused 17 of 29 (59%) deaths. Advanced liver disease occurred significantly more frequently in patients who had established chronic delta infections than in hepatitis B virus carriers with recent delta superinfections. Nonfatal infections with both hepatitis B virus and delta hepatitis virus resulted in clearance of both agents, whereas superinfection in carriers of chronic hepatitis B virus usually led to chronic delta hepatitis. Spontaneous loss of chronic delta infection was not observed. Delta hepatitis, a longstanding infection seen in patients in the Los Angeles area, has caused fulminant hepatitis and progressive liver disease in both intravenous drug users and male homosexuals.     

慢性HBV感染前C区变异与病毒复制水平关系

探讨HBV前C基因变异与病毒复制水平的关系在慢性HBV感染者中的意义。应用错配聚合酶链反应（PCR）－限制性片段长度多态性（RFLP）分析与荧光定量聚合酶链反应检测HBVDNA相结合,对30例HBsAg（＋）、抗－HBe( )及抗－HBc( )慢性HBV感染者,其中无症状携带者（AsC)9例、慢性乙型肝炎（CHB）12例及慢性重症肝炎（CHF）9例进行前C区基因变异与HBVDNA水平关系进行分析。AsC组3例（33．33％）,CHB组9例（75％）及CHF组8例（88．89％）有A83(nt1896)变异。荧光定量PCR结果表明HBVDNA含量在CHF组中最高。HBV前C变异与HBV不同感染状态中都可见,其病毒复制水平与肝病活动相关。     

Fulminant delta hepatitis among Swedish drug addicts

Between 1979 and 1984 11 cases of fulminant hepatitis were seen at the Department of Infectious Diseases in Lund, Sweden. Four cases were associated with hepatitis B virus (HBV) infection. Besides, all 4 patients had serological evidence of delta infection. Two were considered to be simultaneous HBV and delta agent infections, the other 2 were found to be delta superinfections in chronic HBsAg carriers. All 4 patients were intravenous drug addicts. The other 7 cases of fulminant hepatitis had no serological evidence of neither hepatitis A nor B virus infections and none of them were intravenous drug addicts.     

Serologic markers with fulminant hepatitis in persons positive for hepatitis B surface antigen. A worldwide epidemiologic and clinical survey

Of 377 cases of fulminant hepatitis in persons positive for hepatitis B surface antigen (HBsAg) in Greece, Italy, the United States, the United Kingdom, the Central African Republic, Taiwan, Egypt, and India, only 52% could be attributed to infection with hepatitis B virus, which was defined as the presence of the IgM antibody to the hepatitis B core antigen (IgM anti-HBc) and the absence of serum markers of infection by extraneous viruses. Thirty percent of cases were caused by coinfection with hepatitis B virus and hepatitis delta virus or by infection with hepatitis delta virus superimposed on carriers of chronic HBsAg. In 18.5% of the patients, the absence of IgM anti-HBc indicated that they were not known to carry HBsAg, but no obvious superimposed factor of hepatitis could be identified. The cause of fulminant hepatitis is complex, and major risk factors are a pre-existing HBsAg state and hepatitis delta virus infection. Superinfection of HBsAg carriers by non-A, non-B viruses seems to be the cause in a consistent proportion of cases.     

Fas配体启动子区-844T/C单核苷酸多态性与重型乙型肝炎转归的关系

目的 探讨中国汉族人Fas配体(FasL)基因单核苷酸多态性与重型乙型肝炎之间的关系.方法 采用病例一对照研究方法,将HBV感染者作为研究对象.收集相关的非活动性HBsAg携带者233例,重型肝炎患者68例,HBV自发清除者100例,肝硬化患者102例,肝细胞癌患者112例的全血标本及临床相关资料.应用TaqMan探针实时荧光分型PCR方法检测患者FasL基因-844T/C位点的基因多态性,计算比值比(OR)值及95%可信区间(CI).结果 应用二元Logistic回归分析,控制年龄、性别等因素后,非活动性HBsAg携带者的FasL-844 CC、CT、TT基因型频率分别为50.64%、39.91%及9.44%;重型肝炎组中FasL-844 CC、CT、TT基因型频率分别为79.41%、17.65%及2.94%.携带FasL-844CC基因型的非活动性HBsAg携带者与重型肝炎的发生呈显著关联(OR=4.729,95%CI:0.510～21.282,P=0.043),而其他病例对照组中存在的关联差异均无统计学意义(P>0.05).结论 携带FasL-844CC基因型的非活动性HBsAg携带者易发生乙型肝炎重症化,应对这部分人群给予更多的关注.

Abstract：

Objective To investigate the relationship between single nucleotide polymorphism (SNP) of Fas ligand (FasL) and fulminant hepatitis B in Han Chinese. Methods HBV infected subjects were enrolled in this case-control study, including 233 cases of inactive HBsAg carrier, 68 patients with fulminant hepatitis B,100 cases of spontaneous hepatitis B clearance, 102 patients with hepatitis B virus (HBV) related cirrhosis and 112 patients with HBV related primary hepatocellular carcinoma. The blood samples and clinical data were collected. FasL-844T/C polymorphisms of enrolled subjects were examined by TaqMan real time fluorescent genotyping polymerase chain reaction (RT-PCR). A adjusted odds ratios (OR)and 95% confidence intervals (CI)were calculated using the Logistic regression model. Results After adjusting the factors of gender and age, binary Logistic regression analyses indicated that the genotype frequencies of FasL-844 CC,CT,TT in inactive HBsAg carriers were 50. 64% ,39. 91% and 9. 44% respectively, and those in cases of fulminant hepatitis B were 79. 41%, 17. 65% and 2. 94%, respectively. The analysis also revealed that FasL-844CC genotype in inactive HBsAg carriers was high risk factor of developing fulminant hepatitis B (OR =4. 729,95%CI:0. 510 - 21. 282,P = 0. 043), while there were no statistic significances in other cases (P>0. 05). Conclusion The inactive HBsAg carriers harboring FasL-844CC may have greater susceptibility to fulminant hepatitis B, which need arouse high attention.     

Infection with hepatitis delta virus in patients with fulminant hepatitis B and chronic HBsAg carriers in Bulgaria

To evaluate the prevalence and clinical significance of delta infection in a Bulgarian population, 105 HBsAG positive patients with chronic liver diseases, and 42 patients who had died of fulminant hepatitis B were studied. Delta antigen was detected by direct immunofluorescence in the liver of 9 patients with chronic HBV infection (8.6%), and in 3 patients with fulminant hepatitis (7.14%). All chronic HBsAg carriers with delta superinfection had chronic active hepatitis or active liver cirrhosis. They were predominantly anti-HBe (+) in the serum. The mean age and the mean values of serum transaminase did not differ in delta antigen positive and negative patients with chronic liver diseases. A history of parenteral manipulations directly before the hepatitis was present in patients with delta antigen positive fulminant hepatitis. These results indicate a relatively low incidence of delta infection in our population, but it is invariably associated with severe liver disease.