慢性HBV感染者血清GP73水平与白细胞介素6含量的相关性

目的观察慢性乙型肝炎病毒(HBV)感染者血清高尔基体蛋白73(GP73)水平与白细胞介素6(IL-6)含量的变化,探讨血清GP73水平与IL-6含量的相关性。方法选取2015年3月至2016年4月在解放军第一八〇医院住院的慢性HBV感染者268例,其中慢性乙型肝炎(CHB)139例,乙型肝炎肝硬化(HLC)58例,HBV相关肝细胞癌(HCC)71例。选择同期健康体检者50名作为对照组。采用ELISA法检测血清GP73浓度,采用电化学发光法检测血清IL-6含量。结果慢性HBV感染者血清GP73水平显著高于对照组(F=68.61,P0.001),且随着病情的进展,血清GP73浓度在CHB(111.96±73.02 ng/mL)、HLC(190.86±89.83 ng/mL)和HCC(228.58±114.45 ng/mL)中持续升高,HLC和HCC患者中血清GP73浓度均显著高于CHB,差异有统计学意义(P0.001)。经过相关性分析,血清GP73含量与慢性HBV感染者病情严重程度呈正相关(r=0.669,P0.001)。慢性HBV感染者血清IL-6含量显著高于对照组(F=39.94,P0.001),且随着病情的进展,血清IL-6含量在CHB(3.52±4.85 ng/mL)、HLC(23.42±34.65 ng/mL)和HCC(38.81±40.85 ng/mL)中持续升高,各组间比较,差异有统计学意义(P0.001)。经过相关性分析,血清IL-6含量与慢性HBV感染者病情的严重程度呈正相关(r=0.500,P0.001),慢性HBV感染者血清IL-6含量与GP73水平呈正相关(r=0.548,P0.001)。结论血清GP73水平和IL-6含量与慢性HBV感染者疾病进展密切相关,血清GP73水平和IL-6含量可作为评估肝脏炎症损伤程度的一个重要指标。血清IL-6含量与GP73水平呈正相关,血清IL-6可能参与调节GP73的表达。     

自身免疫性肝炎患者血清高尔基体糖蛋白73的变化特征

目的观察血清高尔基体糖蛋白73(GP73)在自身免疫性肝炎患者的变化特征及诊断意义。方法纳入接受肝组织活检病理学检查并诊断为自身免疫性肝炎的患者共62例。选取70例慢性乙型肝炎患者为对照组。采用ELISA试剂盒测定血清GP73浓度。结果与70例慢性乙型肝炎患者[(64.57±21.53)ng/mL]相比,62例自身免疫性肝炎患者的血清GP73水平[(189.60±57.24)ng/mL]显著升高(P0.01)。其中42例血清ALT200 U/L的患者,其血清GP73水平[142.8±56.4)ng/mL]显著高于20例血清ALT200 U/L者[113. 6±68.41)ng/mL],且差异具有统计学意义(P=0.004)。凝血酶原活动度(PTA)60%的患者中,有85%(9/11)的患者血清GP73142 ng/mL。GP73曲线下面积0.801,标准误0.049,95%可信区间(0.704,0.897),诊断价值中等。结论血清GP73水平与自身免疫性肝炎损伤程度有关,血清GP73是诊断自身免疫性肝炎的良好标志物之一。     

慢性乙型肝炎病毒携带者血清GP73水平与肝组织病理学变化的关系研究

目的探讨慢性乙型肝炎病毒携带者血清高尔基体蛋白73(GP73)水平与肝组织病理学变化的关系。方法 2014年1月~2016年12月我院诊治的慢性HBV携带者150例、慢性乙型肝炎患者150例和乙型肝炎肝硬化患者150例,另选同期健康人50例,采用ELISA法检测GP73水平,对150例慢性HBV携带者进行肝穿刺活检,采用Metavir评分对肝组织炎症和纤维化进行评价。结果慢性HBV携带者血清GP73水平为(46.5±7.8)ng/ml,慢性乙型肝炎组为(90.2±10.9)ng/ml,乙型肝炎肝硬化组为(231.6±20.1)ng/ml,均显著高于健康人组的(36.7±6.6)ng/ml,差异有统计学意义(P0.05),肝硬化患者血清GP73水平也显著高于慢性乙型肝炎或HBV携带者(P0.05);经肝组织检查,150例慢性HBV携带者肝内炎症活动度分级和纤维化分期表现为G0~G1105例,G230例,G3~G415例,其血清GP73水平分别为(45.2±12.8)ng/ml、(63.8±15.0)ng/ml和(83.7±20.1)ng/ml,S0~S198例,S230例,S3~S422例,其血清GP73水平分别为(45.1±16.8)ng/ml、(67.3±16.4)ng/ml和(72.0±18.4)ng/ml,肝组织炎症活动度分级和纤维化分期严重的患者血清GP73水平显著升高,与分级或分期轻的人群比,差异有统计学意义(F=16.8,F=19.2,P均0.05);Logistic回归分析发现血清GP73水平升高是慢性HBV携带者肝组织显著炎症(OR=1.1,95%CI:1.0~1.1,P0.05)和显著肝纤维化(OR=2.1,95%CI:0.8~1.2,P0.05)的高危因素。结论检测血清GP73水平可能有助于对慢性HBV携带者肝组织炎症分级和纤维化分期的判断,能否作为预测慢性HBV携带者肝组织炎症分级和纤维化分期的潜在标志物,还需要扩大验证。     

HBV相关慢加急性肝衰竭患者血清GP73、suPAR和AT-Ⅲ水平变化及其临床意义探讨

目的 探讨乙型肝炎病毒相关性慢加急性肝衰竭(HBV-ACLF)患者血清高尔基体蛋白73(GP73)、可溶性人尿激酶型纤溶酶原激活物受体(suPAR)和抗凝血酶-Ⅲ(AT-Ⅲ)水平变化及其临床意义。方法 2019年11月～2022年10月我院收治的HBV-ACLF患者81例(早期29例,中期28例,晚期24例)和慢性乙型肝炎(CHB)患者65例,采用ELISA法检测血清GP73、suPAR和AT-Ⅲ水平。应用受试者工作特征曲线(ROC)评估各指标评估疾病预后的价值。结果 HBV-ACLF患者血清GP73和suPAR水平分别为(227.4±48.4)ng/mL和(8.3±2.3)ng/mL,显著高于CHB患者【分别为(126.6±31.6)ng/mL和(5.1±1.6)ng/mL,P<0.05】,而血清AT-Ⅲ水平为(48.2±12.9)%,显著低于CHB患者【(76.6±18.7)%,P<0.05】;晚期HBV-ACLF患者血清GP73和suPAR水平分别为(265.6±27.1)ng/mL和(9.4±1.2)ng/mL,显著高于中期患者【分别为(231.7±29.5)ng/...     

血清GP73对慢性乙型肝炎病毒携带者肝脏炎症损伤的预测价值

目的观察慢性乙型肝炎病毒(hepatitis B virus,HBV)携带者血清GP73水平与肝脏病理变化的关系,探讨血清GP73水平对慢性HBV携带者肝脏炎症损伤的预测作用。方法选取2012年1月-2014年10月在解放军第一八〇医院就诊的慢性HBV感染者300例,其中慢性HBV携带者100例,慢性乙型肝炎(chronic hepatitis B,CHB)100例,HBV相关肝硬化(liver cirrhosis,LC)100例。选取同期健康体检者50名作为对照组。采用ELISA法检测血清GP73浓度。100例慢性HBV携带者进行肝脏穿刺活检术,分析血清GP73水平与肝脏炎症活动度分级(G)和纤维化分期(S)的关系。结果慢性HBV感染者血清GP73水平显著高于对照组(P0.001),且随着病情的进展,血清GP73浓度在慢性HBV携带者(47.21±17.69)ng/ml、CHB(98.45±65.29)ng/ml和HBV相关LC(229.93±95.00)ng/ml中持续升高,各组间比较,差异有统计学意义(P0.001)。经过相关性分析,血清GP73含量与慢性HBV感染者病情严重程度呈正相关(r=0.746)。100例慢性HBV携带者进行肝脏穿刺活检术后发现,血清GP73含量随着肝脏炎症活动度分级、肝纤维化分期的加重而逐渐升高(P0.001),血清GP73水平与肝脏炎症活动度分级(r=0.549)和肝纤维化分期(r=0.528)呈正相关。在100例ALT正常的慢性HBV携带者中,有显著肝脏炎症(≥G2)和纤维化(≥S2)的患者分别为29例(29.00%)和33例(33.00%)。病理分级为≥G2和≥S2的慢性HBV携带者血清GP73水平显著高于无明显坏死性炎症(G0~G1)和纤维化(S0~S1)患者(P0.001)。多变量Logistic回归分析结果显示,诸因素中只有血清GP73水平被确定为预测肝脏坏死性炎症和肝纤维化的独立因素。结论血清GP73水平与慢性HBV携带者肝组织病理分级分期密切相关。部分慢性HBV携带者尽管ALT水平正常,但是肝组织却存在明显的炎症坏死和纤维化,其血清GP73水平明显升高。因此,血清GP73可用于慢性HBV携带者预测肝脏炎症损伤的标志物。     

克罗恩病患者血清25OHD水平及其临床意义

目的:了解克罗恩病(Crohn's disease,CD)患者血清25OHD水平及其与CD相关临床因素的关系.方法:收集2015-11/2016-03在安徽医科大学附属省立医院门诊及住院的CD患者共45例(CD组),健康体检者40例(NC组),用电化学发光法检测CD组及NC组的血清25OHD水平,并进行对比分析;将血清25OHD水平与CD组临床指标进行相关性分析,并分析与血清25OHD水平具有相关性的临床指标对血清25OHD的影响.结果:CD组血清25OHD水平低于NC组(12.17 ng/mL±6.12 ng/mL vs 19.56 ng/mL±5.69 ng/mL,P0.05,t=5.738).CD组25OHD缺乏的检出率高于NC组(86.7%vs 62.5%,P0.05,X~2=6.649).血清25OHD水平与体质量指数(P0.05,r=0.508),C反应蛋白(P0.05,r=-0.713),血沉(P0.05,r=-0.389),日照时间是否30 min/d(P0.05,r=0.362),疾病是否活动(P0.05,r=0.384),是否使用类克(P0.05,r=0.475)相关.日照时间30min/d CD患者血清25OHD水平低于日照时间≥30 min/d者(10.33 ng/mL±5.75 ng/mL vs 14.47 ng/mL±5.91 ng/mL,P0.05,t=2.371);无类克治疗史的CD患者血清25OHD水平低于有类克治疗史者(8.51 ng/mL±3.95ng/mL vs 14.19 ng/mL±6.21 ng/mL,P0.05,t=3.302);活动期CD患者血清250HD水平低于缓解期患者(9.36 ng/mL±4.43 ng/mL vs14.05 ng/mL±6.44 ng/mL,P0.05,t=2.693).结论:CD患者250HD水平明显低于健康人群,疾病活动度、日照时间、BMI以及类克治疗可以影响CD患者的250HD水平.     

慢性乙型肝炎和肝硬化患者血清骨桥蛋白和TGF-β1水平变化

目的分析慢性乙型肝炎和肝硬化患者血清骨桥蛋白(OPN)和转化生长因子β1(TGF-β1)水平变化。方法选择慢性乙型肝炎患者268例,其中轻度54例、中度89例、重度73例和乙型肝炎肝硬化52例,采用ELISA法检测血清OPN和TGF-β1,采用化学发光免疫法检测血清III型前胶原(PC III)、IV型胶原(C IV)、层连蛋白(LN)和透明质酸(HA)。结果慢性乙型肝炎中度患者血清OPN和TGF-β1水平分别为(67.45±8.33)ng/ml和(164.30±34.61)pg/ml,显著高于慢性乙型肝炎轻度患者【分别为(31.28±7.45)ng/ml和(89.21±18.54)pg/ml,P0.05】;重度患者血清OPN和TGF-β1水平分别为(83.21±12.45)ng/ml和(248.95±52.33)pg/ml,显著高于轻度【分别为(31.28±7.45)ng/ml和(89.21±18.54)pg/ml,P0.05】或中度【分别为(67.45±8.33)ng/ml和(164.30±34.61)pg/ml,P0.05】;重度患者血清PC III和LN水平分别为(22.04±6.12)ng/ml和(181.06±37.89)ng/ml,显著高于轻度【分别为(13.84±3.11)ng/ml和(121.32±20.84)ng/ml,P0.05】;乙型肝炎肝硬化患者血清OPN和TGF-β1水平分别为(138.42±29.11)ng/ml和(456.39±97.60)pg/ml,显著高于慢性乙型肝炎患者(P0.05);无论是在肝炎还是肝硬化患者,血清OPN水平与血清PC III、C IV、LN、HA水平呈显著正相关(r=0.397、r=0.416、r=0.402、r=0.435,P0.05);血清TGF-β1水平与PC III、C IV、LN、HA水平呈显著正相关(r=0.426、r=0.493、r=0.415、r=0.481,P0.05)。结论慢性乙型肝炎和肝硬化患者血清OPN和TGF-β1水平升高,可能与肝纤维化发生有关。     

自身免疫性肝炎患者血清趋化因子和GP73水平变化及其临床意义研究

目的 探讨自身免疫性肝炎(AIH)患者血清趋化因子和高尔基体糖蛋白73(GP73)水平的变化及其临床意义。方法 2018年3月～2019年3月我院就诊的46例自身免疫性肝炎患者和46例同期健康人群,采用ELIS法检测血清趋化因子C-C-基元受体6和20(CCR6、CCL20)、血清趋化因子配体10(CXCL10)和GP73水平。AIH患者接受肝活检,并将肝炎程度分为轻中重度。结果 AIH血清CCR6、CCL20、CXCL10和GP73水平分别为(112.4±59.3)pg/mL、(186.5±71.8)pg/mL、(81.5±42.0)pg/mL和(171.4±62.5)ng/mL,均显著高于健康人【分别为(75.8±32.6)pg/mL、(123.7±42.2)pg/mL、(53.9±28.1)pg/mL和(83.1±35.2)ng/mL,P<0.05】;10例重度患者血清CCR6、CCL20、CXCL10和GP73水平分别为(174.2±81.4)pg/mL、(271.5±99.7)pg/mL、(162.7±83.1)pg/mL和(278.3±91.5)ng/mL,,显著高于14例中度组【分别为(124.5±55.3)pg/mL、(198.6±66.9)pg/mL、(88.4±46.8)pg/mL和(186.2±75.8)ng/mL,P<0.05】或22例轻度组【分别为(83.5±34.5)pg/mL、(155.6±51.0)pg/mL、(42.6±22.7)pg/mL和(123.9±58.9)ng/mL,P<0.05】;26例肝组织G3～4级患者血清CCR6、CCL20、CXCL10和GP73水平分别为(154.5±28.1)pg/mL、(201.6±56.3)pg/mL、(98.4±56.1)pg/mL和(196.2±59.78)ng/mL,显著高于20例G1～2级组【分别为(73.5±34.8)pg/mL、(135.6±41.7)pg/mL、(62.5±20.1)p g/mL和(93.9±33.9)ng/mL,P<0.05】。结论 AIH患者血清CCR6、CCL20、CXCL10和GP73水平升高,且随着疾病程度和肝组织炎症活动度加重而升高。检测自身免疫性肝炎患者血清趋化因子和GP73水平可能有助于评估患者病情的变化。     

乙型肝炎后肝硬化患者血清XCL1、IFN-γ及T细胞亚群的相关性分析

目的探讨XCL1、γ干扰素、T细胞亚群在乙肝病毒所致肝硬化中的水平变化及其临床意义。方法彩色腹部多普勒B超检查肝脏,测量脾脏厚度、门静脉宽度、有无腹水;全自动生化仪检测肝功能;采用酶联免疫吸附法(ELISA)检测血清XCL1、IFN-γ的水平;流式细胞仪检测T淋巴细胞亚群。结果正常对照组、慢性乙型肝炎组、乙型肝炎肝硬化组XCL1水平分别为(8.29±1.82)ng/mL、(13.18±2.86)ng/mL、(11.86±2.47)ng/mL,IFN-γ水平分别为(19.98±2.92)pg/mL、(37.55±6.15)pg/mL、(31.26±5.44)pg/mL。慢性乙型肝炎组、乙型肝炎肝硬化组血清XCL1、IFN-γ水平显著高于正常对照组血清XCL1、IFN-γ水平(P0.01);慢性乙型肝炎组血清XCL1、IFN-γ水平显著高于乙型肝炎肝硬化组血清XCL1、IFN-γ水平(P0.01或0.05);XCL1水平与IFN-γ水平呈正相关(r=0.457,P0.01);XCL1水平与CD4+T细胞百分比呈负相关(r=-0.339,P0.01);IFN-γ水平与CD8+T细胞百分比呈正相关(r=0.330,P0.05)。结论 XCL1通过影响IFN-γ从而导致CD4+T/CD8+T比值失衡,引起肝细胞的慢性炎症参与肝硬化进程。     

血清高尔基体蛋白73诊断原发性肝癌价值探讨

目的探讨高尔基体蛋白73（GP73）诊断肝癌的价值。方法在肝癌107例、肝硬化53例、肝衰竭患者40例和健康人34例,采用ELISA法检测血清GP73浓度,采用ROC曲线寻找GP73诊断肝癌的最佳截断点,并与AFP进行比较,以评价GP73诊断肝癌的价值。结果原发性肝癌、肝硬化和慢性肝衰竭患者血清GP73水平分别为123.5±22.4ng/ml、108.9±30.3ng/ml和130.3±45.6ng/ml,均显著高于健康对照人群（44.1±38.9ng/ml,P〈0.05）;原发性肝癌、肝硬化和慢性肝衰竭患者血清AFP水平分别为236.6±205.3ng/ml、5.3±5.56ng/ml和53.9±40.40 ng/ml;选择血清GP73最佳截断点为77.4ng/ml,其诊断原发性肝癌的灵敏度为89.6%,特异度为100%,AFP的最佳截断点为35.4ng/ml,其诊断原发性肝癌的灵敏度为64.2%,特异度为100%;原发性肝癌患者血清GP73水平在不同年龄、性别、Edmondson分级和结节数目多寡之间无显著性相差,而在不同肿瘤大小、TNM分期和是否合并肝硬化方面均有显著性差异（P＜0.05）。结论血清GP73诊断肝癌的灵敏度优于AFP,尤其在AFP阴性患者诊断中有一定的意义。     

依非韦仑为主的方案治疗人类免疫缺陷病毒/丙型肝炎病毒感染患者的安全性和有效性

目的 评价以依非韦仑为主的方案治疗HIV/HCV合并感染患者的安全性和有效性.方法 以依非韦仑为主的方案治疗53例HIV/HCV合并感染患者7年,观察CD4+T淋巴细胞计数、HIV RNA、肝功能、肝纤维化指标、血脂、血糖、血尿酸、血常规的变化.治疗前、后均数的比较采用t检验.结果 53例患者治疗前、后HIV RNA分别为(4.56±0.88)lg拷贝/mL和(1.70±1.10)lg拷贝/mL(t=14.781,P＜0.01);CD4+T淋巴细胞分别为(188.37±151.14)×106/L和(445.18±314.25)×106/L(t=5.362,P＜0.01);ALT分别为(36.6±16.3)和(57.2±9.9)U/L(t=7.864,P＜0.01);甘胆酸(CG)分别为(444.22±476.74)和(556.88±733.05)mg/L(t=0.938,P＜0.05);ⅣC分别为(45.13±8.25)和(47.88±4.51)ng/mL(t=2.129,P＜0.05);三酰甘油分别为(1.57±0.65)和(2.51±1.29)mmol/L(t=4.737,P＜0.01);血尿酸分别为(298.5±48.2)和(495.1±89.4)mmo1/L(t=14.092,P＜0.01).结论 以依非韦仑为主的方案治疗HIV/HCV合并感染患者是有效的,但可引起肝脏功能损害和代谢异常.

Abstract：

Objective To evaluate the efficacy and safety of efavirenz-based therapy in patients with human immunodeficiency virus (HIV)/hepatitis C virus (HCV) co-infection. Methods Fiftythree HIV/HCV co-infected patients received efavirenz-based therapy were followed up for 7 years.The changes of CD4+ T lymphocyte count, HIV virus load, hepatic function, hepatic fibrosis index,blood lipid, blood glucose, blood uric acid and blood routine were observed. The comparison of means before and after treatment was performed by t-test. Results The HIV RNA levels at baseline and endpoint were (4. 56±0. 88) lg copy/mL and (1.70±1.10) lg copy/mL, respectively (t=14. 781, P＜0.01). The peripheral blood CD4+ T lymphocyte counts were ( 188.37±151.14)×106/L and (445.18±314.25)×106/L, respectively (t=5.362, P＜0.01).The alanine aminotransferase (ALT) levels were (36.6±16.3) U/L and (57.2±9.9) U/L, respectively (t=7.864, P＜0. 01).The glycocholic acid levels were (444.22±476.74) mg/L and (556.88±733.05) mg/L, respectively (t=0.938, P＜0.05). The Ⅳ-collagen(Ⅳ-C) levels were (45.13±8.25) ng/mL and (47.88±4.51) ng/mL, respectively (t= 2.129, P＜0.05). The riacylglycerol levels were (1.57±0.65)mmol/L and (2.51±1.29) mmol/L, respectively (t=4.737, P＜0.01). The blood uric acid levels were (298.5±48.2) mmol/L and (495.1±89.4) mmol/L, respectively (t= 14.092, P＜0.01).Conclusions The efavirenz-based therapy is efficacious in HIV/HCV co-infected patients, but it could cause liver injury and metabolic disorder.     

艾滋病病毒／丙型肝炎病毒双重感染者的艾滋病病毒特异性CTL应答

目的探讨中国艾滋病病毒/丙型肝炎病毒（HIV/HCV）双重感染患者HIV特异性细胞毒性T淋巴细胞（CTL）应答的特征。方法观察对象为HIV/HCV双重患者、单纯HIV感染者。以HIV-1 B亚型构建的全基因组肽库作为抗原,通过酶联免疫斑点（ELISPOT）法检测HIV/AIDS患者HIV特异性CTL应答。并对HIV/HCV双重感染患者的HIV特异性CTL应答进行相关性分析。结果 HIV/HCV双重感染组和单纯HIV感染组的HIV特异性CTL应答强度与频率在肽段水平存在一定差异,与单纯HIV感染组相比,合并HCV感染组反应增强的肽段主要集中在Gag。两组特异性CTL应答强度与频率均呈明显正相关,且合并HCV感染组较单纯感染组正相关性增强。不同肽段累计反应强度的比较,Gag反应强度最高,其次是Nef。CD4计数与特异性CTL应答强度的关系无统计学意义。结论 HIV/HCV双重感染患者HCV对HIV进程的影响可能与对Gag蛋白CTL应答的增强有关。     

人类免疫缺陷病毒与重叠丙型肝炎病毒感染者免疫指标比较

目的 分析HIV/HCV重叠感染人群与HIV单独感染人群治疗前临床特征及免疫功能的差异,探讨其可能的影响因素.方法 以HIV/HCV重叠感染患者59例、HIV单独感染患者38例为研究对象,取患者治疗前外周血,检测其肝功能、血常规、外周血T细胞亚群(CD4+、CD8+)及HIV、HCV病毒载量,酶联免疫斑点法(ELISPOT)检测HIV特异性细胞毒性T淋巴细胞(CTL)的数量和功能.结果 HIV/HCV重叠感染率达60.8%.重叠感染组ALT、AST均明显高于HIV组(49.8 U/L比23.6 U/L,49.1 U/L比32.3 U/L,P值分别为0.000、0.013);重叠感染组PLT明显低于HIV组[(167.3±59.2)×109/L比(198.0±63.9)×109/L,P=0.040].外周血T细胞亚群检测结果两组间差异无统计学意义.重叠感染组HIV RNA定量为(4.046±0.541)lOglo拷贝/mL,低于HIV组的(4.394±0.507)log10拷贝/mL(P=0.018).重叠感染组对HIV-Gag全序列肽段的阳性孔斑点数(平均秩次30.85)较HIV组(平均秩次44.34)低,阳性孔数(4.60±5.52)低于HIV组(6.24±6.93),但两组比较差异无统计学意义.重叠感染组Alb与HCV病毒载量呈负相关(r=-0.540),CD4+与PLT呈正相关(P=0.000).结论 单采血浆感染HIV患者中,有较高的HIV/HCV重叠感染率和较低的细胞免疫功能.     

Biochemical and virologic parameters in patients co-infected with hepatitis C and HIV versus patients with hepatitis C mono-infection

BACKGROUND: Previous studies of patients with hepatitis C virus (HCV) infection looking at the effect of human immunodeficiency virus (HIV) co-infection on biochemical parameters and HCV RNA level have shown conflicting results. Accurate characterization of the effect of HIV is important for evaluation and treatment of HCV in co-infected persons. METHODS: We studied 315 HCV mono-infected and 75 HCV-HIV co-infected subjects to determine the effect of HIV on biochemical parameters and HCV RNA and to determine the predictors of elevated serum alanine aminotransferase (ALT) levels and HCV RNA levels. RESULTS: The co-infected subjects were more likely to be African-American (55% vs 26%, P < 0.0005), have used injection drugs (68% vs 60%, P = 0.02), have detectable HCV RNA (84% vs 70.5%, P = 0.018), have HCV RNA levels >6 log10 IU/mL (60% vs 38%, P = 0.001), and have lower mean serum ALT levels (50.4 IU/mL vs 73.7 IU/mL, P = 0.006). In multivariable analyses, the following factors predicted an ALT level >50 IU/mL: log10 HCV RNA (OR, 1.15; 95% CI, 1.00 to 1.32); HIV co-infection (OR, 0.48; 95% CI, 0.25 to 0.89); and having ever been treated for HCV (OR, 1.92; 95% CI, 1.16 to 3.18). The only significant predictor of HCV RNA level >6 log10 IU/mL was HIV co-infection (OR, 2.75; 95% CI, 1.46 to 5.15). Significant predictors of having a detectable HCV RNA level were female sex (OR, 3.81; 95% CI, 1.18 to 12.25); HIV co-infection (2.45; 95% CI, 1.14 to 5.26); and ever being treated for HCV (OR, 1.96; 95% CI, 1.10 to 3.48). CONCLUSIONS: HCV-HIV co-infected persons have higher HCV RNA levels but lower serum ALT levels than HCV mono-infected patients. Criteria for performing liver biopsy and treating HCV infection in co-infected patients may need to be revisited.     

慢性乙型肝炎患者血清血管生成素样蛋白2和高尔基体蛋白73水平变化及其诊断显著肝纤维化的效能分析*

目的 评价血清血管生成素样蛋白2(ANGPTL2)和高尔基体蛋白73（GP73）诊断慢性乙型肝炎（CHB）患者肝纤维化程度的价值。方法 2015年3月~2017年10月我院收治的117例CHB患者,采用ELISA法检测血清ANGPTL2和GP73水平,采用受试者工作特征曲线（ROC）下面积（AUC）评价血清ANGPTL2和GP73诊断CHB患者肝纤维化和肝硬化的效能。结果 15例CHBS3~S4期患者血清ANGPTL2和GP73水平分别为（9.1±2.4）ng/ml和（84.9±15.2） ng/ml,显著高于78例S1~S2期[分别为（6.7±2.3） ng/ml和（65.1±14.8） ng/ml,P<0.05]或24例S0期患者[分别为（4.4±1.4） ng/ml和（53.7±14.3） ng/ml,P<0.05];以肝组织纤维化大于等于S3为严重肝纤维化,分别以血清ANGPTL2水平等于8.6 ng/mL和9.6 ng/ml或血清GP73水平等于75.6 ng/ml和103.5 ng/ml为诊断严重肝纤维化和肝硬化的截断点, 结果ANGPTL2诊断慢性乙型肝炎患者严重肝纤维化和肝硬化的AUC与GP73比,差异无统计学意义（Z=1.872,P=0.061;Z=0.328,P=0.743）;ANGPTL2与GP73联合诊断慢性乙型肝炎患者严重肝纤维化的效能显著高于单指标诊断,即AUC联合检测>AUCANGPTL2（Z=3.310,P=0.001）或AUC联合检测>AUCGP73（Z=2.004,P=0.045）,血清ANGPTL2与GP73联合诊断乙型肝炎肝硬化的效能与单指标诊断的效能比,差异无统计学意义（Z=1.471,P=0.141;Z=1.575,P=0.115）;采用血清ANGPTL2与GP73联合诊断肝纤维化的效能与基于4因子模型（FIB-4）或天门冬氨酸氨基转移酶/血小板指数（APRI）比,差异无统计学意义（Z=0.869,P=0.386;Z=0.492,P=0.623）;血清ANGPTL2与GP73联合诊断肝硬化的效能与FIB-4或APRI比,差异也无统计学意义（Z=1.834,P=0.067;Z=0.610,P=0.512）。结论 慢性乙型肝炎患者血清ANGPTL2和GP73水平有一些变化规律,应用两者诊断肝纤维化分期有一些有意义的苗头,值得进一步探讨。     

河北省HIV-1感染者中HCV和HBV合并感染状况调查

目的了解河北省艾滋病病毒Ⅰ型(HIV-1)感染者中,丙型肝炎病毒(HCV)、乙型肝炎(乙肝)病毒(HBV)的感染状况。方法采集了HIV-1感染者的抗凝全血样品,进行了HCV抗体和乙肝病毒表面抗原(HBsAg)的检测。结果 147例HIV-1感染者中,HCV感染率为17.7%(26/147),HBV感染率为15.0%(22/147),HCV/HBV混合感染率为3.4%(5/147)。在HIV-1感染者中,HCV的感染率在注射吸毒感染者中为100%(6/6),血液途径感染者中为73.3%(11/15),性感染者中为6.3%(7/111),不同感染途径间的差异有统计学意义(P<0.001);女性高于男性(P=0.002);低文化程度的感染者中感染率较高,文化程度方面差异有统计学意义(P<0.01)。在HIV-1感染者中,HBV的感染率小年龄组较高(P<0.05)。结论在HIV感染人群中,有较高的HCV和HBV感染率。     

Patients co-infected with human immunodeficiency virus and hepatitis C virus demonstrate higher levels of hepatic HCV RNA

Serum and liver hepatitis C virus (HCV) RNA levels in patients with hepatitis C have previously been quantified using different techniques. In this work, we used an automated, multicycle, polymerase chain reaction (PCR)-based technique to quantify HCV RNA in 1-2 mm of frozen liver tissue, and in serum, from 70 patients with antibodies to HCV (anti-HCV), with and without human immunodeficiency virus (HIV) co-infection. Stored liver tissue and sera collected at the time of liver biopsy were used for measurement of HCV RNA. Forty-eight HCV patients and 22 HIV/HCV co-infected patients were studied. Co-infected patients had significantly higher median serum and liver HCV RNA (6.7 log copies ml-1 serum and 2.90 log copies microg-1 liver nucleic acids) than patients with HCV alone (6.2 log copies ml-1 serum and 2.19 log copies microg-1 liver nucleic acids). There was only a weak correlation between serum and liver HCV RNA (r = 0.43). There was no correlation between liver and serum HCV RNA and host factors such as duration of disease, CD4 counts, alanine aminotransferase levels or histological score. There was no correlation with HCV genotype. Co-infected patients were more likely to harbour HCV genotype 1 (85%) when compared to patients with HCV alone (58%). An identical genotype was found in liver and serum in 89% of those tested; in 11%, a mixed genotype was present in serum. Patients with HCV genotypes 1 and non-1 had similar histological scores. Hence, an automated PCR-based technique is useful for measuring both liver and serum HCV RNA. Serum HCV genotypes closely paralleled those found in liver tissue. HIV co-infection was associated with higher serum, as well as intrahepatic, HCV RNA levels, by mechanisms not directly related to CD4 counts. The lack of correlation between liver HCV RNA and histology suggests that HCV is not directly cytopathic.