手术及输血前患者肝炎感染情况调查

目的：了解手术及输血前患者肝炎感染情况，探讨医源性肝炎传染的风险，避免可能发生的医疗纠纷。方法：对6147例手术及输血前患者采用ELISA法检测HBsAg、HBsAb、HBeAg、HBeAb、HBcAb、抗-HCV；采用速率法测ALT。结果：患者血液异常的总阳性率为23．6％，其中HBsAg阳性867人（阳性率14．1％）、HBcAb阳性287人（阳性率4．52％）、抗-HCV阳性88人（阳性率1．43％）、ALT阳性573人（阳性率9．32％）。结论：对患者进行手术及输血前肝炎指标检测有利于患者的治疗及医务人员的自我保护，还可减少或避免因手术及输血而引起的医疗纠纷及防止医院感染。     

乙型及丙型肝炎病毒感染与原发性肝癌的临床研究

目的研究HBV DNA、HBsAg、HBeAg、HBeAb、HBcAb及抗-HCV与原发性肝癌发生的相关性。方法采用回顾性调查分析方法,对58例原发性肝癌患者（病例组）,同期收治的58例其他恶性肿瘤患者（对照组）HBV和HCV感染情况进行统计,并分析HBV血清标志物及HBV DNA与原发性肝癌发生发展的规律。结果两组资料的HBV感染率分别为82.76%和44.83%,病例组与对照组比较有显著性差异（P〈0.05）,单纯HCV感染及HBV/HCV混合感染率两组无明显差异（P〉0.05）;血清HBV DNA阳性率在病例组和对照组分别为72.92%、23.08%（P〈0.05）;HBsAg、HBeAb和HBcAb检出率病例组高于对照组（P〈0.05）;而HBeAg阳性率两组比较无显著性差异（P〉0.05）。结论在慢性HBV感染的肝癌高发人群中,HBV DNA、HBsAg、HBeAg、HBeAb及HBcAb所反映的HBV感染状态及不同临床演变过程与肝癌的发生发展密切相关,共同参与肝癌的发病机制。     

4600例拟输血患者输血前4项传染病指标检测结果分析

目的：了解拟输血患者输血前传染病感染状况,减少因输血引起的医疗纠纷并探讨有关检查项目设置的必要性。方法：对4600例拟输血患者采用酶联免疫吸附试验（ELISA）检测其血清中乙型肝炎病毒表面抗原（HBsAg）、丙型肝炎病毒抗体（抗-HCV）、人类免疫缺陷病毒抗体（抗-HIV）、梅毒螺旋体抗体（抗-TP）4项常见传染病指标。结果：在4600例患者中,HBsAg阳性348例（7．57％）、抗-HCV阳性116例（2．52％）、抗-HIV阳性（经省CDC确诊）1例（O．0002％）、TP阳性77例（1．67％）。检测阳性总数为542例,总阳性率为11．78％。结论：对受血者进行输血前检测,可以减少医院感染,降低职业暴露的危险,加强医护人员的自我保护,减少因输血引起的医疗纠纷。     

手术、分娩及输血前患者血液感染性指标检测结果分析

目的:了解手术、分娩及输血前患者乙型肝炎病毒、丙型肝炎病毒、梅毒螺旋体及人类免疫缺陷病毒血液感染性指标的感染情况。方法:采用酶联免疫吸附试验(ELISA)对手术、分娩及输血前患者行乙肝表面抗原(HBsAg)、丙型肝炎抗体(抗-HCV)、梅毒螺旋体抗体(抗-TP)及人类免疫缺陷病毒抗体(抗-HIV)检测。结果:23 516例患者总阳性率为11.95%,HBsAg、抗-TP、抗-HCV及抗-HIV分别检出2 300例(9.78%)、322例(1.40%)、175例(0.74%)和13例(0.05%),HBsAg阳性率高于其他3项检测指标,差异有统计学意义(P<0.05);男性患者感染性指标总阳性率显著高于女性(P<0.05);不同年度感染性指标阳性率比较差异无统计学意义。结论:对手术、分娩及输血前患者进行血液感染性标志物的检测可有效预防和减少医疗纠纷的发生,避免医源性交叉感染。     

南昌地区青年学生献血人群输血相关传染病标志物检测结果分析北大核心CSCD

目的 了解南昌地区青年学生无偿献血人群经血传播病原体感染（TTI）状况及血液质量，为开展学生健康宣教、疾病防控及优化低危献血者招募策略提供数据支持。方法 采用速率法检测无偿献血血液标本ALT，采用ELISA双试剂检测HBsAg、抗-HCV、人类免疫缺陷病毒1型/2型抗体和p24抗原（抗-HIV/HIV Ag）、梅毒螺旋体特异性抗体（抗-TP）。HBsAg、抗-HCV、抗-HIV/HIV Ag、抗-TP筛查阴性标本采用核酸检测HBV DNA、HCV RNA及HIV RNA。以相同时期社会其他献血人群作为对照组，通过启奥血站管理信息系统统计南昌地区2019-2022年青年学生献血人群、社会其他献血人群输血相关传染病标志物检测不合格数据。通过中国疾病预防控制信息系统收集2019-2022年江西省血液中心报告的青年学生献血者HIV感染病例资料。结果 南昌地区2019-2022年大中专院校学生无偿献血者177 232人次。青年学生献血人群输血相关传染病标志物筛查总不合格率（1.53%）低于社会其他献血人群（1.92%）（χ2=74.33,P<0.01）；学生献血人群输血相关传染病标志物不合格率由高到低依次为ALT(1.02%)、抗-TP(0.16%)、HBsAg/HBV DNA(0.15%)、抗-HCV/HCV RNA(0.13%)、抗-HIV/HIV Ag/HIV RNA(0.08%)；男性学生总不合格率（1.98%）高于女性学生（0.84%）（χ2=365.13,P<0.01）；不同学历学生总不合格率由高到低依次为大学专科（1.72%）、中职（1.66%）、研究生（1.44%）、本科（1.38%）（χ2=33.08,P<0.01）;HIV确证学生感染者12例，其中10例感染途径为男男同性性传播。结论 南昌地区青年学生人群血液安全性高于社会其他人群。艾滋病、梅毒在学生人群中流行情况需引起高度重视。加强大中专院校学生献血知识普及和健康宣教，促进学生团体献血事业持续向好发展。     

1242例受血患者输血前相关病原标志物检测结果分析

目的：对受血患者进行输血前相关病原学标志物的检测，了解患者输血前状况，预防临床输血引起的医疗纠纷。方法：用酶联免疫吸附试验技术（ELISA）对1242例受血患者进行乙肝病毒标志物以及艾滋病（HIV）抗体、丙型肝炎（HCV）抗体检测；用甲苯胺红不加热血清反应素试验对梅毒进行检测。结果：1242例受血患者HBsAg阳性率为10．15％；HBcAb（IgG）阳性率为10．15％；HBeAg阳性率为2．90％；HBeAb阳性率为6．28％；HCV抗体阳性率为0．97％；HIV抗体阳性率为0％；梅毒阳性率为0．32％。结论：HIV、病毒性肝炎及梅毒等感染途径多种多样，判断是否由输血所致，必须对受血患者进行输血前相关病原学标志物的检测，及时发现阳性患者，否则感染来源难以界定，极易造成医疗纠纷。     

济南地区无偿献血者血液检测指标阳性模式调查分析

目的：调查济南地区无偿献血者中血液指标ALT、HBsAg、抗-HCV、抗-TP阳性模式种类与分布,探讨彼此的相关程度,寻找有效的筛检模式,为筛检献血者提供理论数据支持,保证血液安全。方法：调查2009年75078例济南地区无偿献血者血液检测指标数据,对阳性模式进行统计分析,统计学方法采用χ2检验。结果：总阳性人数为4603例,其中ALT阳性3511例,HBsAg阳性522例,抗HCV阳性404例,抗-TP阳性166例,血液指标阳性模式共有11种,在ALT阳性模式中,ALT单项阳性率97.93%,ALT与HBsAg双项阳性率1.06%,ALT与抗-HCV双项阳性率0.61%;HBsAg阳性模式中HBsAg单项阳性率92.55%,抗-HCV阳性模式中抗-HCV单项阳性率93.3%。结论：ALT与HBsAg关联程度强于ALT与抗-HCV（χ2=3.31,P〈0.05）,血液筛检ALT与HBsAg仍是重点,加强献血前的快速筛检可以有效降低复检阳性率。     

台州地区2072例患者输血前4项感染性指标检测情况分析

目的:了解台州地区拟输血患者经输血传播疾病的感染状况,减少输血医疗纠纷,保证临床输血的安全。方法:用ELISA法检测2 072例准备输血患者的HBsAg(定性),抗HCV抗体,TPPA抗体和HIV抗体4项感染性指标。结果:2 072例患者中,HBsAg阳性率8.16%,抗HCV阳性率0.63%,TPPA阳性率1.16%,抗HIV阳性率0.14%。结论:通过输血前感染指标检测,明确患者的感染情况,保护医患双方的利益,避免输血引起的医患纠纷。     

云南地区老挝籍留学生重要传染性疾病调查

目的调查云南地区老挝籍留学生传染病感染状况,为当地传染性疾病的防控措施提供依据。方法采集受检者血液采用ELISA法检测血清中的乙肝表面抗原(HBsAg)、丙肝(HCV)抗体和梅毒(TP)抗体和HIV抗体水平;采用免疫层析法检测登革热非结构蛋白1抗原(DENV-NS1)。结果共检测504例,其中HIV抗体阳性4例、TP抗体阳性1例、HBsAg阳性48例,阳性率分别为0.79%、0.19%和9.52%,HCV和DENV抗原均阴性。阳性者中,HBsAg和TP合并感染1例,HBsAg和HIV合并感染2例,HBsAg、抗-TP同时合并抗-HIV感染(抗-HIV/HBsAg/抗-TP)1例。感染者主要来自老挝的万象省、南塔省、琅勃拉邦省和波乔省,分别占27.08%、18.75%、14.58%和12.50%。结论云南省中老边境地区老挝籍留学生HBV、HIV感染率较高,建议加强对外籍人员HBV、HIV和TP等重要传染病的监测。     

云南地区老挝籍留学生重要传染性疾病调查北大核心CSCD

目的调查云南地区老挝籍留学生传染病感染状况,为当地传染性疾病的防控措施提供依据。方法采集受检者血液采用ELISA法检测血清中的乙肝表面抗原(HBsAg)、丙肝(HCV)抗体和梅毒(TP)抗体和HIV抗体水平;采用免疫层析法检测登革热非结构蛋白1抗原(DENV-NS1)。结果共检测504例,其中HIV抗体阳性4例、TP抗体阳性1例、HBsAg阳性48例,阳性率分别为0.79%、0.19%和9.52%,HCV和DENV抗原均阴性。阳性者中,HBsAg和TP合并感染1例,HBsAg和HIV合并感染2例,HBsAg、抗-TP同时合并抗-HIV感染(抗-HIV/HBsAg/抗-TP)1例。感染者主要来自老挝的万象省、南塔省、琅勃拉邦省和波乔省,分别占27.08%、18.75%、14.58%和12.50%。结论云南省中老边境地区老挝籍留学生HBV、HIV感染率较高,建议加强对外籍人员HBV、HIV和TP等重要传染病的监测。     

慢性乙型肝炎患者外周血HBsAg与HBV DNA相关性分析

目的探讨HBeAg（＋）和HBeAg（-）慢性乙型肝炎患者外周血HBsAg与HBV DNA的关系。方法定量检测HBeAg（＋）55例和HBeAg（-）36例慢性乙型肝炎患者血清HbsAg和HBV DNA的水平。结果 HBeAg（＋）患者血清HBV DNA、ALT和AST水平较HBeAg（-）患者高（P〈0.05）;HBeAg（＋）患者血清HBsAg水平较HBeAg（-）患者低（P〈0.05）;高水平血清HbsAg患者血清HBV DNA水平低（F=10.096,P〈0.01）;HBeAg（＋）慢性乙型肝炎患者HBsAg与HBV DNA存在负相关（r=-0.796,P〈0.01）,而HBeAg（-）慢性乙型肝炎患者HBsAg与HBV DNA无相关性（r=0.289,P〉0.05）。结论定量检测慢性乙型肝炎患者血清HBsAg水平有一定的临床意义。     

HBsAg carrier infants with serum anti-HBc negativity

A total of 128 HBsAg carrier infants born to HBeAg-positive HBsAg carrier mothers were tested for serum HBsAg, HBeAg, hepatitis B virus DNA and anti-HBc. Ninety-three of them had received hepatitis B vaccination. Anti-HBc had been found to be negative in sera of 12 infants who were HBsAg, HBeAg and hepatitis B virus DNA positive during the follow-up period of 3 to 5 years. Liver damage, as measured by serum ALT levels, was found to be normal among the 12 HBsAg carrier infants with serum anti-HBc negativity, whereas 39.7% of the 116 anti-HBc-positive HBsAg carrier infants had abnormal ALT levels during the follow-up period. Anti-HBe and anti-HBs also were not detected in sera of these anti-HBc-negative HBsAg carrier infants. Thus, HBsAg carrier infants with anti-HBc negativity probably result from immune incompetency of the hepatitis B virus antigens.     

Hepatitis B virus pre-S gene-encoded antigenic specificity and anti-pre-S antibody: relationship between anti-pre-S response and recovery

A solid-phase radioimmunoassay involving specific antibody was developed for determination of the pre-S gene-encoded epitopes of hepatitis B virus and anti-pre-S antibody in sera of hepatitis B patients. The reaction for pre-S determinants associated with HBsAg was quantitatively inhibited by soluble, polymerized human serum albumin, and the lower limit of the assay was about 1.6 ng of HBsAg per ml. Continuous expression of pre-S-coded antigenic sites on HBsAg particles in chronic hepatitis B patients seropositive for HBeAg or anti-HBe shows that these determinants may be considered as a marker of chronicity during hepatitis B virus infection. The anti-pre-S antibody was determined by inhibition of the reaction for pre-S determinants. This antibody, different from anti-HBs, was detected during HBsAg antigenemia in patients recovering from acute type B hepatitis, before anti-HBs response. Kinetics of synthesis of anti-pre-S antibody in the course of acute type B hepatitis, followed by elimination of HBsAg and recovery, suggest the possible role of this antibody in the immunological clearance of infective hepatitis B virus particles.     

恩替卡韦联合免疫制剂治疗免疫耐受期乙型肝炎病毒携带者疗效探讨

目的观察恩替卡韦联合免疫制剂治疗免疫耐受期乙型肝炎病毒（HBV）携带者的临床疗效。方法按就诊顺序编号将66例HBV携带者随机分为治疗组33例和对照组33例。给予治疗组恩替卡韦联合重组乙肝疫苗（CHO细胞）20 μg、重组人白细胞介素-II 20万单位和重组人粒细胞集落刺激因子75 μg三角肌皮下注射,1次/m,疗程为3年;对照组只接受单纯的恩替卡韦治疗,疗程也为3年。治疗前后常规检测血清丙氨酸氨基转移酶（ALT）、HBV DNA、血清HBV标记物的变化。结果在治疗结束时,治疗组患者血清HBeAg阴转率、HBeAg血清转换率和HBV DNA阴转率分别为33.3%、24.2％和75.7%,显著高于对照组的12.1%、6.0%和51.5% （P<0.05）;在治疗结束后6个月时,治疗组血清HBeAg阴转率、HBeAg血清转换率和HBV DNA阴转率分别为42.3%、27.2%和78.7%,也显著高于对照组的12.1%、6.0%和45.4% （P<0.05）;在治疗过程中两组部分患者ALT升高,其中治疗组为42.3%,显著高于对照组的9.0%（P<0.05）。结论核苷类药物联合免疫制剂治疗HBV携带者,在部分人群能打破免疫耐受,并获得病毒学清除。     

Serum alanine aminotransferase level in relation to hepatitis B and C virus infections among blood donors

Abstract: To assess the serum alanine aminotransferase (ALT) activity in relation to hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among blood donors, antibodies to HCV (anti-HCV) and hepatitis B surface antigen (HBsAg) were detected in 400 blood donors with normal ALT level (≤750 μmol/s per liter), and 76 blood donors with raised ALT level. The prevalence of anti-HCV (10.5%) and HBsAg (28.9%) in the latter was higher than that (2.0% and 17.5%, respectively) in the former (p<0.001 and p<0.03, respectively). There was a trend that indicated that the risk of anti-HCV positivity increased with increasing age (p<0.001). Thirty of 76 (39.5%) donors with raised ALT level were positive for anti-HCV or HBsAg. Compared with HBsAg-positive donors, donors with anti-HCV had higher serum ALT levels (p<0.01) and greater mean age (p<0.01). Multivariate analysis indicated that both anti-HCV (odds ratio: 6.2; 95% confidence interval: 2.2–17.8) and HBsAg (odds ratio: 2.2; 95% confidence interval: 1.3–3.9) were significantly associated with raised serum ALT activity. The estimated population-attributable risk was 8.6% for anti-HCV, and 13.8% for HBsAg. In conclusion, although HBV and HCV infections are independent risk factors of raised ALT activity among blood donors, they play a minor role in the etiology of raised ALT activity.     

Prevalence of hepatitis B surface antigen, hepatitis C antibody, and HIV-1 antibody among residents of a long-term-care facility.

OBJECTIVE: To determine the prevalence of hepatitis B antigen (HBsAg), antibody to hepatitis C virus (anti-HCV), and antibody to human immunodeficiency virus (anti-HIV) among residents of a long-term care facility. DESIGN: Anonymous unlinked serosurvey. SETTING: Accredited university-affiliated long-term-care facility in Toronto with 300 chronic-care hospital patients, 350 nursing home residents, and 200 residents of a senior citizens' apartment complex. INTERVENTIONS: Sera from left-over blood samples obtained from residents in November 1990 were tested for HBsAg, anti-HCV, and anti-HIV using standard methods. RESULTS: A total of 508 sera were tested. The number (%) positive for HBsAg, anti-HCV, and anti-HIV, respectively were: 3(0.6%), 7(1.4%), and 0(0%). CONCLUSIONS: This is the first report defining rates of infection with bloodborne infective agents among residents of a long-term care facility. These results support the use of hepatitis B vaccine for medical and nursing staff and the implementation of universal precautions in long-term care facilities.     

Anti-pre-S responses and viral clearance in chronic hepatitis B virus infection.

Serial sera were collected prospectively during the clinical course of 13 HBsAg carriers with chronic liver disease and analyzed for ALT levels, pre-S1 and pre-S2 antigens and corresponding antibodies and other serological hepatitis B virus markers. In five patients, anti-pre-S1 and anti-pre-S2 antibodies became detectable in multiple serum samples, whereas in eight patients anti-pre-S was never detected or only appeared transiently during the follow-up. The first pattern was associated with normalization of ALT levels and undetectable pre-S antigens and viral DNA by the polymerase chain reaction assay at final follow-up. HBsAg clearance occurred in two of the five patients. The second pattern was one of persistence of HBsAg and pre-S antigens, associated with the presence of serum HBV DNA detectable by spot hybridization or polymerase chain reaction regardless of clinical outcome. These findings demonstrate the occurrence of anti-pre-S antibodies in chronic hepatitis B virus-induced liver disease and associate anti-pre-S appearance with the clearance of hepatitis B virus from serum.     

Clearance of HBsAg in seven patients with chronic hepatitis B.

The natural history of chronic hepatitis B patients who spontaneously cleared serum HBsAg was investigated. A total of 351 patients with chronic hepatitis B were observed in our hospital for at least 3 yr. Seven of these patients became HBsAg negative during the follow-up period. HBsAg disappeared within 6 mo (range = 11 to 169 days, mean = 70 days) after acute elevation of ALT. ALT levels as high as 500 IU were found in three patients, whereas such elevation was not demonstrated in the other four patients. After the disappearance of HBsAg, ALT levels returned to normal in all patients. With one exception, all patients seroconverted to antibody to HBsAg; however, hepatitis B virus DNA remained detectable in serum using the polymerase chain reaction in five patients. The titer of percent inhibition of antibody to HBcAg gradually decreased to less than 70% when a 1:200 dilution of the serum of six patients was used. Four of the patients had active liver disease develop: two had chronic active hepatitis and two had cirrhosis. Three of these four patients subsequently had hepatocellular carcinoma develop. These findings suggest that patients may suffer complications of chronic hepatitis even after normalization of transaminase activities and after the clearance of HBsAg. Thus hepatitis B virus should be considered as a possible factor associated with hepatocellular carcinoma even in the absence of HBsAg, particularly if serum hepatitis B virus DNA persists.     

乙型肝炎患者HBV—DNA载量与肝功能以及乙型肝炎病毒表面抗原定量的关系

目的研究外周血中HBV—DNA载量与反映肝脏损伤的相关肝功能指标以及乙型肝炎病毒表面抗原（HBsAg）定量的关系。方法采用荧光定量PCR（FQ—PCR）检测HBV—DNA载量，用全自动生化仪检测肝功能，时间分辨法（TRFIA）测表面抗原，然后做统计分析。结果丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）水平与HBV—DNA含量以及表面抗原经相关分析无统计学意义，肝细胞损伤程度与HBV—DNA复制水平以及血清感染标志物HBsAg水平并无明显的关系。结论乙肝患者血清中HBV—DNA水平是评定HBV复制状态的一个重要指标，乙型肝炎患者HBV—DNA载量与肝功能以及表面抗原定量无关。