hbeag阳性/阴性慢性乙型肝炎的临床病理特征对比分析

目的 探讨hbeag阳性和阴性慢性乙型肝炎(chb)的临床病理学差异.方法 选择2002年6月-2010年1月在宁波市第二医院住院并做活体肝组织穿刺病理学诊断的chb患者665例,其中hbeag阳性组428例,hbeag阴性组237例,对两组患者的血清hbv dna载量、肝组织病理变化结果进行对比分析.采用spss 11.5软件进行统计学处理,计量资料采用t检验(正态分布)或mann-whitney u检验(偏态分布),计数资料用卡方检验,相关性分析采用pearson法.结果 hbeag阴性与阳性患者在肝组织炎症分级和纤维化分期的构成上差异有统计学意义(x2=7.92和10.35,p值均＜0.01),hbeag阴性组的炎症分级、纤维化分期高于hbeag阳性组.hbeag阴性患者血清hbv dna水平在＜3、≥3～＜5 log10拷贝/ml的比例明显高于hbeag阳性组(x2=105.16和36.92,p值均＜0.01),而≥7 log10拷贝/ml所占的比例较hbeag阳性组低(x2=110.18,p＜0.01).随着血清hbv dna水平的上升,hbeag阳性chb患者肝组织炎症分级和纤维化分期呈下降趋势(r=-0.287和-0.224,p＜0.01),而在hbeag阴性chb患者中则呈上升趋势(r=0.360和0.303,p＜0.01).结论 hbeag阴性chb患者肝组织损伤较hbeag阳性患者更加严重,须密切监测. abstract： objective to identify the differences in clinicopathological features between hbeag-positive and hbeag-negative chronic hepatitis b (chb). methods a total of 665 chb patients who were admitted to ningbo no. 2 hospital during june 2002 and january 2010 were enrolled, in which 428 were hbeag-positive and 237 were hbeag-negative. hbv dna loads, live histological inflammation grades and fibrosis stages were compared between two groups. spss 1 1. 5 was used for statistical analysis. for measurement data, t (for normal distribution) or mann-whitney u (for skew distribution) was performed; for enumeration data, chi-square test was performed; and pearson correlation analysis was conducted. results liver inflammatory grade and fibrosis staging in hbeag-negative chb patients were more severe than those in hbeag-positive patients (x2 = 7.92 and 10.35, p ＜ 0. 01 ). the ratio of serum hbv dna levels ＜ 3, ≥3- ＜ 5 log10 copies/ml in hbeag-negative chb patients were significant higher than those in hbeag-positive patients (x2 = 105.16 and 36.92 ,p ＜0.01 ) ; and the ratio of hbv dna ≥7 log10 copies/ml in hbeag-negative group was lower than that in hbeag-positive group (x2 = 110. 18, p ＜0. 01 ). with the rising of serum hbv dna levels, liver inflammatory grade and fibrosis staging in hbeag-positive patients had a descending tendency (r =-0. 287 and-0. 224, p ＜0.01 ), while those in the hbeag-negative group were ascending (r = 0. 360 and 0. 303, p ＜ 0. 01 ). conclusion compared with hbeag-positive chb patients, liver inflammation and tissue damage in hbeag-negative patients are more severe, which need close monitoring.     

干扰素联合胸腺素α1治疗hbeag阳性慢性乙型肝炎52周疗效分析

目前用于治疗慢性乙型肝炎(chb)的抗病毒药物有两大类,即核苷(酸)类药物和干扰素(ifn),两者均不能彻底清除体内病毒.核苷(酸)类药物服用方便,不良反应小,但需长期服用,且有产生耐药的风险.ifn的疗程明确,hbeag/抗-hbe血清学转换率相对较高[1],但不良反应较大,病毒学应答率仍有待提高.胸腺素α1具有免疫调节作用.本研究主要观察胸腺素α1是否具有增强ifn抗hbv的作用.     

慢性乙型肝炎与重型肝炎的临床分型新探

目的：探讨慢性乙型肝炎与重型肝炎临床分型存在的问题,提出新的分型建议。方法对124例慢性乙型肝炎及重型肝炎患者的临床资料进行分析,根据丙氨酸氨基转移酶（ALT）、总胆红素（TBil）和凝血酶原活动度（PTA）3个生化指标进行临床分型。结果124例慢性乙型肝炎患者中,轻型、中型和重型患者分别占总例数的38.7%,31.5%和29.8%。ALT、TBil和PTA 3个指标在不同类型慢性乙型肝炎患者均存在显著性差异。轻型和中型患者的临床治愈好转率均为100%,而重型肝炎患者为51.4%;在重型肝炎患者中,有肝性脑病患者的病死率或无效率显著高于无肝性脑病患者（χ^2=,14.4,P=0.000）。结论根据ALT、TBil和PTA 3个生化指标对慢性乙型肝炎进行临床分型,简单实用,值得推广。     

聚乙二醇干扰素α-2b治疗HBeAg阴性和阳性慢性乙型肝炎疗效分析

HBeAg阴性与HBeAg阳性CHB在流行病学、发病机制、自然病程、预后和治疗等方面都截然不同[1-2].本研究旨在探讨聚乙二醇干扰素α-2b(Peg IFNα-2b)在HBeAg阴性和HBeAg阳性CHB抗病毒治疗中的差异,同时评估影响应答的相关因素. 1 资料与方法 1.1 研究对象选取2007年1月至2009年6月在杭州市第六人民医院用PegIFNα-2b治疗的88例CHB患者,其中HBeAg阴性31例,HBeAg阳性57例.PegIFNα-2b的用法:1～ 1.5 μg/kg,1次/周,皮下注射,连续48周,治疗期间不使用其他抗病毒药物及保肝药物.所选病例均符合《慢性乙型肝炎防治指南(2010年版)》[3]中IFN治疗的适应证.所有患者均签署知情同意书,治疗方案经医院伦理委员会批准.     

胶原蛋白寡肽在慢性乙型肝炎肝硬化患者抗病毒治疗期间的营养价值

慢性乙型肝炎肝硬化患者由于长期肝功能损害,食欲不振、消化吸收功能障碍,极易导致患者出现营养不良,主要表现为能量与蛋白质营养不良。多项研究认为,肝炎、肝硬化患者适量补充蛋白质,并不会对患者造成不利。     

乙型肝炎病毒感染引起的肝源性糖尿病52例临床分析

肝脏是人体重要的代谢器官,对人体内糖的贮存、分解和血糖调节起着关键作用。同时,肝脏也是胰岛素的主要靶组织。肝功能水平异常时极易发生糖代谢紊乱,出现糖耐量减退或糖尿病,这种继发于肝实质损害的糖尿病被称为肝源性糖尿病。国内已有研究报道,50％～80％的慢性肝病患者存在糖耐量减退,其中20％～30％最终会发展为糖尿病。     

阿德福韦酯治疗HBeAg阳性慢性乙型肝炎血清学应答的预测因素分析

目的探讨基线血清TNFα、ALT、HBVDNA载量及24周HBV血清学标志物等因素对阿德福韦酯（ADV）治疗HBeAg阳性慢性乙型肝炎（CHB）48周时患者血清学应答的预测价值。方法203例HBeAg阳性CHB患者口服ADV治疗48周,10mg/d。采用ELISA测定HBV血清学标志物和基线血清TNFα水平,荧光定量PCR检测HBVDNA,Logistic回归分析影响HBeAg阳性患者血清学应答的因素。结果203例患者治疗24周时HBV DNA转阴率为31．5％（64／203）,ALT复常率为59．1％（120／203）,HBeAg转阴率为15．8％（32／203）,HBeAg转换率为8．9％（18／203）,应答率为13．3％（27／203）;治疗48周时HBV DNA转阴率为58．6％（119／203）,ALT复常率为78．3％（159／203）,HBeAg转阴率29．6％为（60／203）,HBeAg转换率为16．7％（34／203）,应答率为25．6％（52／203）。Logistic回归分析发现,48周HBeAg转阴的患者较未转阴者的24周HBV DNA转阴率、HBeAg转阴率及转换率、基线TNFα水平高（P值分别为0．017、0．001、0．029和0．040）;48周HBeAg转换的患者较未转换者的24周HBeAg转换率高,而基线HBVDNA低（P值分别为0．000和0．004）。结论24周HBVDNA转阴率、HBeAg转阴率和转换率,及基线TNFα水平可以预测48周HBeAg转阴率,而24周HBeAg转换率和基线HBV DNA载量可以预测48周HBeAg转换率。     

慢性乙型肝炎患者肝组织 HBV cccDNA含量与血清 HBV 标志物和病毒载量的相关性

乙型肝炎病毒共价闭合环状 DNA （ HBV cccDNA）是嗜肝病毒持续感染和HBV复制的突出标志,也是评价HBV感染状态及治疗效果最客观、敏感的指标。监测肝脏内 HBV cccDNA的含量对于病情判断、疗效和预后评估均具有重要意义。本研究通过检测拉米夫定初治后患者肝组织内HBV cccDNA 的含量及血清 HBsAg、HBeAg、HBV DNA等水平,探讨肝组织内HBV cccDNA的含量与HBV血清学标志物和病毒载量的相关性。     

生长分化因子-15在慢性乙型肝炎和肝硬化中的表达

生长分化因子-15（GDF-15）又称巨噬细胞抑制因子-1（MIC-1）,是转化生长因子-B（TGF-B）超家族成员之一。     

恩替卡韦与拉米夫定治疗慢性乙型肝炎的临床对照研究

慢性乙型肝炎（CHB）的抗病毒治疗可抑制HBV复制,阻止或延缓肝脏疾病的进展,从而改善疾病预后,提高患者的生活质量。恩替卡韦（ETV）是新一代抗HBV核苷类似物,在体外实验、动物模型和人体临床试验中均显示出强大的抑制HBV复制作用,疗效优于拉米夫定（LAM）和阿德福韦酯（ADV）。为进一步确定ETV的疗效及安全性,笔者对150例核苷（酸）类似物初治的CHB患者分别给予ETV和LAM治疗,进行随机对照临床研究。     

轻度慢性乙型肝炎患者肝脏细胞外基质和超微结构改变与临床相关性分析

目的 探讨轻度慢性乙型肝炎(chb)患者细胞外基质和肝脏超微结构改变与临床的相关性.方法 选择慢性hbv感染者为研究对象,将其分为轻度chb组(66例)和慢性hbv携带组(10例).对所有患者采集血清,并行肝穿刺活检,光镜和电镜下观察样本,将结果与血清生化学等指标进行对比分析.计量资料比较采用t检验,计数资料比较采用χ2检验,等级资料相关性使用非参数spearman 分析.结果 轻度chb组和慢性hbv携带组在alt和ast两项指标上比较差异有统计学意义(t=12.42和7.06,p＜0.05),但hbv dna水平差异无统计学意义(t=0.24,p＞0.05).两组患者血清肝纤维化指标(透明质酸、Ⅲ型胶原、Ⅳ型胶原和层黏连蛋白)差异均无统计学意义(t=0.45、0.95、0.76和1.21,p值均＞0.05).光镜组织学结果显示,轻度chb组中,g2、s2以上的患者为33例,慢性hbv携带组为2例,两组差异有统计学意义(χ2=4.17,p＜0.05).轻度chb组s3～4的患者(17例)明显多于慢性hbv携带组(0例,χ2=4.75,p＜0.05).电镜超微结构表现,狄氏间隙胶原纤维增生、汇管区扩大、贮脂细胞增生等反映肝脏纤维化相关的指标与光镜下纤维化分级相关系数分别为0.351、0.675和0.301(p值分别为0.004、0.000和0.014).结论 电镜下肝脏超微结构改变敏感性较光镜高,对轻度chb患者的病情评估具有重要价值. abstract： objective to investigate the correlations of extracellular matrix and hepatic ultramicrostructural changes with clinical manifestations in patients with mild chronic hepatitis b (chb).methods patients with chronic hbv infections were enrolled and were divided into mild chb group (n=66) and hbv carrier group (n=10).serum samples were collected from patients, and serum hbv markers, hbv dna load and liver fibrosis indexes were measured.all subjects received liver biopsy, and the tissue samples were observed by light microscope and electron microscope.t test and χ2 test were performed for measurement data and enumeration data, respectively.spearman test was used for ranked data.results the differences on alt and ast levels between mild chb group and hbv carrier group were significant (t=12.42, 7.06, p＜0.05), but there was no significant difference on hbv dna load between two groups (t=0.24, p ＞ 0.05).serum liver fibrosis indexes (hyaluronic acid, type Ⅲ collagen,type Ⅳ collagen and laminin protein) in mild chb group were not significantly higher than those in hbv carrier group (t=0.45, 0.95, 0.76 and 1.21, p ＞0.05).in mild chb group, there were 33 patients with ≥g2 and ≥s2, but in hbv carrier group were only 2 patients (χ2=4.17, p ＜ 0.05).seventeen patients in mild chb group were with s3-4, while that was not observed in hbv carrier group (χ2=4.75, p ＜0.05).in mild chb group, hepatic ultramicrostrutural changes on fat storing cell, collagen protein and portal area were correlated with fibrosis grades, and the correlation coefficients were 0.351, 0.675 and 0.301, respectively (p=0.004, 0.000 and 0.014).conclusion electron microscope is of higher sensitivity than light microscope in observing hepatic ultramicrostructural changes, which is effective in evaluating the severity of mild chb.     

慢性乙型肝炎突发机制研究进展

在慢性hbv感染者的自然史中,经常出现急性发作或者突发,其基本定义为alt高于5倍正常上限值(uln)或高于基线值2倍以上[1].出现突发的原因可能是自发性、干扰素(ifn)治疗诱导或者核苷(酸)类药物治疗停止所致等[2].慢性hbv感染者突发的机制目前尚不清楚,多数学者认为,hbv复制和表达水平与特异性免疫应答处于一个动态的平衡,当hbv的数量或抗原表达超过一定阈值,可能激发肝脏内的天然免疫应答,从而打破肝脏内hbv特异性t细胞的免疫耐受,导致肝脏内突发性炎性反应.随着对hbv变异研究的深入,有学者提出,病毒致病株的出现可能是乙型肝炎突发的始动因素,但这两者间是否为因果关系尚需要进一步研究证明.     

慢性乙型重型肝炎抗病毒治疗的研究进展

目前,慢性重型乙型肝炎已成为导致乙型肝炎患者死亡的主要原因,病死率国外为80%～90%,国内为50%～78%[1].近年来,慢性重型乙型肝炎患者的抗病毒治疗取得了较大进展,现将相关研究结果作一综述.     

乙肝相关性肝癌和丙肝相关性肝癌的临床病理特征及意义

【摘要】〓目的〓探讨乙肝相关性肝癌和丙肝相关性肝癌在临床病理特征的差异,以及这些差异的临床意义和对预后的影响。方法〓收集2003年12月~2010年10月在南方医科大学附属南方医院行手术治疗C-HCC标本18例和2011年3月~2012年12月行手术治疗的B-HCC标本34例,以及这些肝癌患者的临床病理资料。分析乙肝相关性肝癌和丙肝相关性肝癌在临床病理特征的差异,以及这些差异的临床意义和对预后的影响。结果〓乙肝相关性肝癌平均年龄(46.9±10.5)显著低于丙肝相关性肝癌组(59.0±9.9),平均住院天数(17.9±6.8)显著低于丙肝相关性肝癌组(34.9±16.5),平均术后住院天数(11.5±4.3)显著低于丙肝相关性肝癌组(19.4±11.9),肝功能分级中A级肝功明显较丙肝相关性肝癌组多,最大肿瘤直径明显大于丙肝相关性肝癌组,差异均有统计学意义(P<0.05)。B-HCC组患者中位无瘤生存时间为13个月,1年、2年无瘤生存率分别为56.3%和32.0%;C-HCC组患者中位无瘤生存时间为16.5个月,1年、2年无瘤生存率分别为75%和75%。Cox模型分析提示肝炎类型是肝细胞癌术后复发的独立影响因素。乙肝相关肝细胞癌术后复发的风险是丙肝相关性肝癌的2.35倍(P=0.108)。结论〓乙肝病毒与丙肝病毒相关肝细胞癌的临床病理特征及预后有显著差异。乙肝相关性肝癌术后恢复较丙肝相关性肝癌快,而丙肝相关肝细胞癌术后复发风险低于乙肝相关肝细胞癌。     

药物性肝炎34例临床特点及相关因素分析

目的 通过分析34例药物性肝炎的临床特点和相关因素为临床安全用药、规避药物造成肝损害的不良反应提供依据.方法 对2004～2007 年收治的已经确诊为药物性肝炎的34例患者的临床和组织学资料进行回顾性总结分析.结果 34例患者均有肝功能损害,多数有不同程度的乏力、纳差、恶心、黄疸,部分病例有嗜酸细胞增高、单核细胞数增多;中药致肝损伤占47.1%;女性、年龄大者、药物过敏者发病率较高;皮肤病用药、保健药、中药造成的肝损害有上升趋势.结论 药物性肝炎与病毒性肝炎临床表现相似,淤胆型多见,重型肝炎发病率较低.性别、年龄、特异性体质等与药物性肝炎发生有关,中药所致肝损伤应引起重视.     

慢性乙型肝炎防治指南(2010年版)

为规范慢性乙型肝炎的预防、诊断和治疗,中华医学会肝病学分会和感染病学分会于2005年组织国内有关专家制订了<慢性乙型肝炎防治指南>[1].近5年来,国内外有关慢性乙型肝炎的基础和临床研究取得很大进展,为此我们对该指南进行更新.     

Renal involvement in juvenile chronic arthritis: clinical and pathologic features

Over an 18-year period, renal involvement was diagnosed in 13 patients, who represent 1% of the total juvenile chronic arthritis population referred to us. All had severe arthritis. This study illustrates the importance of renal biopsy and indicates that renal involvement in juvenile chronic arthritis is a heterogeneous group of diseases, with a variety of causes. In eight patients with nephrotic syndrome, renal biopsy revealed amyloidosis. One rapidly died of diffuse amyloidosis and infection. The other seven received chlorambucil. Disappearance of proteinuria was noted in three of them. Four patients have persistent proteinuria but normal serum creatinine. It is suggested that, despite the long-term oncogenic risk of the drug, chlorambucil may be beneficial in patients with amyloid deposits. In one patient, the nephrotic syndrome was attributed to systemic lupus erythematosus, and in another, the chance association of an arthritis and nephrotic syndrome with minimal glomerular changes was considered. Although drug responsibility is difficult to determine in these patients receiving several medications in association, the renal involvement presented by the remaining three patients was probably related to drug(s). Moreover, it is possible that the effect of the association of medications is deleterious to the kidney. Drug-induced nephropathy is usually reversible when drugs are stopped. Unfortunately, because of persistent joint pain, these patients will continue to require pain-relieving drugs over prolonged periods.