病毒性肝炎TTV DNA阳性者的临床分型和肝组织学观察

目的：了解输血传播病毒（TTV）感染的临床特点和肝组织形态学特征,探讨TTV与肝损伤的关联性,方法：对93例血清TTV DNA阳性病毒性肝炎患者的临床资料及其中10例单一TTV笔DNA阳性慢性非甲－瘐型肝炎（HNA－G）的肝组织光镜和电镜检查结果进行分析,结果：各型病毒性肝炎中的均有一定比例的TTVDNA阳性,以慢性肝炎,慢性重型肝炎,肝硬化多见,可呈T TV＋HAV,TTV＋HBV,TTV＋HEV,TTV＋HAV,TTV＋HBV＋HCV,TTV＋HBV＋HEV,TTV＋HBV＋HGV重叠感染,与HBV重叠感染可有慢性重型肝炎,肝硬化之临床类型,半日一TTV DNA阳性慢性肝炎患者存在肝细胞变性,坏死和肝组织淋巴细胞浸润,纤维明显增生,结论：TTV DNA阳性慢性肝炎患者在肝细胞变性,坏死和肝组织淋巴细胞浸润,纤维明显增生,结论：TTV在肝脏慢性损伤中可能起一定作用,可引起慢性肝炎并与肝硬化和慢性重型肝炎的发生相关联。     

Effect of ecdystene on parameters of the sexual function under experimental and clinical conditions

The effects of ecdysterone and the related drug ecdysten on the sexual activity were studied under experimental and clinical conditions. A 10-day administration of ecdysterone (5 and 10 mg/kg, p.o.) improved behavioral characteristics of the sexual function in rats, the effect being especially pronounced during the fist days of experiment. The administration of ecdysten to men with the infertility diagnosis (disturbed spermatogenesis as a complication of some urologic diseases) increased the copulative function and improved the sperm quality. The administration of ecdysten to patients in the stage of recovery upon myocardial infarction also improved the sexual function.     

Lamivudine. A review of its therapeutic potential in chronic hepatitis B.

Lamivudine is a deoxycytidine analogue that is active against hepatitis B virus (HBV). In patients with chronic hepatitis B, lamivudine profoundly suppresses HBV replication. Clinically significant improvements in liver histology and biochemical parameters were obtained with lamivudine in double-blind, randomised, trials in hepatitis B e antigen (HBeAg)-positive patients with chronic hepatitis B and compensated liver disease. After 52 weeks of treatment, relative to placebo (< or = 25%), significantly more Chinese (56%) or Western patients (52%) treated with lamivudine 100 mg/day had reductions of > or = 2 or more points in Knodell necro-inflammatory scores. Moreover, significantly fewer lamivudine 100 mg/day than placebo recipients had progressive fibrosis in liver biopsies (< or = 5 vs > or = 15%) and fewer lamivudine- than placebo-treated patients progressed to cirrhosis (1.8 vs 7.1%). More lamivudine 100 mg/day than placebo recipients acquired antibodies to HBeAg after 52 weeks (16 vs 4% in Chinese patients and 17 vs 6% in Western patients). ALT levels normalised in significantly more lamivudine than placebo recipients enrolled in these trials. In HBeAg-negative, HBV DNA positive patients with compensated liver disease enrolled in a double-blind, randomised study, HBV DNA levels were suppressed to below the limit of detection (< 2.5 pg/ml) and ALT levels normalised in 63% and 6% of patients treated with lamivudine 100 mg/day or placebo for 24 weeks. Clinically significant improvements in liver histology were obtained in 60% of patients treated with lamivudine for 52 weeks in this study. Lamivudine 100 mg/day for 52 weeks produced similar or significantly greater improvements in liver histology and ALT levels than 24 weeks' treatment with lamivudine plus interferon-alpha. In liver transplant candidates with chronic hepatitis B and end-stage liver disease, lamivudine 100 mg/day alone, or in combination with hepatitis B immune globulin, generally suppressed HBV replication and appeared to protect the grafted liver from reinfection. Lamivudine 100 mg/day suppressed viral replication and improved liver histology in liver transplant recipients with recurrent or de novo chronic hepatitis B. Lamivudine 300 or 600 mg/day reduced HBV replication in HIV-positive patients. The incidence of adverse events in patients with chronic hepatitis B and compensated liver disease treated with lamivudine 100 mg/day or placebo for 52 to 68 weeks was similar. 3.1- to 10-fold increases in ALT over baseline occurred in 13% of patients during treatment with lamivudine 100 mg/day or placebo for 52 weeks. Post-treatment ALT elevations were more common in lamivudine than placebo recipients; however, these generally resolved spontaneously; < or = 1.5% of lamivudine- or placebo-treated patients experienced hepatic decompensation. CONCLUSION: Lamivudine inhibits HBV replication, reduces hepatic necro-inflammatory activity and the progression of fibrosis in patients with chronic hepatitis B, ongoing viral replication and compensated liver disease including HBeAg-negative patients. The drug also suppresses viral replication in liver transplant recipients and HIV-positive patients. Thus, lamivudine is potentially useful in a wide range of patients with chronic hepatitis B and ongoing viral replication.     

阿德福韦酯联合苦参素治疗干扰素无应答HBeAg阳性慢性乙型肝炎患者疗效观察

目的：探讨阿德福韦酯联合苦参素治疗干扰素无应答HBeAg阳性慢性乙型肝炎患者临床疗效。方法选择我院2011～2012年感染科收治的40例干扰素无应答HBeAg阳性慢性乙型肝炎患者的资料,根据患者治疗方式,将患者分为观察组及对照组各20例,两组均应用阿德福韦酯治疗,观察组患者加用苦参素片口服,连续治疗12个月,治疗前后测定患者肝功能生化指标及病毒指标。结果观察组患者肝功能生化指标及病毒指标改善明显,优于对照组,比较差异有统计学意义（P＜0.05）。结论阿德福韦酯联合苦参素治疗干扰素无应答HBeAg阳性慢性乙型肝炎患者,能有效抑制体内HBV复制,有较好的改善肝功能和抗纤维化的作用,效果满意。     

慢性乙型肝炎血清HBV DNA基因检测及其临床意义

目的探讨不同类型慢性乙型肝炎患者病毒复制水平与肝损害程度的关系。方法 150例慢性乙型肝炎(轻度70例、中度60例、重度20例)患者血清HBV DNA含量采用荧光标记(Ampli Sensor)定量PCR方法检测。结果慢性乙型肝炎轻度、中度患者HBV DNA含量(105.58±1.92、106.27±2.05)与慢性乙型肝炎重度患者HBV DNA含量(105.73±1.90)相比较无显著性差异(P>0.05),且不同HBV DNA水平患者的TBil、ALT、AST差别无显著性(P>0.05)。结论随着肝损害程度的加重,慢性乙型肝炎轻度、中度、重度患者血清HBV DNA基因含量未发生显著变化,同时血清HBV DNA含量与TBil、ALT、AST水平无明显关系。     

Metabolic syndrome is associated with severe fibrosis in chronic viral hepatitis and non-alcoholic steatohepatitis

Background The prevalence of metabolic syndrome and its possible impact on the severity of liver histological lesions have not been studied prospectively in chronic liver diseases. Aim To investigate the prevalence of metabolic syndrome in patients with chronic viral hepatitis or non‐alcoholic steatohepatitis, and to determine its associations with histological severity. Methods We prospectively included 317 patients (hepatitis B e antigen‐negative chronic hepatitis B: 95, chronic hepatitis C: 176, non‐alcoholic steatohepatitis: 46) with liver biopsy. Metabolic syndrome was defined using the Adult Treatment Panel III criteria. Histological lesions were evaluated according to Ishak’s or Brunt’s classification. Results Metabolic syndrome was present in 10.4% of patients being significantly more prevalent in non‐alcoholic steatohepatitis than in chronic viral hepatitis (41.3% vs. 5.1%, P < 0.001). In chronic viral hepatitis, cirrhosis (stages 5–6) was independently associated with increasing age, higher aspartate aminotransferase and gamma‐glutamyl‐transpeptidase levels, severe necroinflammation and metabolic syndrome (P = 0.016). In non‐alcoholic steatohepatitis, severe fibrosis (stages 3–4) was independently associated with severe necroinflammation and metabolic syndrome (P = 0.033). Presence of metabolic syndrome was not associated with presence or severity of steatosis both in chronic viral hepatitis and in non‐alcoholic steatohepatitis. Conclusion Metabolic syndrome is more prevalent in non‐alcoholic steatohepatitis than in chronic viral hepatitis; it is associated independently with more severe fibrosis but not with the severity of steatosis, both in chronic viral hepatitis and in non‐alcoholic steatohepatitis.     

重型肝炎患者血糖、甲胎蛋白和胆碱脂酶检测的临床意义

目的探讨血糖、甲胎蛋白和胆碱脂酶水平对重型肝炎的诊断以及预后判断价值。方法回顾性分析慢性乙型肝炎、肝硬化失代偿、慢性重型肝炎、亚急性重型肝炎患者之间,以及重型肝炎好转组与死亡组之间血糖、甲胎蛋白、胆碱脂酶的差异。结果亚急性重型肝炎、慢性重型肝炎患者血糖和胆碱脂酶水平明显低于慢性乙型肝炎及肝硬化患者（均P〈0．05）;而甲胎蛋白水平显著高于慢性乙型肝炎（P〈0．01）;重型肝炎好转组血糖、甲胎蛋白、胆碱脂酶水平明显高于死亡组（均P〈0．05）。结论血糖、甲胎蛋白、胆碱脂酶检测对肝脏疾病的进展程度及预后估计有重要判断价值。     

小柴胡汤联合水飞蓟素治疗慢性乙型肝炎肝纤维化疗效分析

目的观察小柴胡汤和水飞蓟素联用治疗慢性乙型肝炎肝纤维化的临床疗效。方法90例慢性乙型肝炎肝纤维化患者随机分为两组,治疗组50例服用小柴胡汤和水飞蓟素,对照组40例服用水飞蓟素,疗程均为6个月。观察两组用药前后肝功能、血清肝纤维化及乙肝病毒标志物指标变化。结果治疗组肝功能及血清肝纤维化指标均有明显改善（P〈0．01或P〈0．05）,对乙肝病毒的清除作用也优于对照组（P〈0．05）。结论小柴胡汤和水飞蓟索联用对慢性乙型肝炎肝纤维化具有明确的临床意义。     

山西地区病毒性肝炎2263例病原学和临床类型分布研究

目的研究山西地区病毒性肝炎的病原和临床特征,为制定病毒性肝炎防治方案提供依据。方法对2000—2007年在山西医科大学第一医院住院的2263例病毒性肝炎患者资料进行回顾性临床流行病学调查,并运用描述性统计学方法进行分析。结果在2263例病毒性肝炎病例中,病原学以乙型肝炎病毒占绝对优势,感染构成比达73.8%,其次是未定型肝炎,为10.3%;临床分型以慢性肝炎和肝硬化比例为高,分别为44.1%和32.9%。在急性病毒性肝炎中,以乙型病原比例最高,约35.0%,戊型其次,为30.1%,而甲型相对较少,仅13.4%;慢性肝炎、肝硬化和重型肝炎的病原也均以乙型为主。病原未定型在急性和重型病毒性肝炎中比例较高,分别为20.8%和31.3%。结论山西地区病毒性肝炎病原学以乙型为主,但病原未定型的比例高于全国平均水平;临床类型以慢性肝炎和肝硬化为主。在急性病毒性肝炎中,甲型肝炎比例显著下降,乙型和戊型比例增高。病原学未定型在急性和重型病毒性肝炎中比例较高,提示我们应提高对病毒性肝炎病原的检测手段,并加强对新型肝炎病毒的关注。另外,需要加强对戊型肝炎的监测,警惕其暴发流行。     

Epidemiology, prevention and treatment of viral hepatitis with emphasis on new developments

There are a large number of viruses, such as cytomegalovirus, Epstein-Barr, Herpes simplex, mumps, varicella, yellow fever, etc., known to cause inflammatory disease of the liver, but the term viral hepatitis generally refers to the five well described hepatotropic viruses which are divided into enteral and parenteral groups based on their mode of transmission. Hepatitis A and E viruses are enterically transmitted by the faecal-oral route and do not exist in a chronic carrier state. Hepatitis B, C and D viruses are parenterally transmitted, occur both in the acute and chronic forms, and, when they persist in a chronic carrier state, they serve as a reservoir for infection and give rise to chronic hepatitis, cirrhosis and hepatocellular carcinoma. Hepatitis G virus has recently been described but its significance in the causation of human liver disease is yet to be established. Also, the most recently described TT virus in patients with post-transfusion hepatitis awaits further studies. Acute sporadic and epidemic viral hepatitis are common world-wide, mostly in the developing countries, including Ethiopia, and account for high morbidity and mortality, especially among pregnant women. Chronic infection with hepatitis B virus is a significant problem on a global scale, affecting over 300 million people. Hepatitis C virus infection is probably the most common cause of chronic viral hepatitis, end-stage liver disease and hepatocellular carcinoma in the world, especially in sub-Saharan Africa, including Ethiopia. Therefore, this article will review and highlight the relevant epidemiological, preventive and therapeutic aspects of viral hepatitis with emphasis on new developments and recent data obtained from Ethiopian studies.     

胸腺肽α_1在慢性病毒性肝炎抗病毒治疗中的应用

胸腺肽α1是从胸腺素第5组分中分离纯化出的一种小分子生物活性多肽。近年来,胸腺肽α1开始用于慢性乙型病毒性肝炎和慢性丙型病毒性肝炎的治疗,其耐受性较好,可能成为一种较好的治疗药物。但是,由于胸腺肽α1治疗肝炎相关数据的缺乏,使得人们对其治疗作用及作用机制还不太明确。鉴于此,本文对胸腺肽α1在病毒性肝炎抗病毒治疗中的应用进行综述。     

中医养阴柔肝化湿解毒方治疗慢性乙型病毒性肝炎32例

目的 观察中医养阴柔肝化湿解毒方治疗慢性乙型病毒性肝炎的疗效。方法 选取2010年9月至2012年9月收治的慢性乙型病毒性肝炎患者64例,随机分为研究组和对照组,各32例。对照组给予澳泰乐颗粒治疗,研究组则采用养阴柔肝化湿解毒方治疗,对比两组患者的临床疗效和不良反应。结果 两组患者在治疗后乏力、肝区不适、消化道症状等临床症状和体征均较治疗前明显改善,且研究组改善更明显（χ^2=4.95,3.98,P〈0.05）。两组患者在治疗后丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、总胆红素（TBil）、氨基异丁酸（AIb）等肝功能指标与治疗前相比均有显著性差异,且研究组改善更明显（t=3.21,4.22,3.84,5.67,P〈0.05）。研究组治疗后乙型肝炎病毒（HBV）DNA、乙型肝炎E抗原（HBeAg）转阴率与对照组相比明显升高,乙型肝炎表面抗体（HBsAb）阳性率则明显下降,差异有统计学意义（χ^2=3.89,3.79,6.34,P〈0.05）。结论 养阴柔肝化湿解毒方治疗慢性乙型病毒性肝炎疗效佳,不良反应少,值得临床推广。     

TAF初治CHB合并脂肪肝患者病毒应答时间差异性分析

目的分析富马酸丙酚替诺福韦(TAF)治疗慢性乙型肝炎(CHB)合并脂肪肝患者与治疗单纯CHB患者病毒应答时间的差异性。方法73例使用TAF治疗的CHB患者,均获得病毒应答。其中33例CHB合并脂肪肝患者作为观察组,40例单纯CHB患者作为对照组。比较两组患者的基线资料及病毒应答时间。结果两组患者的性别、年龄、谷丙转氨酶(ALT)、乙型肝炎病毒脱氧核糖核酸(HBV-DNA)(lg)、乙型肝炎表面抗原(lg)、乙型肝炎e抗原阳性率、肝硬度(FS)比较,差异无统计学意义(P>0.05)。两组整体的病毒应答时间均值为30.329周,中位数为25周;观察组病毒应答时间的均值为36.667周,中位数为34周;对照组病毒应答时间的均值为25.100周,中位数为23周;两组病毒应答时间比较,差异具有统计学意义(P<0.05)。结论TAF治疗CHB合并脂肪肝患者至病毒应答所需的时间大于单纯CHB。临床上治疗CHB时,需关注代谢相关脂肪性肝病(MAFLD),并对其进行同步治疗,以提高病毒应答效果。     

谷胱甘肽对慢性乙型肝炎的疗效分析

目的:观察还原型谷胱甘肽对慢性乙型肝炎的疗效。方法:选择慢性乙型肝炎60例,按随机表分组,治疗组和对照组各30例。对照组采用一般的护肝治疗,治疗组在一般治疗基础上加用还原型谷胱甘肽,每日1次,每次1 200m g,静脉滴注,4周为一疗程,分别于治疗前、治疗后2周、治疗后4周观察患者临床症状、体征并测定肝功能指标。结果:治疗组肝功能恢复明显较对照组快(P<0.05)。临床显效率为36.7%,总有效率为86.7%。结论:还原型谷胱甘肽对慢性乙型肝炎患者肝功能的恢复、改善临床症状有重要意义。     

Review article: hepatitis vaccination in patients with chronic liver disease

Evidence regarding the outcomes of viral super-infection in patients with chronic liver disease and practical strategies for hepatitis A and B vaccination of these individuals are reviewed. Patients with acute hepatitis A and chronic hepatitis B have a more severe clinical course and a higher death rate compared with otherwise healthy individuals with hepatitis A, and these differences are most pronounced in older patients and those with histological evidence of chronic hepatitis or cirrhosis, rather than in asymptomatic hepatitis B carriers. Patients with acute hepatitis A super-infection and chronic hepatitis C have an increased risk of fulminant hepatitis and death. In addition, patients with other chronic liver diseases also appear to be at increased risk for more severe disease with superimposed hepatitis A. Patients with chronic hepatitis B and hepatitis C virus co-infection have more severe laboratory abnormalities, more severe histological disease, a greater frequency of cirrhosis and complications of cirrhosis, and a higher incidence of hepatocellular carcinoma. Vaccines for both hepatitis A and B are safe and effective if used early in the course of chronic liver disease. Hepatitis A and B vaccination should be part of the routine management of patients with chronic liver disease, preferably as early as possible in the natural course of their disease.     

联合应用复方甘草酸苷与恩替卡韦对慢性重型乙型肝炎的临床疗效

目的分析并评价联合使用复方甘草酸苷与恩替卡韦对慢性重型乙型肝炎患者的临床疗效。方法选择江苏镇江解放军第三五九医院自2007年至2009年期间收治的慢性重型乙型肝炎患者36例作为观察组;选择2004年至2006年期间收治的慢性重型乙型肝炎32例作为对照组。对照组患者采取复方甘草酸苷(20ml/支)加综合治疗;观察组给予复方甘草酸苷(20ml/支)加恩替卡韦(0.5 mg/片)加综合治疗。结果两组患者经治疗后,在主要临床症状改善、TB及凝血酶原活动度、疸酶分离、并发症、抢救成功率、病死率以及住院时间方面比较,两组之间差异均显著(P<0.01或P<0.05),均具有统计学意义;随访或治疗2年后,观察组HBV-DNA与HBeAg转阴率均明显高于对照组,两组之间比较差异均显著(P<0.01),均具有统计学意义;2年后通过B超和/或肝组织活检证实肝硬变者,观察组明显少于对照组,两组比较差异显著(P<0.01),具有统计学意义。结论恩替卡韦在治疗慢性重型乙型肝炎患者方面具有较高的安全性,其与复方甘草酸苷联合使用能够发挥协同作用,提高临床疗效和抢救成功率,长期服用能够有效抑制病毒复制,延缓肝硬变进程。     

中西医结合治疗慢性乙型肝炎临床观察

目的：运用中西医结合方法治疗慢性乙型肝炎。方法：对102例慢性乙肝患者,采用随机分组形式,分为中药组,西药组,中西医结合组,分别予中药复方汤剂加减,西药拉米夫定及两者结合治疗,并分别对肝功能及HBV病毒复制及半年后复发情况进行临床观察。结果：中西医结合组在肝功恢复正常及HBV病毒复制上明显优于中药组及西药组。结论：中西医结合治疗慢性乙型肝炎不仅可以迅速使肝功能恢复正常,同时可以降低患者血中的含量,使HBeAg及HBV-DNA转阴率提高。     

血清丙氨酸氨基转移酶检测评价慢性乙型肝炎肝组织炎症活动程度的临床价值

目的评价慢性乙型肝炎患者血ALT指标诊断肝组织炎症活动度的临床价值。方法对125例慢性乙型肝炎患者活体肝穿刺的病理标本进行组织炎症活动度及纤维化评分并分别与同期检测的血清ALT指标比较。结果血清ALT平均值随着病理炎症活动度的升高而升高,但仅在412两组之间差异具有统计学意义(t=1.9143,P<0.05);血清ALT平均值随病理组织纤维化增加而升高,但仅在中重度两组之间差异具有统计学意义(t=2.108,P<0.05)。以组织学诊断为金指标,临床诊断中各指标仅Knodell≤4组特异度为79.5%,余均较低。结论血清ALT不能反映慢性乙型肝炎肝组织炎症活动的程度。     

苦参碱联合还原型谷胱甘肽治疗慢性乙型肝炎的疗效观察

目的:观察苦参碱联合还原型谷胱甘肽治疗慢性乙型肝炎的临床疗效。方法:将98例慢性乙型肝炎患者随机分为2组,对照组(n=43)应用还原型谷胱甘肽治疗,疗程8周;治疗组(n=55)在对照组相同治疗基础上加用苦参碱注射液,疗程8周。观察2组患者的症状、体征并测定血清总胆红素(TBIL)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、谷氨酰转肽酶(GGT)等指标在治疗前后的变化,并行组间比较。结果:治疗组在临床症状、体征、TBIL、ALT、AST、ALP、GGT方面的改善明显优于对照组(P<0.05)。结论:还原型谷胱甘肽联合苦参碱治疗慢性乙型肝炎,在降酶、退黄及改善临床症状方面有满意疗效。     

Recommendations and potential future options in the treatment of hepatitis B

The natural history of chronic hepatitis B should be clearly defined before appropriate recommendations for treatment can be advocated. In patients who acquire the disease in early life, the complications of chronic hepatitis B continue to occur as a result of prolonged insidious damage to the liver, even in the low viraemic phase. Treatment that ends with hepatitis B e antigen seroconversion with hepatitis B virus DNA levels just below 10(5) copies/ml may not be sufficient. Patients with mild elevation of alanine aminotransferase levels are already at considerable risk of developing complications. Treatment strategy should aim at maximal and prolonged viral suppression to the lowest possible hepatitis B virus DNA levels. Nucleotide/nucleoside analogues will become the mainstay of treatment. Future treatment strategic plans should target maximising antiviral potency and minimising the chance of drug resistance.