黑龙江省慢性丙型肝炎病毒感染者的血清型及其临床意义

慢性丙型肝炎是危害人类健康的严重疾病.我国丙型肝炎的感染率为3.2%[1],国内HCV RNA基因型主要为1b和2a.不同地区丙型肝炎的血清型不同,不同血清型的致病性不同,对干扰素治疗的反应也不一致[2].我们随机选取黑龙江省120例慢性丙型肝炎病毒感染者进行HCV血清型的检测并探讨其与疾病严重程度的关系.     

瘦素在慢性丙型肝炎中的研究进展

瘦素是由脂肪细胞分泌的一种细胞因子,具有广泛的生物学作用.瘦素的生物学作用与糖尿病、肥胖、代谢综合征、癌症等多种疾病的发生发展相关,受到了广大学者的关注.目前聚乙二醇干扰素联合利巴韦林为慢性丙型肝炎抗病毒治疗一线用药,但其不良反应较多,因此对于慢性丙型肝炎的机制及治疗的研究尚需不断扩大.越来越多研究发现,瘦素作为新发现的脂肪细胞因子与慢性丙型肝炎密切相关,并且为慢性丙型肝炎的治疗提供了新的靶点.本文就瘦素在慢性丙型肝炎炎症、脂肪变性、肝纤维化、基因型及抗病毒治疗等方面进行综述.     

HCV感染获得持续病毒学应答后的随访原则

丙型肝炎病毒(HCV)主要通过血液传播、性传播、母婴传播等途径在人群之间流行.HCV感染人体可以引起急性和慢性丙型肝炎,其中慢性丙型肝炎已成为全球健康问题,影响全球1.84亿人[1].根据世界卫生组织的估计数据,全球在2015年有7100万慢性HCV感染者[2].HCV分为不同的基因型及亚型,基因1 型是主要的流行类型...     

慢性丙型肝炎患者抗甲状腺抗体异常相关影响因素的研究

目的研究导致慢性丙型肝炎患者甲状腺抗体异常的相关影响因素。方法对我院感染科2014年1月至2015年12月收治的未经抗病毒治疗的256例慢性丙型肝炎患者进行回顾性分析。记录患者入院时年龄、性别、甲状腺过氧化物酶抗体(TPOAb)和甲状腺球蛋白抗体(TgAb)滴度及HCV载量、HCV基因型,从而研究不同年龄、性别、HCV载量及基因型与甲状腺抗体异常的相关性。结果丙型肝炎合并甲状腺抗体异常的患者中女性比例较高,为66.0%(P0.05),且女性的平均年龄大于男性的平均年龄(P0.05)。丙型肝炎合并甲状腺抗体异常与HCV载量及基因型之间无相关性(P0.05)。结论慢性丙型肝炎患者中,女性且年龄较大者为甲状腺抗体异常的好发人群。     

索非布韦治疗慢性丙型肝炎的研究进展

近几年慢性丙型肝炎的治疗发生了新的变化,直接抗病毒药物治疗活动性丙型肝炎显示出强大的作用,即使是难治性丙型肝炎也能出现较高的持续病毒学应答。其中索非布韦(SOF)以其抗病毒疗程短,应答率高,甚至对于某些丙型肝炎基因型患者可免干扰素治疗的优势脱颖而出。介绍了SOF的作用机制、临床应用现状以及主要不良反应,指出了其在难治性丙型肝炎患者中的应用前景。     

慢性丙型肝炎患者幽门螺杆菌感染及其相关因素分析

目的:探讨幽门螺杆菌(H pyloH)在慢性丙型肝炎中的作用.方法:采用Hpylor流行病学诊断标准检测血清anti-Hpylori-IgG,来判定是否存在Hpylori 感染,实时荧光定量聚合酶链反应(FQ-PCR)方法检测血清中HCV RNA的含量,聚合酶链反应.微板核酸杂交.酶联免疫测定法检测血清中HCV基因型.结果:HpyloN感染率在慢性丙型肝炎组、丙型肝炎肝硬化组和合并肝癌组明显高于健康对照组(55.5%、76.5%、78.6%VS 43.4%,P＜0.05),且随着病变程度的加重,Hpylon感染率增加.不同HCV载量的慢性丙型肝炎患者Hpylon感染率均增加.基因1a型、1b型、2a型和2b型患者HpyloN感染率分别为59.5%、66.7%、65.0%和59.2%,各基因型之间比较无显著性差异.结论:慢性丙型肝炎患者幽门螺杆菌感染率明显增加,H pylori在慢性丙型肝炎向肝硬化和肝癌的发展过程中可能与HcCV发挥协同作用.     

徐春军教授以益气养血通络方治疗丙型肝炎肝硬化脾功能亢进患者42例

<正>随着丙型肝炎小分子直接抗病毒药(DAA)的上市,丙型肝炎的治愈率得到极大提升。目前优先推荐无干扰素的泛基因型方案,其在已知主要基因型和主要基因亚型的HCV感染者中都能达到90%以上的持续病毒学应答^[1]。但仍有部分丙型肝炎患者在HCV清除之前就已经发展为肝硬化,或是因抗病毒效果不佳发展为肝硬化。随着肝硬化进展,可出现肝功能失代偿、门静脉高压症,脾脏血液回流受阻,发生脾功能亢进。 脾功能亢进的主要临床表现有血细胞计数减少等,     

乙型肝炎病毒基因型与抗病毒治疗疗效相关性

乙型肝炎病毒(HBV)具有高度的基因异质性,根据毒株全基因序列的异质性≥8%可分为A~H 8个基因型[1]。近年来的研究发现,HBV基因型的一个显著特征是呈一定的地理区域性分布:A型主要分布于欧洲及美国;B、C型主要分布于亚洲;D型是分布最广泛的基因型,是地中海地区和中东的优势基因型;E型主要分布于非洲;F型主要分布于南美及中美洲[1-2]。除了上述主要的HBV基因型外,尚有一些基因亚型被鉴定。在我国大陆地区流行的HBV基因型主要以B、C为主(分别为39.3%及50.2%)[3]。此外,一些研究发现,HBV基因型之间存在分子生物学特征、临床结局以及对抗病毒药物疗效等方面的差异[1]。在丙型肝炎的研究中,病毒基因型已显示出与临床疗效的高度相关性,基因型分析也已用于指导丙型肝炎的临床治疗。基因型分析是否将对乙型肝炎临床治疗具有指导意义也是当前研究的热点。以下结合我们在HBV基因型研究方面的工作,介绍有关HBV基因型与抗病毒治疗疗效相关性研究进展。一、HBV基因型与核苷类似物治疗疗效有关HBV基因型与核苷类似物(如拉米夫定与阿德福韦)治疗应答的关系尚未进行广泛的研究。一些小范围的研究认为:在拉米夫定治疗的慢性乙型肝...     

皖北地区丙型肝炎流行病学及临床疗效

目的 探讨本地区丙型肝炎的流行特征和基因型分布,探索提高丙型肝炎疗效的方法.方法 调查了解丙型肝炎传播途径,对丙型肝炎病毒(HCV)进行测序分型,根据患者具体情况分别采用普通干扰素(IFN)联合利巴韦林(RBV)和聚乙二醇干扰素(PEG-IFN)联合RBV治疗,根据病毒基因型及应答情况等决定疗程,总疗程24～72周,对治疗过程中出现的不良反应进行适当处理.结果 本地区HCV基因型有1a、1b、2a、3a、3b、6k型.1b型最多,占56.3％,其次为2a型占21.3％,1b和2a混合型占5.3％,3b型占9.6％,3a型占4.3％,1a型占2.1％,6k型占1％.传播途径中通过静脉吸毒感染35.8％(102/285),输血及血制品感染31.2％(89/285).基因1b型和非1b型两组早期病毒学应答(EVR)、治疗结束时病毒学应答(ETVR)、持续病毒学应答(SVR)分别为12(46.1％)、16(61.5％)、15(57.7％)和17(81.0％)、19(90.4％)、19(90.4％),差异均有统计学意义(P＜0.05).采取个体化治疗,能大幅提高丙型肝炎的应答率,减少不良反应,但因各个病例差异较大,无法进行统计学处理.结论 皖北地区丙型肝炎的主要传播方式是静脉吸毒及输血;基因型以1b型为主,占56.3％,其次为2a型,并可见混合型及6k型.治疗上基因1b型疗效远不如非1b型.个体化治疗能明显提高SVR.     

山东地区慢性HCV感染者病毒的基因型分布

目的明确山东地区慢性丙型肝炎及丙肝肝硬化患者感染丙型肝炎病毒(HCV)的基因型分布,探讨HCV基因型与肝脏疾病严重程度及感染途径之间的关系。方法根据HCV 5′非编码区(NCR)设计基因芯片,对山东地区慢性HCV感染者(慢性丙型肝炎128例,丙肝肝硬化42例)应用基因芯片法检测HCV基因型,并对其中22份标本进行测序,比较慢性丙型肝炎、肝硬化病人HCV基因型分布以及不同途径感染的病HCV人基因型分布的差别。结果 168例患者标本可以分型,HCV基因型分别为:1b型106例,2a型48例,1a及3b型均为2例,1b+2a混合型9例,1a+1b混合型1例;对22例患者标本测序,1b型12例,2a型9例,3b型1例,与基因芯片法检测结果完全一致;肝硬化和慢性肝炎病人的HCV基因型分布差异无统计学意义(χ2=1.82,P>0.05),有输血史者和无输血史者HCV基因型分布差异无统计学意义(χ2=7.63,P>0.05)。结论山东地区HCV主要流行株是基因1b型,其次为2a型,同时有少量的1a、3b型以及混合感染,HCV基因型与疾病的进展及感染途径无关。     

Acute hepatitis C virus superinfection followed by spontaneous HBeAg seroconversion and HBsAg elimination

Summary Acute hepatitis C virus superinfection followed by spontaneous hepatitis B e antigen seroconversion and hepatitis B surface antigen clearance in a patient with chronic type B hepatitis is described. The observations suggests that HCV may exert a suppressive effect on hepatitis B virus.

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Spontane Serokonversion gegen HBeAg und Elimination von HBsAg nach akuter Hepatitis C Virus Superinfektion

Zusammenfassung Nach akuter Superinfektion mit dem Hepatitis C Virus trat bei einem Patienten mit chronischer B Hepatitis eine Serokonversion gegen das Hepatitis B Virus e- Antigen und Elimination des Hepatitis B Virus Oberflächenantigens ein. Nach dieser Beobachtung könnte HCV eine suppressive Wirkung gegen das Hepatitis B Virus haben.

     

Detection of Hepatitis C Viral RNA in Serum of a Patient with Acute Non A, Non B Hepatitis

The sequence of serologic events in a patient with acute type C hepatitis associated with intravenous drug abuse is described. Hepatitis C virus (HCV) ribonucleic acid was detectable in serum during the acute episode of hepatitis, whereas antibody to the hepatitis C virus appeared later, after the acute illness had subsided. The patient developed chronic hepatitis with persistently elevated serum aminotransferase activities. Both hepatitis C viral ribonucleic acid and antibody to hepatitis C virus persisted in serum, together with elevated serum aminotransferases. Thus, detection of HCV RNA may be useful in the diagnosis of acute type C hepatitis, particularly in the absence of detectable antibody to the hepatitis C virus.     

Hepatitis C: an update

Hepatitis C virus (HCV) infection is a leading cause of chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma worldwide. While current therapeutic options for hepatitis C are limited, recent progress in the understanding of the biology of HCV led to the identification of novel targets for antiviral intervention. In addition, molecular and immunotherapeutic strategies to inhibit HCV replication or gene expression and to enhance the cellular immune response against HCV are being explored. These and other novel antiviral strategies may eventually complement existing therapeutic modalities. Here, we briefly review current concepts of the epidemiology, molecular virology, pathogenesis, natural history, diagnosis, therapy, and prevention of hepatitis C.     

The virus of non-A, non-B hepatitis. Serological diagnosis]

Persistence of viral post-transfusion hepatitis together with epidemiological data led to identify 3 forms of clinical non A non B hepatitis: enteric, post-transfusional and sporadic hepatitis. Two groups of viruses are responsible for this pathology; they are designated as HEV (Hepatitis E Virus) and HCV (Hepatitis C Virus). HEV described by D. Bradley is a 27 to 34 nm. non enveloped particle containing a single strand RNA and belonging to the calicivividae family. HCV described by M. Houghton is a 50 to 60 nm. enveloped virus containing a 10,000 nucleotide long single strand RNA who belongs to the Flaviviridae family. The serological diagnosis is based on the detection of antibodies against the C100-3 antigen, a 363 amino acid recombinant protein produced in yeasts. Reactive samples are to be confirmed for antibodies specificity by using a neutralization assay in the presence of the same antigenic material. Alternatively, it is also possible to identify some sequences of viral genome in the serum, after amplification by the technic of Polymerase Chain Reaction (PCR).     

Diagnostic tests for hepatitis C: Recent trends in electrochemical immunosensor and genosensor analysis

Hepatitis C is a liver disease that is transmitted through contact with the blood of an infected person. An estimated 150 million individuals worldwide have been chronically infected with the hepatitis C virus (HCV). Hepatitis C shows significant genetic variation in the global population, due to the high rate of viral RNA mutation. There are six variants of the virus (HCV genotypes 1, 2, 3, 4, 5, and 6), with 15 recorded subtypes that vary in prevalence across different regions of the world. A variety of devices are used to diagnose hepatitis C, including HCV antibody test, HCV viral load test, HCV genotype test and liver biopsy. Rapid, inexpensive, sensitive, and robust analytical devices are therefore essential for effective diagnosis and monitoring of disease treatment. This review provides an overview of current electrochemical immunosensor and genosensor technologies employed in HCV detection. There are a limited number of publications showing electrochemical biosensors being used for the detection of HCV. Due to their simplicity, specificity, and reliability, electrochemical biosensor devices have potential clinical applications in several viral infections.     

Elimination of HCV in Russia: Barriers and Perspective

Hepatitis C virus (HCV) is highly prevalent in Russia, representing the largest pool of hepatitis C patients in Europe. Effective treatment regimens with direct-acting antivirals can achieve HCV cure in all patients; therefore, in 2016 the World Health Organization proposed eliminating hepatitis C as a public health threat by 2030. However, only a small number of countries are on track to meet the WHO’s hepatitis C elimination targets by 2030 due to many barriers in healthcare systems. This review focuses on a discussion about the epidemiology of HCV in Russia, the economic burden of HCV-related diseases, and treatment access with particular reference to the barriers for the elimination of HCV.     

Natural history of acute and chronic hepatitis C

Hepatitis C virus (HCV) infection remains a major global health burden. Hepatitis C causes significant liver-related morbidity and mortality due to hepatic decompensation and development of hepatocellular carcinoma. In addition, extra-hepatic manifestations of hepatitis C are frequent. There is a very large interindividual variability in the natural history of both acute and chronic hepatitis C which can be explained in part by a combination of various host, viral and environmental factors. Successful antiviral treatment can prevent short- and long-term complications of HCV infection in many patients. Still, the relative contribution of distinct risk factors for disease progression in different phases of HCV infection needs to be better defined. Personalized treatment approaches for HCV infection should consider individual risk profiles to avoid both under- and over-treatment – which will remain important also in upcoming era of interferon-free treatment of hepatitis C.     

Acute hepatitis C virus infection, 1986-2001: a rare cause of fulminant hepatitis in Chiba, Japan

BACKGROUND/AIMS: Hepatitis C virus (HCV) is the most common cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma. It is controversial whether HCV causes fulminant hepatitis. METHODOLOGY: To determine the clinical features and etiology of acute hepatitis and fulminant hepatitis in Japan, an endemic area of hepatitis C, between 1986 and 2001 inclusively, a retrospective study of consecutively referred patients was performed. Two hundred and sixty-three patients admitted to a liver clinic after diagnosis of acute hepatitis or fulminant hepatitis, were evaluated. RESULTS: We found 181 cases of acute hepatitis and 82 cases of fulminant hepatitis/late onset hepatic failure. No cases of fulminant hepatitis were positive for HCV RNA. Only three cases had positive anti-HCV antibody, and they were thought to indicate past HCV infection. The main cause of infection in these three patients was hepatitis A virus in one,hepatitis B virus in one, and drugs in the remaining one. HCV did not seem to be the major cause. The three cases died without receiving liver transplantation. CONCLUSIONS: It was revealed that fulminant hepatitis C rarely occurs in Japan, as well as in the USA and European countries. Investigators should search for other causes in fulminant cases presenting an HCV marker.