苦参素和甘利欣对慢性乙型肝炎患者肝纤维化指标的影响

目的:探讨苦参素联合甘利欣治疗慢性乙型肝炎的疗效,及对肝纤维化指标的影响。方法:选择我院200-01/2009-01收治的80例慢性乙型肝炎合并肝纤维化患者作为研究对象,随机分成治疗组和对照组各40例,治疗组给予甘利欣加苦参素,对照组应用复方丹参治疗,3个月为一个疗程。观察比较两组的临床疗效及肝功能指标与肝纤维化指标的改变。结果:治疗组40例的总有效率90.0%;对照组40例的总有效率为57.5%,两组总有效率比较,差异有统计学意义(P0.05)。治疗前两组的肝纤维化指标HA、LN、PCⅢ、Ⅳ-C比较,差异无显著性,治疗3个月后,肝纤维化指标HA、LN、PCⅢ、Ⅳ-C均较治疗前明显下降,且治疗组与对照组比较,差异有统计学意义(P0.05)。治疗前两组的肝功能指标ALT、AST、TBIL、ALB比较,差异无显著性,治疗3个月后,肝功能指标ALT、AST、TBIL、ALB比较均较治疗前明显下降,但治疗组与对照组比较,差异无显著性(P0.05)。结论:苦参素和甘利欣对慢性乙型肝炎患者肝纤维化具有协同作用,阻止或改善肝纤维化有疗效明显,无明显副作用,值得临床推广和应用。     

甘利欣联合苦参素治疗慢性乙型病毒性肝炎肝纤维化指标的变化

目的观察联合应用甘利欣和苦参素治疗慢性乙型病毒性肝炎患者血清肝纤维化指标的变化。方法选择39例慢性乙型病毒性肝炎中度患者,随机分成：治疗组19例,联合应用甘利欣和苦参素治疗;甘利欣组20例,给予甘利欣治疗。分别于治疗前后一周内检测血清肝纤维化指标HA、LN、ⅣP。结果两组治疗前血清HA、LN、ⅣP均明显高于正常对照组（P〈0.05）。两组患者治疗后的血清HA、LN、ⅣP水平较治疗前降低,治疗组血清HA、LN、ⅣP水平治疗前后存在统计学差异,且明显低于甘利欣组治疗后水平（P〈0.05）。结论苦参素和甘利欣合用较与单纯应用甘利欣治疗慢性乙型肝炎可明显改善肝纤维化指标,说明苦参素有较强的抗肝纤维化作用。     

慢性乙型肝炎患者血清HBV-DNA病毒载量与血清肝纤维化指标变化

目的：探讨慢性乙型肝炎患者血清HBV-DNA病毒载量与血清肝纤维化指标变化的关系。方法：以慢性乙型病毒性肝炎患者20例为对象,分为应用抗病毒药有效抑制组10例与未进行抗病毒药治疗组10例,跟踪调查治疗情况5年（2002～2007年）,用荧光定量聚合酶链反应（FQ-PCR）检测HBV-DNA病毒载量,采用放射免疫分析对20例慢性乙肝患者检查血清肝纤维化指标透明质酸（HA）、层黏蛋白（LN）、Ⅳ型胶原（Ⅳ-C）、Ⅲ型前胶原（PCⅢ）水平。结果：5年来,抗病毒药有效抑制组10例患者平均HBV-DNA病毒载量对数水平3.56±1.12,未进行抗病毒药治疗组10例平均HBV-DNA病毒载量对数水平7.76±1.23,有显著差异（P〈0.05）。2002年抗病毒药有效抑制组血清肝纤维化指标分别为HA（82.72±30.62）μg/ml、LN（71.18±26.71）μg/ml、Ⅳ-C（93.77±69.87）μg/ml、PCⅢ（91.4±18.64）μg/ml,2002年未进行抗病毒药治疗组血清肝纤维化指标分别为HA（79.32±31.34）μg/ml、LN（70.25±28.23）μg/ml、Ⅳ-C（90.35±67.81）μg/ml、PCⅢ（85.77±20.56）μg/ml,两组间各项指标统计学无显著差异（P〉0.05）。2007年抗病毒药有效抑制组血清肝纤维化指标分别为HA（85.72±29.52）μg/ml、LN（70.18±25.4）μg/ml、Ⅳ-C（94.2±70.92）μg/ml、PCⅢ（93.4±19.32）μg/ml,2007年未进行抗病毒药治疗组血清肝纤维化指标分别为HA（105.67±28.54）μg/ml、LN（97.75±26.25）μg/ml、Ⅳ-C（132±72.13）μg/ml、PCⅢ（120.72±19.87）μg/ml,两组间各项指标比较均有显著差异（P〈0.05）。结论：有效控制慢性乙肝患者HBV-DNA病毒载量可能是控制患者肝纤维化进展的重要因素。     

康宁胶囊联合谷膛甘肽治疗慢性乙型肝炎的疗效观察

目的 观察康宁胶囊联合谷胱甘肽治疗慢性乙型肝炎的临床疗效。方法 对照组79例用谷胱甘肽治疗,治疗组93例用谷胱甘肽加用康宁胶囊治疗,通过肝功能指标及纤维化指标评价疗效。结果 经4－8周治疗后,治疗组及对照组肝功能指标及纤维化指标均有明显改善,但在部分指标下,治疗组优于对照组。结论 康宁胶囊联合谷胱甘肽治疗慢性乙型肝炎有较好作用。     

复方木鸡冲剂治疗慢性乙型肝炎的回顾性研究

目的:观察复方木鸡冲剂在慢性乙型肝炎中的疗效。方法:选择28例服用复方木鸡冲剂及护肝药物的慢性乙型肝炎患者作为治疗组,31例仅用护肝药物的患者作为对照组,观察并比较两组治疗前、治疗结束时、治疗结束3月后临床症状改善率、肝功能、血清肝纤维化指标、部分免疫学指标、血常规及超声诊断参数的变化。结果:复方木鸡冲剂可明显改善患者多项检测参数,包括ALT、AST、r-GT、HA、LN、PCⅢ、IgG、r-球蛋白、AFP、血小板、脾厚度和肝光点异常率,部分作用较为持久。结论:复方木鸡冲剂具有保护肝细胞、抑制肝纤维化、降低AFP水平和减轻脾肿大的作用,对慢性乙肝有良好疗效。     

结缔组织生长因子在慢性乙型肝炎和肝硬化中的表达

肝纤维化是肝组织在各种炎性因子的刺激下产生的一种病理反应，与肝细胞外基质大量沉积有关，其分子机制尚不完全清楚，新近研究表明．结缔组织生长因子（CTGF）是转化生长因子（TGF）的下游效应介质．在活体中可以诱导纤维母细胞细胞外基质成分基因的表达。我们对慢性乙型肝炎和肝炎肝硬化患者的肝活检标本进行CTGF的免疫组化染色研究．以期探讨CTGF的肝内表达及其与肝纤维化和肝硬化的关系。     

拉米夫定联合复方鳖甲软肝片治疗慢性乙型肝炎肝纤维化60例临床观察

慢性乙型肝炎肝纤维化尚无特效治疗,目前认为抗病毒和抗纤维化治疗为两大重点.2005年1月至2007年1月,我们采用拉米夫定联合复方鳖甲软肝片治疗60例慢性乙型肝炎肝纤维化患者,取得良好效果,现报告如下.     

拉米夫定联合复方鳖甲软肝片治疗慢性乙型肝炎肝纤维化60例临床观察

慢性乙型肝炎肝纤维化尚无特效治疗,目前认为抗病毒和抗纤维化治疗为两大重点.2005年1月至2007年1月,我们采用拉米夫定联合复方鳖甲软肝片治疗60例慢性乙型肝炎肝纤维化患者,取得良好效果,现报告如下.     

干扰素联合甘利欣治疗慢性乙型肝炎对肝纤维化指标变化的观察

肝纤维化作为肝硬化的前期阶段,是肝脏受到慢性损伤时,细胞外基质（ECM）可逆性沉积的创伤愈合过程,是一个可逆的过程。减缓、阻止甚至逆转其过程在肝硬化的防治中有重要意义。在目前尚无确切有效的治疗方法情况下,积极探索和寻找有效的治疗方法在临床防治工作中有积极意义。本文通过观察干扰素联合甘利欣治疗慢性乙型肝炎患者血清肝纤维化指标的变化,探讨该方法在临床治疗中的意义,现将结果报告如下。     

实时剪切波弹性成像对慢性乙型肝炎肝纤维化程度的诊断价值研究

目的 探讨实时剪切波弹性成像（SWE）对乙型肝炎肝纤维化程度的诊断价值。方法 选择62例慢性乙型肝炎肝纤维化病人，其中男性41例，女性21例；年龄35～68岁，平均年龄51.8岁；病程2～6年，平均病程3.1年。对其分别进行SWE检查及血清学指标检测，对肝进行活检；并与病理肝纤维化程度进行比较。结果 病理诊断S1期8例，S2期31例，S3期23例。随着慢性乙型肝炎病人肝纤维程度的升高，其S1期、S2期、S3期丙氨酸氨基转移酶（ALT）(59.4 U/L±1.6 U/L、73.6 U/L±1.9 U/L、95.6 U/L±2.5 U/L)、天冬氨酸转氨酶（AST）(51.5 U/L±1.2 U/L、65.6 U/L±1.7 U/L、80.9 U/L±2.8 U/L)及总胆红素（TBiL）(15.3μmol/L±3.8μmol/L、17.6μmol/L±4.5μmol/L、26.6μmol/L±4.9μmol/L)逐渐升高（P <0.05）;SWE技术测量S1期、S2期、S3期弹性模量分别为（5.9±1.2） kPa、（8.5±2.6） kPa、（17.3±5.0） kPa，差异有统...     

Assessment of hepatic fibrosis by transient elastography in patients with chronic hepatitis B

Hepatic ultrasonic transient elastography (FibroScan) is a new diagnostic method for the assessment of hepatic fibrosis. There are limited data available on its use as a follow‐up tool for patients with chronic hepatitis B. In this study, 134 patients were enrolled. Hepatic fibrosis was evaluated by liver stiffness measurement and biopsy. The biopsy criteria of the Chinese Program of Prevention and Cure for Viral Hepatitis, Metavir classification, and the modified Chevalier's semiquantitative system were used for histological assessment. The liver stiffness value was correlated with fibrosis stage (r = 0.565, P < 0.001) and fibrosis semiquantitative score (r = 0.727, P < 0.001). The liver stiffness value of G2 was significantly higher than that of G1 within the same fibrosis stage for S1, S3, and S4, respectively. Three patients were graded as G1S1, and had moderate steatosis without distinct fibrosis in the portal area and lobule, while their liver stiffness values were higher than 6.2 kPa. Although belonging to the same fibrosis stage, for thinner thicknesses of the fibrous septa, the liver stiffness value and semiquantitative score were correspondingly lower. Liver stiffness values had a good correlation with hepatic collagen content. However, inflammatory activity and steatosis can influence liver stiffness values to some extent. Transient elastography may be useful as an ideal non‐invasive post‐treatment follow‐up tool.     

Predictors of hepatic steatosis in HBeAg-negative chronic hepatitis B patients and their diagnostic values in hepatic fibrosis

Objective: To investigate predictors of hepatic steatosis in HBeAg-negative chronic hepatitis B (CHB) patients and their diagnostic values in hepatic inflammation and fibrosis. Methods: A total of 106 HBeAg-negative CHB patients with clinically and pathologically proven steatosis and 98 patients without steatosis were recruited into this study. The levels of fasting blood glucose (FBG), fasting insulin (FINS), triglyceride (TG), cholesterol (CHOL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (Alb), globulin (Glb), HBV DNA, body mass index (BMI), homeostatic model assessment of insulin resistance (HOMA-IR) and pathological changes of the liver in inflammation, fibrosis and fatty deposition were examined in all patients. Results: The levels of BMI, HOMA-IR, FBG, insulin, TG, and CHOL were significantly higher in patients with steatosis than those without steatosis (all P<0.05). But ALT, AST and HBV DNA levels were significantly lower in patients with steatosis (all P<0.05). Logistic regression analysis showed that only FINS was a significant predictor for hepatic steatosis (P<0.05); FINS and Glb were significant predictors for hepatic inflammation (all P<0.05); BMI and TC were significant predictors for hepatic fibrosis (all P<0.05). Conclusions: Hepatic steatosis, a common disease in HBeAg-negative CHB patients, was positively associated with BMI, FBG, FINS, TG, TC, GGT, ALP and HOMA-IR. In these patients, the prevalence of hepatic inflammation and fibrosis was also increased.     

慢性乙型肝炎组织中肝前体细胞的免疫组化特征

目的研究肝前体细胞（hepatic progenitor cells,HPCs）、小管样反应、中间型肝细胞在慢性乙型肝炎组织中的分布特征和数量变化,以及与肝细胞再生之间的可能联系。方法对42例慢性乙型肝炎组织行常规病理HE染色,按炎症活动度（G）分为轻、中、重三度,免疫组织化学方法观察肝胆细胞标记（AFP、GST-π、CK7、CK19）和造血干细胞标记（c-kit、CD34）的表达,并以Ki-67标记增殖的肝细胞,用CK7／CK19作为标记物对符合定义的HPCs、中间型肝细胞进行计数,小管样反应程度的判定利用彩色病理图象分析系统。结果慢性乙型肝炎的早期阶段即存在HPCs的活化和小管样反应,其数量随着炎症活动度的增加而增加,均表达CK7、CK19、GST-π和AFP,肝细胞增殖指数在轻、中度肝炎中逐渐增加,重度肝炎、肝硬化患者增殖的肝细胞数下降,而中间型肝细胞数量显著增加。小管样反应面积百分比与HPCs数目正相关（r=0．739,P〈0．05）,中间型肝细胞数目与HPCs数目正相关（r=0．614,P〈0．05）。结论慢性乙型肝炎中不仅有成熟肝细胞增殖,也存在肝前体细胞活化和分化,可能参与肝脏损伤后的再生修复。     

Age-specific prevalence and significance of hepatitis B e antigen and antibody in chronic hepatitis B virus infection in Taiwan: a comparison among asymptomatic carriers, chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma

The age-specific prevalence of hepatitis B e antigen (HBeAg) and its antibody (anti-HBe) were studied by radioimmunoassay, and compared in a large series of patients with chronic hepatitis B virus (HBV) infection, including 268 asymptomatic carriers, 389 chronic hepatitis, 114 liver cirrhosis, and 278 hepatocellular carcinoma (HCC). The prevalence of HBeAg/anti-HBe in asymptomatic carriers and patients with chronic hepatitis correlated closely with age as HBeAg prevalence decreased and anti-HBe prevalence increased with increasing age (P less than 0.0005), and is probably due to high infection rate at young age in Taiwan. The prevalence of HBeAg in patients with both cirrhosis and HCC are much significantly lower and had no correlation with age. Two peaks of age-specific prevalence of HBeAg and anti-HBe were observed in patients with HCC, implicating two patterns of HBV infection in these patients. The difference in the prevalence of HBeAg and anti-HBe might indicate that asymptomatic carriers, chronic hepatitis, liver cirrhosis, and HCC are sequential sequelae of HBV infection.     

INR-to-platelet ratio (INPR) as a novel noninvasive index for predicting liver fibrosis in chronic hepatitis B

Objective: We aimed to investigate whether a novel noninvasive index, i.e., the international normalized ratio-to-platelet ratio (INPR), was a variable in determining liver fibrosis stage in patients with chronic hepatitis B (CHB).Methods: A total of 543 treatment-naïve CHB patients were retrospectively enrolled. Liver histology was assessed according to the Metavir scoring scheme. All common demographic and clinical parameters were analyzed.Results: Based on routine clinical parameters (age, sex, HBeAg status, HBV DNA, hematological parameters, coagulation index, and liver biochemical indicators), a novel index, i.e., the INR-to-platelet ratio (INPR), was developed to magnify the unfavorable effects of liver fibrosis on INR and platelets. The AUCs of INPR for predicting significant fibrosis, advanced fibrosis, and cirrhosis were 0.74, 0.76 and 0.86, respectively. Compared with APRI, FIB-4, and GPR, the INPR had comparable predictive efficacy for significant fibrosis and better predictive performance for advanced fibrosis and cirrhosis.Conclusion: INPR could be an accurate, easily calculated and inexpensive index to assess liver fibrosis in patients with CHB. Further studies are needed to verify this indicator and compare it with other noninvasive methods for predicting liver fibrosis in CHB patients.     

鸭乙型肝炎肝纤维化模型的研究

目的 :用鸭乙型肝炎病毒阳性血清反复攻击建立鸭乙型肝炎肝纤维化动物模型。方法 :用鸭乙型肝炎病毒阳性血清0 1ml/只 (含DHBV颗粒 0 5× 10 9)从胫静脉注射 1日龄樱桃谷鸭 ,每周 1次 ,从每 10周剂量加大为 0 2ml/只 (含DHBV颗粒 2 5× 10 9) ,16周末处死动物 ,观察肝纤维化指标及肝脏组织病理学变化。结果 :用此方法诱发鸭肝纤维化形成率达87 5 % ,与四氯化碳腹腔注射诱发肝纤维化形成率接近 ,肝纤维化指标羟脯氨酸、透明质酸和Ⅲ型前胶原明显增高 ,与肝纤维化程度一致。结论 :用鸭乙型肝炎病毒阳性血清反复攻击复制鸭乙型肝炎肝纤维化模型是成功的     

Transmission routes of hepatitis B virus infection in chronic hepatitis B patients in The Netherlands

The Netherlands is a low endemic country for hepatitis B virus (HBV). Rotterdam, a city in The Netherlands harbors a large group of chronic hepatitis B (CHB) patients of which most are born abroad. The study included 464 consecutive CHB patients who were reported to the Municipal Public Health Service in Rotterdam from January 1, 2002 to September 15, 2005. The HBV genotypes, possible transmission routes of infection and travel history of CHB patients born in The Netherlands, were compared with those CHB patients living in The Netherlands but who were foreign-born, taking into account the ethnicity of the mother. Of the 464 patients with CHB infection, 14% were Dutch-born and 86% were foreign-born. The CHB patients in the Dutch-born group had genotypes A (35%), B (15%), C (11%), D (37%), and G (2%). In the foreign-born group, the distribution of genotypes was A (20%), B (15%), C (11%), D (40%), and E (15%). In the Dutch-born group, sexual transmission accounted for a larger proportion of infections (P < 0.0001) compared to the foreign-born group, whereas perinatal transmission is reported to be higher in the foreign-born group and in the Dutch-born group with a foreign mother. The genotypes of the chronic HBV strains determined corresponded well with the HBV genotypes expected from the countries of origin of the patients or their mothers. Genotypes A and D are predominant in CHB patients in The Netherlands.     

Lipomatous pseudohypertrophy of the pancreas in a patient with cirrhosis due to chronic hepatitis B

Lipomatous pseudohypertrophy of the pancreas was found at autopsy In a 52-year-old Japanese woman with cirrhosis due to chronic hepatitis B. Clinically, there were no clear symptoms of pancreatic Insufficiency during the entire course. Marked atrophy and fat deposition of the pancreas had already been detected by computed tomography (CT) at least 6 years before her death. She died of hepatic failure due to decompensated cirrhosis. Autopsy revealed uniform enlargement of the pancreas due to massive fat replacement (lipomatous pseudohypertrophy): the exocrine glandular elements showed marked atrophy and loss, while the islets of Langerhans were preserved. Although the etiology and pathogenesls of lipomatous pseudohypertrophy Is still unclear, this case suggests that this condition Is causally related to chronic hepatitis B or other chronic advanced hepatic lesions.