Treatment of chronic hepatitis B

The aim of the study was comparison of the efficacy of treatment with INF and lamivudine in chronic hepatitis B. 103 patients with chronic hepatitis B were included in this trial and divided into two groups. Group I consisted of 34 patients treated with INF-alpha (5MU 3x per week during 4-6 months), group II included 69 patients treated with lamivudine (100mg per day during 1-4 years). Virologic, serologic and biochemical factors at ETR were analyzed. Costs of these two therapies were estimated too. In group I HBV DNA clearance was observed in 26/34 cases (76%), seroconversion HBeAg/anti-HBe in 5/34 (15%) and normalization of ALT in 22/30 patients (73%). In group II virological response occurred in 37/69 cases (53%), serological in 16/41 (39%) and biochemical in 34/50 (68%). Patients from group I suffered from adverse events typical for INF therapy. No adverse events were observed in group II. Cost of virological response in group I was 4 500 zl, in group II 8 000 zl, biochemical--INF 4 700 zl, lamivudine 5 700 zl and serological--group I 18 600 zl, in group II 18 700 zl.     

Treatment of chronic hepatitis B virus infection

The treatment of the patient with chronic hepatitis B virus infection (HBV) must be carried out with the knowledge that the percentage of patients infected with the B virus that develop chronic hepatitis remains between 5-10%. Of these, 10-30% will present chronic infection with active viral replication, necroinflammatory hepatic lesion, evolution to hepatic cirrhosis and the risk of developing hepatocarcinoma. For this reason, the aim of treatment is to achieve negativisation of the HBeAg, seroconversion to anti-HBe and a reduction of viral replication to undetectable values (estimated by level of DNA-HBV), for protracted periods of time. When a sustained loss of HBeAg and a reduction of viral replication are obtained, a biochemical, clinical and histological remission is achieved. Up until now the therapeutic alternatives in chronic infection by the B virus have been immunomodulation with Interferon alpha and the blocking of viral replication with lamivudine or adefovir dipivoxil. A difference must be drawn between the biochemical response, defined as a fall in the transaminases to normal values, and the virological response, which refers to a fall in the levels of DNA-HBV below 10(5) copies/ml. Finally, the complete response is defined as the virological and biochemical response with negativisation of the HBsAg. If a sustained response is obtained for several months, a histological response can be predicted with reduction in the intensity of the hepatic lesion and an absence or stabilisation in the process of fibrosis. The sustained response should last for no less than 6 to 12 months following the end of treatment.     

阿德福韦酯联合苦参素治疗慢性乙型肝炎疗效观察

在我国,约有1．5亿人口感染了乙肝病毒,慢性乙型肝炎严重威胁着人类健康。目前公认抗病毒治疗是慢性乙型肝炎治疗的关键。阿德福韦酯和苦参素是近年应用于临床的抗病毒药物,为了探讨阿德福韦酯联合苦参素治疗慢性乙型肝炎的疗效,文章观察了100例慢性乙型肝炎患者的近期疗效。现报道如下：     

Treatment modalities for hepatitis B viral infection and resistance to antiviral therapy

The worldwide problem of hepatitis B viral infection has been the focus of a large number of investigations. In the last decade advances have been made in the understanding of the viral function as well as strategies to combat the virus. Lamivudine, Hepsera, and interferon-alpha therapies that are currently used in the clinic are not optimal because of the emergence of resistance in the former modality and/or adverse effects. There are several new nucleosides that are under development for treatment of HBV. With the combination of a number of treatment protocols, it should be possible to bring down the viral load to undetectable levels and minimize the risk of generating mutations that confer resistance to the therapeutic agent.     

乙肝疫苗免疫规划对乙肝流行影响

目的 了解乙型肝炎(HB)疫苗纳入免疫规划后,江苏省HB的流行病学特征及影响因素.方法 根据《2006年全国人群乙肝等有关疾病血清学调查总体方案》,对3 906人进行现场和血清流行病学调查,并对结果进行描述流行病学分析.结果 全省HBsAg、抗-HBs、抗-HBc阳性率和乙肝病毒(HBV)感染率分别为4.99%,58.70%,25.91%和25.93%.<15岁人群乙肝疫苗(HepB)接种率达96.99%;HBsAg、抗-HBc阳性率及HBV感染率均比其他年龄组低,抗-HBs阳性率则较高,首针及时接种率为70.75%.城市HBsAg阳性率为5.19%,农村为4.80%.家庭中HBsAg阳性者关系中,夫妻占41.67%.结论 HepB纳入免疫规划后,江苏省乙肝感染率大幅下降,<15岁人群更为明显,感染高峰后移;<15岁人群首针及时接种率仍处于较低水平.     

乙肝免疫球蛋白联合乙肝疫苗阻断HBV母婴传播的相关性研究

目的:探讨乙肝免疫球蛋白(HBIG)联合乙肝疫苗阻断乙肝病毒(HBV)母婴传播失败原因。方法:选择HBsAg阳性、HBeAg阳性、HBV-DNA阳性孕妇218例,检测孕妇分娩前HBVDNA,新生儿(出生24h内且未进行阻断前)、7月龄及1岁时婴儿的HBsAg、抗HBs;所有新生儿出生后24h内在三角肌注射HBIG200IU,同时在大腿前部外侧肌内注射基因工程乙肝疫苗10μg,2周再注射同等剂量的HBIG,1、6月时分别注射同等剂量的乙肝疫苗。结果:孕妇分娩前血清HBVDNA含量>1×106copies/ml组7月龄、1岁时HBsAg阳性率分别为18.12%、19.38%,HBVDNA含量<1×106copies/mi组为7.50%、7.25%(P<0.05)。注射HBIG及乙肝疫苗后,宫内感染组7月龄、1岁时HBsAg阳性率分别为75.00%、74.19%,非宫内感染组为3.76%、4.19%(P<0.01)。结论:宫内感染及孕妇分娩前血清HBVDNA含量高是HBV母婴阻断失败的主要原因。采取综合措施可提高母婴阻断效果。     

重组乙型肝炎疫苗阻断乙型肝炎病毒母婴传播方案的保护效果评价

目的 评价国产重组乙型肝炎(乙肝)疫苗及其与中效价乙肝免疫球蛋白(HBIG)联合应用母婴阻断方案的保护效果。方法 在广西等3个地区，对乙肝病毒双阳性母亲新生儿，应用重组乙肝疫苗和重组乙肝疫苗加50IU HBIG两种母婴阻断方案免疫新生儿，共随访单纯重组乙肝疫苗母婴阻断儿289例，重组乙肝疫苗加HBIG阻断儿186例。结果 单纯重组乙肝疫苗的母婴阻断效果为87．8％(95％CI：83．6—91．9)，重组乙肝疫苗加HBIG的阻断效果为91．2％(95％CI：86．7—95．6)，重组(酵母)乙肝疫苗和重组(CHO细胞)乙肝疫苗间(P=0．7072)、两种母婴阻断方案间(P=0．2955)及各地免疫人群间(P=0．9987)的母婴阻断效果差异均无显著统计学意义。两种母婴阻断方案免疫新生儿间抗—HBs的阳转率(P＝0．3188)和抗体滴度(GMT)间(P＝0．8925)差异均无显著统计学意义，首剂免疫后1年，抗—HBs阳性率在单纯重组乙肝疫苗组和重组乙肝疫苗加HBIG组分别为91．1％和93．5％，GMT分别为153mIU／ml和164mIU／ml，以后逐年显著下降(线性趋势检验χ^2＝60．47，P=0．0001)，至免疫后第4年，阳性率分别降为65．0％和66．6％，GMT仅为第一年的1／3。结论 重组乙肝疫苗加中效价HBIG的母婴阻断效果可达90％以上，明显优于常规剂量的血源疫苗。中国现行重组乙肝疫苗抗—HBs的免疫检测技术方法有待改进。     

乙型肝炎疫苗接种预防乙型肝炎和肝癌效果

目的 评价乙型肝炎(乙肝)疫苗预防乙肝和原发性肝细胞癌(肝癌)的保护效果。方法采用出生队列调查、横断面血清流行病学调查以及乙肝发病和肝癌死亡监测,对乙肝疫苗的预防效果进行评价。结果 婴儿乙肝疫苗普种后14年,接种人群HBsAg阳性率为0.7％～2.9％(平均为1.5％),保护率为83.5％～96.6％;HBV感染率为1.1％～5.1％(平均为2.2％),保护率为93.5％～98.4％。乙肝疫苗普种后15年,1～14岁年龄组乙肝发病率为1.4/10万,下降92.4％;0～19岁组肝癌死亡率为0.17/10万,下降19.23倍。结论 婴儿乙肝疫苗普种可降低急性乙肝发病率和肝癌死亡率。     

甘肃省乙肝疫苗接种与乙肝病毒感染相关性分析

目的 分析评价乙肝疫苗免疫对甘肃省居民乙肝病毒(HBV)感染变化的影响.方法 采用多阶段整群抽样方法,抽取5个县区1 ～59岁人群共2 200人,进行基本情况调查,采集血清标本,采用ELISA方法检测乙肝病毒表面抗原(HBsAg)、乙肝病毒表面抗体(抗- HBs)、乙肝病毒核心抗体(抗- HBc)等水平.结果 乙肝疫苗接种率由1992年前出生人群的19.37％提高到2002 - 2006年出生人群的89.37％,HBV感染率由43.06％降为6.56％,HBsAg携带率由4.77％下降到1.13％;有乙肝疫苗免疫史人群HBV感染率和HBsAg阳性率均低于无乙肝疫苗免疫史人群,抗- HBs阳性率明显高于无乙肝疫苗免疫史人群;乙肝疫苗保护率为79.45％.结论 随出生年代后移,无论城市和农村人群,乙肝疫苗接种率均不断提高,HBV感染率、HBsAg和抗- HBc阳性率逐渐降低,抗- HBs阳性率上升,呈现高接种率低感染率趋势.     

乙肝疫苗免疫人群乙肝病毒感染和发病状况研究

目的了解上海市儿童乙肝疫苗免疫后乙肝病毒感染和发病情况。方法采用多阶段随机抽样方法,于2000年和2006年共计抽取1 904份接种人群血液标本,用酶联免疫吸附试验（ELISA）检测HBsAg、抗-HBs和抗-HBc。结果新生儿乙肝疫苗接种率和及时率均保持较高水平。20岁以下人群乙肝发病率明显下降;HBsAg携带率降幅为78.34%。儿童乙肝患者中84.35%（124/147）未接种过乙肝疫苗;23例接种乙肝疫苗但患病的儿童中,12例患儿的母亲或父亲HB-sAg阳性。结论儿童接种乙肝疫苗是预防和降低乙肝感染的有效措施。需加强母（父）婴阻断和家庭内传播机制的研究。     

乙型肝炎的研究进展--2004年美国肝病年会(AASLD)专题报道

2 0 0 4年 10月 2 9日～ 11月 6日在美国波士顿举行的第 5 5届美国肝病年会上 ,与会专家们就乙型肝炎方面深入探讨了乙型肝炎病毒 (HBV)、宿主免疫、新药靶位点、病毒学试验的解析与应用、免疫耐受患者治疗的讨论、核苷类和核苷类似物治疗近况以及PEG_IFN治疗乙型肝炎近况等。本刊将部分内容进行报道。     

芜湖市乙肝免疫球蛋白与乙肝疫苗联合免疫阻断乙肝病毒母婴传播效果评价

目的 观察芜湖市乙肝免疫球蛋白(HBIG)与乙肝疫苗(HepB)联合免疫阻断乙型肝炎病毒传播效果.方法 收集芜湖市2017年4月至2019年12月319例乙型肝炎病毒表面抗原(HBsAg)阳性孕产妇所生婴儿血清,所有婴儿在分娩后24 h内均注射100国际单位(IU)HBIG,并按照"0-1-6"接种程序完成3剂次乙肝疫苗接种,在完成第3剂次乙肝疫苗接种后1～6个月,即儿童7月龄至12月龄期间召回检测"乙肝两对半",评估免疫效果.结果 婴儿HBsAg阴性率98.43％;婴儿HBsAb阳性率98.12％,母亲HBeAg阳性组与阴性组的婴儿HBsAg阴性率差异均有统计学意义(Fisher'确切概率P=0.005);婴儿HBsAb阳性率差异有统计学意义(x2校正=6.079,P=0.014).结论 HBIG与HepB联合免疫阻断乙肝病毒母婴传播效果显著.     

Combined hepatitis B vaccines

The status and likely impact of existing and potential new combined hepatitis B vaccines were broadly considered at the Viral Hepatitis Prevention Board (VHPB) meeting in Malta, October 2001. The currently available and/or licensed combined hepatitis B vaccines in Europe and the prospects for further such vaccines were reviewed. Data on the safety, immunogenicity, and European licensing status and availability of haxavalent vaccines combining hepatitis B (HepB), Haemophilus influenza type b (Hib), diphtheria, tetanus, and pertussis (acellular) (DTPa), and inactivated poliovirus (IPV) antigens were presented. Finally, the impact of the availability of combined hepatitis B vaccines on hepatitis B immunisation programmes in Europe were examined and the added value of combined hepatitis B vaccines globally was estimated.