重型肝炎患者外周血干细胞因子水平及临床意义

目的: 探讨重型肝炎患者外周血干细胞因子(stem cell factor,SCF)与其肝损害程度及预后的关系.方法: 贵州省遵义医学院第一附属医院住院的肝炎患者45例及门诊体检者15例.肝炎患者分为急性肝炎组15例,慢性肝炎组16例和重型肝炎组14例;重型肝炎患者又分为好转组4例,死亡组10例.ELISA法检测各组血清SCF水平.结果: 重型肝炎患者血清SCF水平明显高于急性肝炎、慢性肝炎和健康对照组,差异具有统计学意义(2403.1±42.8 ng/L vs 2354.9±19.0ng/L,2376.7±16.4 ng/L,2358.4±16.0 ng/L,均P＜0.05).重型肝炎患者死亡组血清SCF水平明显高于好转组,差异有统计学意义(2418.1±50.7 ng/L vs 2376.3±11.7 ng/L,P＜0.05).血清SCF与肝细胞生长因子有明显正相关(r =0.38,P＜0.01).SCF与血清白蛋白、凝血酶原时间活动度呈明显负相关( P＜0.01).结论: 重型肝炎患者外周血清SCF水平随着肝损害程度加重而明显升高,提示严重肝损害时,肝再生可能需要干细胞的参与.     

重型病毒性肝炎血清甲状腺激素水平检测及临床意义

目的 探讨重型病毒性肝炎患者血清甲状腺激素水平与肝损害程度关系及临床意义.方法 应用放射免疫法测定54例重型病毒性肝炎、41例急性病毒性肝炎患者及30例正常人血清甲状腺激素水平.结果 重型病毒性肝炎T3、T4、TSH水平显著低于急性病毒性肝炎及正常人(P＜0.05);rT3则增高(P＜0.05).T3、T4与血浆Alb呈正相关,L、TSH与PT,rT3与ALT呈负相关.重型病毒性肝炎死亡者T3、T4、TSH显著低于存活者(P＜0.01).rT3则增高(P＜0.01).结论 重型病毒性肝炎患者甲状腺激素水平可作为反映肝功能的敏感指标,对判断疾病严重程度、预后有重大价值.     

慢性乙型肝炎患者血清HBV DNA、ALT及透明质酸与肝组织病理的关系

目的:探讨慢性乙型病毒性肝炎(CHB)患者血清HBV DNA、ALT(丙氨酸转氨酶)、HA(透明质酸)与肝组织病理的关系,为临床治疗提供一定的理论指导.方法:对127例CHB患者行肝组织病理、乙型肝炎病毒(HBV)免疫组化检查,并检测其血清HBV DNA、HBV-M、ALT、HA水平.结果:ALT对肝脏炎症程度的评估有意义(P＜0.01),HA有助于判断CHB患者肝脏的炎症及纤维化程度(P＜0.01),肝组织S0组与S1~4组、肝组织G0~1组与G2~4组的血清HBV DNA水平比较差异无显著性意义(P＞0.05);HBcAg阳性组与阴性组的HBV DNA含量比较差异有显著性意义(P＜0.01).结论:血清HBV DNA水平与肝组织HBcAg表达有一致性,ALT正常或低水平者应争取肝组织活检,以便及时判断肝组织病理状况,把握治疗时机.     

支链氨基酸/芳香氨基酸(BCAA/AAA)值在病毒性肝炎的临床意义

目的探讨BCAA/AAA比值在病毒性肝炎各临床类型中的变化及其相关性,进一步分析其在肝性脑病发生机制中的作用.方法从1999年9月至2001年4月,总结病毒性肝炎患者154例,年龄32～68岁,平均(54.2±21.0)岁.男104例,女50例,男女为2.11.其中急性肝炎22例,慢性肝炎65例,重型肝炎20例,肝硬化47例.按血清病原学检测,甲型11例,乙型106例,丙型1例,戊型8例,重叠感染16例,病原未明12例.肝硬化Child-Pugh分级为A、B及C.BCAA及AAA用液相色谱法测定,BCAA/AAA正常值为3.0～3.8.结果BCAA/AAA比值在急性肝炎基本正常,慢性肝炎轻度低于急性肝炎(P＞0.05);慢性肝炎重度显著低于慢性肝炎中度(P＜0.001);重型肝炎或肝硬化低于慢性肝炎重度(P＜0.05),各组相比,差异有显著性或非常显著性.在Child-Pugh分级中,BCAA/AAA比值C级＜B级＜A级,各组间相比,差异有非常显著性(P＜0.001或P＜0.02).在重型肝炎或肝硬化中,发生肝性脑病组的BCAA/AAA比值显著低于未发生肝性脑病组(P＜0.001);死亡组的BCAA/AAA比值显著低于存活组(P＜0.01或P＜0.005).结论BCAA/AAA值的测定,在一定程度上能反映肝脏受损情况.其比值越低,肝脏受损越严重,且容易出现肝性脑病.该值对于患者的预后判断也有一定的参考价值.     

肝纤维化指标与疾病程度、病毒含量及病理的关系

目的探讨血清肝纤维化指标与肝炎疾病程度、血清病毒含量及肝脏病理的关系.方法选择190例肝炎患者进行血清HA,LN,Ⅳ-C,PCⅢ测定,其中急黄肝19例,慢肝轻度32例,中度79例,重度20例,肝硬变28例,慢重肝6例,携带者6例.其中乙肝145例,检测血清HBVDNA.有61例慢肝患者进行肝活组织学检查.对不同临床分型肝炎血清HA,LN,Ⅳ-C、PCⅢ进行比较,并分析HBVDNA含量及肝组织病理与之相对应关系.结果随着肝炎疾病程度的加重,血清HA,LN,Ⅳ-C,PCⅢ水平逐渐升高,以肝硬变及慢重肝为最高(P＜0.01,P＜0.01,为与携带组比较).145例乙肝中,HBV DNA(+)组与HBV DNA(-)组血清HA,LN,Ⅳ-C,PCⅢ比较无差异(P＞0.05).61例有肝脏病理的慢肝患者血清HA,LN,Ⅳ-C与病理炎症活动度成正相关(r=0.9783,r=0.9566,r=0.9745,r=0.8648),HA,LN,Ⅳ-C,PCⅢ与病理纤维化程度成正相关(r=0.9557,r=0.9455,r=0.9428,r=0.9435).HA,LN在G4期升高明显,而Ⅳ-C在肝硬变期才升高明显.PCⅢ在G1～4期无变化.PCⅢ在S2期明显升高.结论血清HA,LN,Ⅳ-C,PCⅢ可用于判断肝炎疾病的严重程度,与病毒复制强弱无关,HA,LN能较早反映肝炎炎症活动度,PCⅢ能较早反映肝炎纤维化程度.     

慢性乙型重型肝炎患者血清sICAM-1的检测及临床意义

目的探讨慢性乙型重型肝炎患者血清可溶性细胞间粘附分子-1(sICAM-1)的变化及其临床意义。方法采用双抗体夹心酶联免疫吸附法对50例慢性乙型重型肝炎患者和30例正常人血清sICAM-1水平进行测定。对50例慢性乙型重型肝炎患者用ELISA法检测乙型肝炎病毒血清标志物,荧光定量PCR法检测HBV DNA载量、全自动生化分析仪检测肝功能、全自动血凝分析仪检测凝血酶原活动度(PTA)。结果慢性乙型重型肝炎患者血清sICAM-1水平明显高于健康对照组(P<0.01),存活组血清sICAM-1水平明显高于死亡组(P<0.01);慢性乙型重型肝炎患者血清sI-CAM-1水平与PTA呈显著正相关(r=0.475,P<0.01),与血清总胆红素呈显著负相关(r=-0.395,P<0.01),与丙氨酸氨基转移酶、白蛋白无相关性(r=0.014、-0.214,P>0.05);27例HBV DNA<1×105copies/ml者与23例HBV DNA≥1×105copies/ml者血清sICAM-1水平无显著性差异(P>0.05);7例HBeAg( )/HBeAb(-)者与43例HBeAg(-)/HBeAb( )者血清sICAM-1水平也无显著性差异(P>0.05)。结论慢性乙型重型肝炎患者血清sI-CAM-1水平显著高于健康对照组,存活组血清sICAM-1水平明显高于死亡组。sICAM-1参与了慢性乙型重型肝炎的肝损伤过程,并与患者病情程度有一定的相关性,但与乙型肝炎病毒的复制水平无相关。     

慢性乙肝患者血清ACTA水平及临床评价

目的 探讨激活素A(activin A,ACTA)在估价慢性乙型病毒性肝炎程度中的作用.方法 采用酶联免疫(ELISA)法测定118例患者血清ACTA含量.采用放射免疫(RIA)法测定118例患者血清透明质酸(HA)、Ⅳ型胶原(CIV)、层黏连蛋白(LN)水平.结果 118例慢性乙肝轻、中、重度及肝硬化患者血清ACTA、HA、CIV、LN均高于对照组,以上指标水平按轻、中、重度及肝硬化次序递增,并以肝硬化组为最高.除轻、中度级LN无显著差异外,其他各组间差异显著(P<0.01).ACTA与HA、CIV、LN水平呈明显正相关(r=0.6188,P<0.01;r=0.5741,P<0.01;r=0.3336,P<0.05).结论 ACTA能较好地反映慢性肝病纤维化的进展程度,可作为临床评估慢性肝病病变程度和疗效的良好指标,亦可作为肝纤维化的诊断指标.     

病毒性肝炎患者高迁移率族蛋白1的水平及其临床意义

目的研究晚期炎症介质高迁移率族蛋白1（HMGB1）在慢性肝炎及重型肝炎中的临床意义。方法选择慢性乙型病毒性肝炎患者56例、重型乙型病毒性肝炎患者28例、健康对照者20例,应用ELISA法检测血清HMGB1水平;同时检测相关生化指标、肝纤维化指标、凝血酶原时间（PT）。结果重型肝炎组HMGB1水平高于慢性肝炎组及正常对照组（P〈0.01）,且慢性肝炎组高于正常对照组（P〈0.01）;慢性肝炎组HMGB1水平随病情严重程度增加而增高（P〈0.01）。HMGB1水平与谷丙转氨酶、总胆红素、天冬氨酸氨基转移酶线粒体同工酶、透明质酸、层粘连蛋白、Ⅲ型前胶原、PT水平呈正相关,与白蛋白水平呈负相关。结论血清HMGB1含量可作为评价慢性病毒性肝炎病情严重程度的可靠指标。     

血浆置换联合连续性血液滤过治疗重型乙型病毒性肝炎的临床观察

目的 探讨血浆置换联合连续性血液滤过治疗重型乙型病毒性肝炎的临床疗效.方法 对22例用血浆置换联合连续性血液滤过技术治疗的患者(治疗组)与18例开展连续性血液滤过技术前单用血浆置换治疗的患者(对照组)进行治疗效果的回顾性对比分析.结果 两组治疗后肝功能均较治疗前显著好转(P＜0.01).治疗组治疗后血氨显著降低(P＜0.01),肝性脑病患者意识转清率为76.92%.连续性血液滤过治疗期间可见患者球结膜水肿明显减轻,持续性中枢性高热得到控制.治疗组患者的病情虽较对照组重,但治疗组治愈好转率为45.45%,与对照组相似.结论 血浆置换联合连续性血液滤过治疗重型乙型病毒性肝炎较单纯血浆置换治疗的适应证范围扩大并取得较好效果,为重型乙型病毒性肝炎患者带来了更多的生存机会.     

巨噬细胞移动抑制因子与慢性乙型肝炎、乙型肝炎肝硬化的关系

目的 了解慢性乙型肝炎(乙肝)及乙肝肝硬化患者血清细胞因子巨噬细胞移动抑制因子(MIF)表达水平,探讨血清MIF水平与Ⅲ型前胶原肽(PⅢP)、组织金属蛋白酶抑制剂-1(TIMP-1)的相关性.方法 选择44例慢性乙肝患者(肝炎组)、44例乙肝肝硬化患者(肝硬化组)和30名健康者(对照组),取静脉血并应用ELISA方法检测其血清中细胞因子MIF浓度,分析实验组血清MIF水平与PⅢP、TIMP-1相关性.两组间均数比较采用t检验,MIF水平与ALT、AST、TBil、PTA、PⅢP及TIMP-1关系采用直线相关分析.结果 慢性乙肝组及肝硬化组血清MIF、PⅢP及TIMP-1的浓度比健康对照组升高.差异均有统计学意义(t=12.87、5.28、10.98,t=11.22、14.84、11.17)均P<0.05),但该3种细胞因子在慢性乙肝及肝硬化患者之间差异无统计学意义(t=-1.05、1.52、-2.07;均P>0.05);MIF水平与ALT、AST、TBil及PTA均无相关性;HBeAg阳性和高病毒载量(>1×105拷贝/mL)慢性乙肝患者体内MIF水平高于HBeAg阴性和低病毒载量(≤1×105拷贝/mL)患者.MIF水平与PⅢP水平在慢性乙肝组和肝硬化组中均存在正相关(r=0.603,P<0.05;r=0.415,P<0.05);MIF水平与TIMP-1水平在慢性乙肝组中存在正相关(r=0.458,P<0.05),而在肝硬化组无相关性(r=0.210,P>0.05),PⅢ P与TIMP-1在慢性乙肝组及肝硬化组均存在相关性(r=0.649,P<0.05)r=0.424,P<0.05).结论 慢性乙肝及肝硬化患者体内MIF水平明显升高,MIF的早期生成可能与病毒复制有关,与肝功能无关;MIF参与了肝炎,肝纤维化及肝硬化形成过程,可反应肝硬化程度.     

Viral hepatitis: Past,present, and future

Each hepatitis virus—Hepatitis A, B, C, D, E, and G—poses a distinct scenario to the patient and clinician alike. Since the discovery of each virus, extensive knowledge regarding epidemiology, virologic properties, and the natural clinical and immunologic history of acute and chronic infections has been generated. Basic discoveries about host immunologic responses to acute and chronic viral infections, combined with virologic data, has led to vaccines to prevent Hepatitis A, B, and E and highly efficacious antivirals for Hepatitis B and C. These therapeutic breakthroughs are transforming the fields of hepatology, transplant medicine in general, and public and global health. Most notably, there is even an ambitious global effort to eliminate chronic viral hepatitis within the next decade. While attainable, there are many barriers to this goal that are being actively investigated in basic and clinical labs on the local, national, and international scales. Herein, we discuss pertinent clinical information and recent organizational guidelines for each of the individual hepatitis viruses while also synthesizing this information with the latest research to focus on exciting future directions for each virus.     

急性非甲乙丙丁戊型病毒性肝炎的临床分析

本文对４３例未定型病毒性肝炎患者的流行病学资料、临床表现等进行了分析。结果表明：本组患者起病急，常有短暂发热、消化道症状、黄疸、肝大。在同期住院的急性病毒性肝炎中占１２．４６％。发病时间以冬末及春季为多见，中、老年病人占相当比例。本组患者皮疹，关节痛等血清病样表现极少见，其ＡＬＴ活性及ＳＢ多明显增高，除２例因亚急性重型肝炎死亡外，其余病例都在１个月左右顺利康复，与文献中提及的己、庚型病毒性肝炎的临     

From hepatitis A to E: A critical review of viral hepatitis

Viral infections affecting the liver have had an important impact on humanity, as they have led to significant morbidity and mortality in patients with acute and chronic infections. Once an unknown etiology, the discovery of the viral agents triggered interest of the scientific community to establish the pathogenesis and diagnostic modalities to identify the affected population. With the rapid scientific and technological advances in the last centuries, controlling and even curing the infections became a possibility, with a large focus on preventive medicine through vaccination. Hence, a comprehensive understanding of hepatitis A, B, C, D and E is required by primary care physicians and gastroenterologists to provide care to these patients. The review article describes the epidemiology, pathogenesis, clinical presentation, diagnostic tools and current medication regimens, with a focus on upcoming treatment options and the role of liver transplantation.     

Viral hepatitis in 2021:The challenges remaining and how we should tackle them

Viral hepatitis results in 1.4 million deaths annually.The World Health Organization(WHO)set an ambitious target to eliminate viral hepatitis by 2030,but significant challenges remain.These include inequalities in access to healthcare,reaching at risk populations and providing access to screening and effective treatment.Stigma around viral hepatitis persists and must be addressed.The WHO goal of global elimination by 2030 is a worthy aim,but remains ambitious and the coronavirus 2019 pandemic undoubtedly has set back progress.This review article will focus on hepatitis A to E,highlighting problems that have been resolved in the field over the past decade,those that remain to be resolved and suggest directions for future problem solving and research.     

HDV感染后乙型肝炎患者血清肝炎病毒标志物的变化

目的　分析HDV感染患者血清病毒性肝炎标志物的变化和意义 ,探讨HDV致病机理。方法　对 469例HDV阳性乙型肝炎患者常见各类型病毒性肝炎血清标志物的变化等作统计分析 ,以 2 13例HDV( -)乙型肝炎患者作对照。结果　HDV感染后血清HBeAg检出率降低 (P <0 .0 1)。在HDV ( +)HBVDNA( -)组 ,HBeAg( -)的机会大 (P <0 .0 1)。在急性肝炎、重型肝炎和肝硬化患者HDAg( +)HBeAg( -)为主要血清病毒表现形式 (P <0 .0 1或 0 .0 5 )。HDV感染后合并其它肝炎病毒感染率高于乙型肝炎组。结论　HDV感染可抑制HBV复制或HBeAg表达 ,混合感染HDV的乙型肝炎中HDV的直接细胞毒性作用可能起主要致病作用。重叠感染HDV的乙型肝炎患者其病情重、病死率高和容易慢性化。     

临床肝病患者中庚型肝炎病毒(GBV-C/HGV)的感染

本文应用抗-HGV酶联免疫法(EIA)和逆转录套式聚合酶链反应法(RT-PCR)检测150份乙型、120份丙型、15份戊型和49份非甲-戊型肝炎患者血清。结果显示:乙肝、丙肝、戊肝和非甲-戊型肝炎患者中抗-HGV抗体的阳性率分别为22.0％(33/150)、25.0％(30/120)、33.3％(5/15)和40.1％(20/49)。其中乙型、丙型、戊型和非甲-戊型肝炎的抗-HGV抗体阳性者中,HGV RNA的阳性率分别为58.3％(7/12)、60.0％(6/10)、40.0％(2/5)和45.5％(9/12)。说明GBV-C/HGV可与HBV、HCV或HEV合并感染,该病毒可能引起临床型肝炎。     

Sustained Virological Response in Chronic Hepatitis C Patients after a 6- and a 36-Month Interferon-a2b Treatment Schedule. A Multicenter,Randomized, Controlled Study

With the introduction of medical treatment (chenodeoxycholic acid therapy) of cholesterol gallstones, the prediction of the gallstone type, cholesterol — non-cholesterol stones (i.e. cholesterol predominating or not), has become important. In 24 consecutive patients admitted for surgery because of gallstones, the value of various criteria for differentiation between the two types of stones was assessed. It is concluded that the combined requirements of radiolucency of the stones and a cholesterol saturation index in duodenal bile above 1.00 constitutes a fairly reliable method for selection of patients for dissolution therapy with chenodeoxycholic acid.     

铜相关蛋白和组织铁在丙型、丁型、庚型肝炎肝组织中的定位比较

目的 研究铜相关蛋白(C-AP)和组织铁(IT)在丙型肝炎,丁型肝炎和庚型肝炎中的变化特点。方法应用改良的Shikata和Berlin blue方法,检测三种肝炎患者肝穿活检组织中的C-AP和IT的定位及分级程度。结果 C-AP和IT的阳性率和分级程度随着肝组织损伤的严重程度而递增。在三种肝炎肝组织中,C-AP和IT的阳性率及分级程度有明显差异。结论 C-AP和IT可以反映出三种病毒性肝炎肝组织损伤的差异,庚型肝炎肝组织损伤比丙型肝炎和丁型肝炎肝组织损伤轻。     

Health Related Quality of Life in Iranian Hemodialysis Patients With Viral Hepatitis: Changing Epidemiology

Background

There are surprisingly a few studies that evaluate the impact of chronic viral hepatitis, which is common in HD (hemodialysis) patients, on HRQOL (health related quality of life).

Objectives

We conducted a study to evaluate the impact of chronic viral hepatitis on HRQOL and to compare their HRQOL with non-infected HD patients via a HRQOL questionnaire.

Patients and Methods

The Iranian adapted version of the Kidney Disease Quality of Life Short Form (KDQOL-SF) version 1.3 questionnaires were filled out by the HD patients. In all HD patients, serum HBsAg, HBS Abs, and HCV Abs [enzyme-linked immunosorbant assay (ELISA)] were routinely checked every six months. Patients were considered to have chronic HBV infection if HBsAg was positive for more than six months. In all HD patients, third generation assay was used to detect HCV infection. Furthermore, serum HCV-RNA (PCR) was examined in anti-HCV-positive patients for confirmation of HCV infection.

Results

in this cross sectional study 4101 patients from 103 dialysis units in Iran between October 2010 and August 2011 were included. Prevalence of hepatitis B and hepatitis C infection was 2.1% and 1.3% respectively. Almost all KDQOL items for viral hepatitis patients had equivalent or better scores than those without viral hepatitis. In the logistic regression after adjustment for age, sex, educational level, marital status, dialysis vintage, HBs Ag positivity and HCV Ab positivity, only age (P < 0.001) and educational level (P = 0.015) had negative impact on quality of life.

Conclusions

Our data show that not only general health and physical activity were preserved but also health perception may be better among HD patients with viral hepatitis.