乙型肝炎病毒携带及感染患者硬膜外麻醉的效果研究

目的观察乙型肝炎病毒携带及感染者行剖宫产手术时应用硬膜外麻醉的临床效果。方法选取妇科产行剖宫产的乙型肝炎病毒携带者、感染患者及非HBV感染的孕妇各35例为研究对象,记为携带组、感染组和对照组。通过回顾性研究,记录三组患者实施硬膜外麻醉的临床麻醉效果及置管时的出血情况。结果三组研究对象在麻醉起效时间、麻醉完善时间、麻醉效果、低血压发生率、心率减慢发生率差异无统计学意义（P〉0．05）。HBV感染组与HBV携带组的置管出血率均高于对照组（P〈0．05）,但HBV感染组与HBV携带组的置管出血率差异无统计学意义（P〉0．05）。结论对HBV携带及感染患者行剖宫产时,应用硬膜外麻醉,其麻醉效果与未感染HBV正常人麻醉效果基本相同,但HBV携带及感染患者置管出血率高于常人,应引起临床重视。     

不同慢性肝病患者血清中乙型肝炎病毒DNA定量检测及其临床意义

目的探讨乙型肝炎病毒ＤＮＡ含量的临床意义。了解乙型肝炎病毒（ＨＢＶ）免疫标志不同状态的慢性肝病患者血清ＨＢＶＤＮＡ浓度及其临床意义。方法应用建立的竞争性聚合酶链反应（ＰＣＲ）方法定量检测慢性肝炎（ＣＨ）５１例、肝硬化（ＬＣ）３６例、原发性肝癌（ＰＨＣ）３８例的血清ＨＢＶＤＮＡ浓度。结果ＨＢＶＤＮＡ阳性的ＣＨ患者血清ＨＢＶＤＮＡ浓度为４．３６ｌｏｇ１０ＨＢＶＤＮＡ拷贝５０μｌ（下同），ＬＣ为４．５５，ＰＨＣ为４．４３，三组间无显著性差异（Ｐ＞０．０５）；血清ＨＢＶ五项免疫标志均阴性或抗－ＨＢｓ阳性的慢性肝病患者中，有３７．５％患者存在低水平ＨＢＶ复制；ＨＢｅＡｇ阳性患者的ＨＢＶＤＮＡ浓度总体上明显高于抗－ＨＢｅ阳性组，但其中部分患者的ＨＢＶＤＮＡ浓度也很高。结论提示ＨＢＶ的复制状态与慢性肝病的病期无明显关系；在抗－ＨＢｅ阳性的患者中存在个体差异，故不能仅依据抗－ＨＢｅ阳转来判断ＨＢＶ复制减少或停止。     

Functional and phenotypical studies of the Leu-4 (CD3)+, Leu-1 (CD5)- T lymphocyte.

A small T cell subpopulation expressing the phenotype Leu-5(CD2)+, Leu-4(CD3)+, Leu-1 (CD5)- can be found in peripheral blood and bone marrow of normal individuals. When these cells were sorted out by three colour immunofluorescence cell sorting and tested in limiting dilution assays, they were found to have lower frequencies of proliferating (9.0 +/- 5.6 times, n = 7) and of IL-2 producing cells (11.5 +/- 5.0 times n = 5), and a higher frequency of cytotoxic cells (3.1 +/- 2.6 times, n = 2) than T lymphocytes expressing the three markers. In peripheral blood lymphocytes, 1/3 of the CD3+, CD5- cells were positive for Leu-2a (CD8) while virtually all were negative for Leu-3a (CD4). Four colour flow cytometric analysis revealed a small subset of T cells positive for CD3 and negative for CD5, CD4 and CD8. Approximately 75% of the CD3+, CD5- cells were negative for Leu-7 and CD16 simultaneously. These results shed a light on the phenotype of T cells that escape killing by CD5 and complement in T cell depleted bone marrow and may explain why fewer residual T cells in the depleted marrow are detected by limiting dilution assays than by flow cytometric analysis.     

Rescue therapy with adefovir in decompensated liver cirrhosis patients with lamivudine-resistant hepatitis B virus

Background/Aims

Adefovir dipivoxil (ADV) is a nucleotide analogue that is effective against lamivudine-resistant hepatitis B virus (HBV). The aim of this study was to determine the long-term clinical outcomes after ADV rescue therapy in decompensated patients infected with lamivudine-resistant HBV.

Methods

In total, 128 patients with a decompensated state and lamivudine-resistant HBV were treated with ADV at a dosage of 10 mg/day for a median of 33 months in this multicenter cohort study.

Results

Following ADV treatment, 86 (72.3%) of 119 patients experienced a decrease in Child-Pugh score of at least 2 points, and the overall end-stage liver disease score decreased from 16±5 to 14±10 (mean ± SD, P<0.001) during the follow-up period. With ADV treatment, 67 patients (56.3%) had undetectable serum HBV DNA (detection limit, 0.5 pg/mL). Virologic breakthrough occurred in 38 patients (36.1%) and 9 patients had a suboptimal ADV response. The overall survival rate was 89.9% (107/119), and a suboptimal response to ADV treatment was associated with both no improvement in Child-Pugh score (≥2 points; P=0.001) and high mortality following ADV rescue therapy (P=0.012).

Conclusions

Three years of ADV treatment was effective and safe in decompensated patients with lamivudine-resistant HBV.     

IL-10 is predominantly produced by CD19(low)CD5(+) regulatory B cell subpopulation: characterisation of CD19 (high) and CD19(low) subpopulations of CD5(+) B cells

IL-10 production by CD19(+)CD5(+) B cells was investigated, by determining the expression levels of CD19, a classical B cell marker. Peripheral mononuclear cells were stained with fluorescence-conjugated anti-CD5, anti-CD19, anti-IL-10, and Annexin V. Interestingly, IL-10-producing B cells were found to be localised within the CD19(low)CD5(+) B cell subset. Apoptotic changes were also observed mainly in CD19(low) cells among B cells. Thus, CD5(+) B cells should be classified as CD19(high) and CD19(low) cells, and the immunological significance of CD19 for the IL-10 production by CD5(+) B cells requires further studies.     

不同慢性肝病患者血清中乙型肝炎病毒DNA定量检？…

目的 探讨乙型肝炎病毒ＤＮＡ含量的临床意义。了解乙型肝炎病毒（ＨＢＶ）免疫标志不同状态的慢性肝病患者血清ＨＢＶＤＮＡ浓度及共临床意义。方法 应用建立的竞争性聚合酶链反应（ＰＣＲ）方法定量检测慢性肝炎（ＣＨ）５１例、肝硬化（ＬＣ）３６例、原发性肝癌（ＰＨＣ）３８例的血清ＨＢＶ ＤＮＡ浓度。结果 ＨＢＶＤＮＡ阳性的ＣＨ患者血清ＨＢＶ ＤＮＡ浓度为４．３６ｌｏｇ１０ＨＢＶＤＮＡ拷贝／５０μｌ，ＬＣ为４．     

Chronic liver disease and cirrhosis among patients with hepatitis B virus infection in northern Portugal with reference to the viral genotypes

The prevalence of infection with hepatitis B virus in Portugal is around 1% of the population; 20-30% of those infected typically develop cirrhosis. The study focuses on the epidemiological profile of patients with hepatitis B infection and liver damage, in particular, cirrhosis. Of the 358 individuals that comprised the study, a liver biopsy was performed in 249 to identify the presence of cirrhosis. Cirrhosis was observed in 59 patients (23.7%) The Child-Pugh classification was used to assess the prognosis of cirrhosis: 3 out of the 59 patients were classified as Child-Pugh grade C, the most severe, 17 (28.8%) as grade B, and 39 (66.2%) as grade A. Patients classified as grade B were older, drank more, and showed higher levels of AST and alkaline phosphatase when compared with individuals classified as grade A. Genotypes A and D were predominant, and no significant differences with respect to genotype distribution were observed. Analysis of the hematological parameters showed that patients classified as Child's grade B had lower levels of platelets and higher levels of prothrombin time than those classified as Child's grade A. The profile of the patients with cirrhosis, including an extended number of individual characteristics, provides useful information, however, only a prospective study could evaluate definitively if liver disease is influenced by these factors. Future studies would benefit from the analysis of the impact of genotypes on liver disease, particularly genotypes A and D, the most predominant genotypes in northern Portugal.     

Serum hepatitis B virus DNA in hepatitis B virus seropositive and seronegative patients with normal liver function

The presence of hepatitis type B virus (HBV) DNA in serum specimens from 926 apparently healthy people with normal liver functions was determined by polymerase chain reaction; 41.2% of people with positive results for HBV surface antigen (HBsAg) (94 of 228) and 95.2% of people with positive results for HBV e antigen (HBeAg) (60 of 63) were found to have positive results for serum HBV DNA. On the other hand, serum HBV DNA was found in 11.0% (77 of 698) of HBsAg-negative people and in 13% (69 of 530) of those who had positive results for serum antibodies directed against HBsAg. The results seem to suggest that HBV DNA can be found in a significant portion of apparently healthy people with normal liver function who are either seronegative for HBsAg or seropositive for antibodies directed against HBsAg.     

Histologic changes in Chinese patients with chronic hepatitis B virus infection after interferon-alpha therapy.

To evaluate the histologic effects of interferon-alpha (IFN alpha) therapy on chronic hepatitis B virus (HBV) infection, a semiquantitative study using a modified Knodell's numeric histologic scoring system was performed on paired pre- and post-treatment liver biopsy specimens from 127 adult Chinese patients from two trials of IFN alpha therapy (IFN alpha, n = 86; control, n = 41). The effects of IFN alpha therapy on the hepatic expression of HBV antigens were also determined using immunohistochemical analysis. Serologic response with clearance of HBV e antigen (n = 18) was associated with reduction in lobular activity, periportal piecemeal necrosis, portal inflammation, and total histologic scores. Loss of HBV e antigen also was associated with a reduction in the amount of HBV core antigen in the hepatocytes. In contrast, there was an increase in hepatic expression of HBV surface antigen after IFN alpha therapy. Patients who lost HBV e antigen with IFN alpha therapy were characterized by more severe initial periportal piecemeal necrosis before treatment. These data indicate that (1) serologic response is associated with a reduction in hepatic HBV replication and an improvement in hepatic histology, and (2) patients with severe periportal piecemeal necrosis respond more favorably to IFN alpha therapy.     

Distribution of hepatitis B virus in the liver of chronic hepatitis C patients with occult hepatitis B virus infection

Although occult hepatitis B virus (HBV) infection (HBV-DNA in serum in the absence of hepatitis B surface antigen [HBsAg]) is common in chronic hepatitis C, its characteristics are not well known. In this work, the presence of HBV-DNA (by polymerase chain reaction; PCR) and its distribution (by in situ hybridization) in liver biopsies and peripheral blood mononuclear cells (PBMCs) from 32 patients with chronic hepatitis C and occult HBV infection and in 20 HBsAg chronic carriers were determined. The results showed that serum HBV-DNA levels were statistically lower (P = 0.001) in patients with occult HBV infection than in HBsAg chronic carriers. The HBV infection pattern in liver cells was identical between patients with occult HBV infection and those with chronic hepatitis B. However, the mean percentage of HBV-infected hepatocytes was significantly lower (P = 0.001) in patients with occult HBV infection (5 +/- 4.44%) than in HBsAg chronic carriers (17.99 +/- 11.58%). All patients with chronic hepatitis B have HBV-DNA in their PBMCs while this occurred in 50% of the cases with occult HBV infection. In conclusion, patients with occult HBV infection have a low number of HBV-infected hepatocytes and this fact could explain the lack of HBsAg detection and low viremia levels found in these cases.     

Seroconversion to various hepatitis C virus antigens in patients with hepatitis C from various sources

A total of 136 patients with acute icteric hepatitis C, including patients with known outcome, were examined. Therefore, 46 serological samples, obtained from 13 patients with subsequent remission, and 63 samples, obtained from 13 patients, who subsequently developed the chronic disease stage, were analyzed. The serum of known outcome patients were examined, by using the immune-enzyme analysis method, to the antibodies of both class IgG, and IgM. Differences in the dynamics of the immune humoral response were established with due regard for a pathological course process, including the acute disease stage. The obtained results are interesting because of their prognostic values.     

Occult hepatitis B virus infection in Lebanese patients with chronic hepatitis C liver disease

Occult hepatitis B virus (HBV) infection, characterised by the presence of HBV infection with undetectable hepatitis B surface antigen (HBsAg), was investigated in 98 Lebanese patients with chronic hepatitis C liver disease and 85 control subjects recruited from eight institutions in different parts of the country. The prevalence of occult HBV infection ranged from 11.9% to 44.4% in hepatitis C virus (HCV)-infected patients and it increased with increasing severity of the liver disease. The overall rate of HBV DNA in our 98 HCV-infected patients was 16.3%. On the other hand, the rate of HBV DNA was 41.0% in anti-HBc alone positive patients compared to only 7.1% in healthy controls who were also anti-HBc alone positive (p < 0.001). Moreover, the prevalence HBV DNA increased with increasing severity of the liver disease, but this increase was only marginally significant and, perhaps, could have been significant if more patients were involved in the study. Although Lebanon is an area of low endemicity for both HBV and HCV, occult HBV infection is common in HCV-infected patients. The presence of HBV DNA, therefore, presents a challenge for the effective laboratory diagnosis of hepatitis B, particularly if polymerase chain reaction (PCR)-based HBV detection methods are not used.     

Occult hepatitis B virus infection in patients with chronic hepatitis C liver disease.

BACKGROUND: Hepatitis B virus (HBV) infections in patients who lack detectable hepatitis B surface antigen (HBsAg) are called occult infections. Although such infections have been identified in patients with chronic hepatitis C liver disease, their prevalence and clinical significance are not known. METHODS: With the polymerase chain reaction, we searched for HBV DNA in liver and serum samples from 200 HBsAg-negative patients with hepatitis C virus (HCV)-related liver disease (147 with chronic hepatitis, 48 with cirrhosis, and 5 with minimal histologic changes). One hundred of the patients had detectable antibodies to the HBV core antigen (anti-HBc); 100 were negative for all HBV markers. Eighty-three were treated with interferon alfa. We also studied 50 patients with liver disease who were negative both for HBsAg and for HCV markers. In six patients found to have occult HBV infection, we evaluated possible genomic rearrangements through cloning or direct sequencing procedures. RESULTS: Sixty-six of the 200 patients with chronic hepatitis C liver disease (33 percent) had HBV sequences, as did 7 of the 50 patients with liver disease unrelated to hepatitis C (14 percent, P=0.01). Among the 66 patients, 46 were anti-HBc-positive and 20 were negative for all HBV markers (P<0.001). Twenty-two of these 66 patients (33 percent) had cirrhosis, as compared with 26 of the 134 patients with hepatitis C infection but no HBV sequences (19 percent, P=0.04). HBV sequences were detected in 26 of the 55 patients in whom interferon therapy was ineffective and 7 of the 28 patients in whom interferon therapy was effective (P=0.06). None of the sequenced HBV genomes had changes known to interfere with viral activity and gene expression. CONCLUSIONS: Occult hepatitis B infection occurs frequently in patients with chronic hepatitis C liver disease and may have clinical significance.     

Receptor for pre-S1(21-47) component of hepatitis B virus on the liver cell: role in virus cell interaction.

Attachment of hepatitis B virus to a hepatoblastoma cell line (HepG2) was examined using a synthetic peptide corresponding to the pre-S1 (21-47) region of the envelope protein. Scatchard analysis revealed a single class binding site of Kd 104 +/- 27 nM/l and 5.4 +/- 1.2 x 10(5) sites per cell. Competition of HBV with pre-S1 peptides was dose dependent, and demonstrated it as the dominant binding site. In view of the suggested sequence homology between the peptide and IgA, cross-competition studies were carried out. The results indicate no direct role of IgA receptor in HBV binding. The receptor for the pre-S1 peptide was identified as a single major peptide of molecular weight 31 kD using in-situ ligand receptor crosslinking.     

Hepatitis B virus DNA in leukocytes of patients with hepatitis B virus-associated liver diseases

In order to determine the relationship between hepatitis B virus (HBV) infection of human white blood cells and different forms of HBV-associated liver diseases, we tested for HBV DNA in the sera and leukocytes of 11 healthy individuals without any serological markers of HBV infection and 91 patients with HBV infection and other gastrointestinal and urinary diseases by dot and Southern blot hybridization. HBV DNA was found in leukocytes of chronic HBV carriers, in acute and chronic hepatitis, and in patients with liver cirrhosis and hepatocellular carcinoma. Between 27 and 50% of individuals in different categories of patients examined were positive for leukocyte HBV DNA. HBV DNA was also detected in the sera of some of these patients but was absent in others. Serum HBV DNA-positive rates seemed to be highest in hepatitis B e antigen-positive asymptomatic carriers (8/10, 80%), and tended to drop to lower levels as the disease progressed to liver cirrhosis (0/8) while leukocyte HBV DNA-positive rates were highest in patients with cirrhosis (4/8, 50%). The results also show that in individuals who were serologically negative for hepatitis B surface antigen (HBsAg) and positive for antibodies to HBsAg and/or HBcAg, HBV DNA was absent in most of the sera (27/28, 96%) but it was present in leukocytes of some of these patients (7/28, 25%). In control experiments with 11 healthy individual, HBV DNA was not detected in either sera or leukocytes. In all the cases with leukocyte HBV DNA, the HBV DNA molecules were present in free forms with discrete sizes. The exceptions were a case of liver cirrhosis and a case of chronic hepatitis with possible HBV sequence integration into high molecular weight cellular DNA. Since HBV does infect human leukocytes, it may perhaps interfere with the immunological functions of the white blood cells, and thus play an important role in the pathogenesis of HBV-induced liver disease.     

Virological significance of low-level hepatitis B virus infection in patients with hepatitis C virus associated liver disease

Cytomegalovirus (CMV) infection is an important cause of morbidity in solid organ recipients. Early markers to identify the progress of the infection and patients at high risk are required in order to apply a strategy of pre-emptive therapy. The efficacy of pre-emptive therapy relies on accurate laboratory tests to monitor CMV infection. The evaluation of CMV DNA kinetics by the polymerase chain reaction (PCR) is widely used for the management of CMV infection but markers predicting the progression of the infection and standardization of the technique are essential for the clinical interpretation of PCR results. A commercially available PCR system, the COBAS AMPLICOR Monitor (Roche Diagnostics, Brachburg, NJ), was used for the quantitation of CMV DNA in weekly blood samples (n = 504) from 47 solid organ recipients in the first 6 months after transplantation. PCR results were evaluated according to the development of clinical disease in order to find a DNA threshold and time points predicting the progression of CMV infection. Week 4 from transplantation was the earliest time point to note a significant difference between those patients who eventually developed CMV disease (n = 30) and those who remained asymptomatically infected (n = 17). At week 4, viral loads were significantly higher in patients who developed CMV disease than in asymptomatic infections (median value: 4 log(10)/10(6) leukocytes vs. 2.8, P < 0.0001). At week 4, a DNA level >/=4 log(10)/10(6) leukocytes was associated with a 45.37 odds ratio for CMV disease. Any increase >/=1 log from the first DNA detection to week 4 correlated with the clinical progression of CMV infection (odds ratio 1.74). In those patients who were treated with anti-CMV therapy, a >97% reduction of the baseline viral load was associated with a complete therapeutic success. In conclusion, CMV infection is a highly dynamic process and the quantitation of CMV DNA by PCR is a powerful marker to control successfully the infection, but a strict follow-up of the recipient and standardized PCR tests are mandatory for the best management of the infection.     

活化Th细胞及HBeAg与慢性乙肝肝损伤及纤维化关系的探讨

目的探讨活化Th细胞（CD4^＋HLA-DR^＋）及HBeAg与慢性乙型肝炎肝脏损伤及纤维化的关系。方法检测58例慢性乙型肝炎患者和18例既往感染患者（HBsAg阴性而HBcAb阳性者）CD4^＋抗原和HLA-DR抗原双阳性淋巴细胞,血小板（PLT）数和血清丙氨酸氨基转移酶（ALT）和天门冬氨酸氨基转移酶（AST）活度,计算AST／PLT比值。结果既往感染患者、HBeAg阴性及阳性慢性乙肝患者活化CD4^＋细胞数量明显低于对照者（P〈0．05）,且呈显著递减（P〈0．05）,HBeAg阴性及阳性者AST,ALT以及AST／PLT值明显高于对照者（p〈0．02）和既往感染者（P〈0．02）,且HBeAg阳性患者明显高于阴性患者（P〈0．05）,此二组活化CD4^＋细胞与ALT,AST和AST／PLT呈明显负相关（P〈0．05）。结论活化Th细胞降低可以作为慢性乙肝患者预测肝脏损伤进展的有用指标,HBeAg可以辅助评价肝损伤和纤维化的发展程度。     

乙型肝炎病毒C基因启动子及前C变异的动态研究

目的明确乙型肝炎病毒（ＨＢＶ）Ｃ基因启动子（ＢＣＰ）与前Ｃ变异株在慢性乙型肝炎患者中的动态消长,及与ＨＢｅＡｇ血清学状态的关系。方法对３２例慢性乙型肝炎患者的１０５份系列血清进行错配聚合酶链反应（ＰＣＲ）－限制性片段长度多态性分析,并对其中１５例患者系列血清标本的ＰＣＲ产物进行直接测序。结果ＢＣＰ和Ａ８３变异株感染率均明显增高（６２．５％＞４６．９％;３１．３％＞１２．５％）;ＢＰＣ变异株更多地（１４／１６）表现为优势积累,且先于ＨＢｅＡｇ血清阴转;ＢＣＰ野株／变异株比例变化影响ＨＢｅＡｇ血清学的稳定性。结论两种类型的变异株在炎症活动中均具有选择优势,最终造成ＨＢｅＡｇ（－）的ＨＢＶ感染;可能与ＨＢＶ感染之持续有关。