妊娠期肝病对围产儿的影响

目的：探讨妊娠期肝病对围产儿的影响。方法：测定４７例正常孕妇和６３７例妊娠期肝病孕妇所生６４８名新生儿的Ａｐｇａｒ分值和出生时体重。结果：与病毒性肝炎孕妇相比,对照组和乙肝病毒携带产妇所生新生儿Ａｐｇａｒ分值和出生时体重均有显著差异（均Ｐ〈０．０１）,而ＩＣＰ孕妇所生新生儿Ａｐｇａｒ分值和出生时体重则均无显著差异（均Ｐ〉０．０５）。肝功能异常孕妇血清总胆红素,直接胆红素和总胆汗酸与新生儿Ａｐｇａｒ分值和出生时体重呈非常显著和显著负相关（均Ｐ〈０．０１,均Ｐ〈０．０５）,而血清谷丙转氨酶、谷草转氨酶和碱性磷酸酶与新生儿Ａｐｇａｒ评分和出生时体重却无显著相关关系（均Ｐ〉０．０５）。血清白蛋白和总蛋白水平与１分钟Ａｐｇａｒ评分分别有非常显著和显著正相关（Ｐ〈０．０１,Ｐ〈０．０５）。结论：孕妇病毒性肝炎与ＩＣＰ对围产     

丙型肝炎病毒感染与各类肝病关系的探讨

为了解肝病患者丙型肝炎病毒（ＨＣＶ）的感染状况，用ＲＴＰＣＲ及ＥＬＩＳＡ法测定肝炎病毒标志。有受血史者，急性丙肝（６０５３％）高于急性乙肝（１０５３％，Ｐ＜００１）。无受血史者，急性肝炎以甲、乙型肝炎为主（４１６７％、３０５６％），高于丙肝（４１７％，Ｐ＜００１）。有受血史者的急、慢性丙肝及无症状ＨＣＶ感染者（６０５３％、２０３４％，２９１７％），高于无受血史者的４２％、８７４％，３３３％（Ｐ＜００１～００５）。慢性及重型肝炎、肝硬化、肝癌及无症状感染者乙肝病毒（ＨＢＶ）感染均高于ＨＣＶ感染（Ｐ＜００１）。提示ＨＣＶ感染多与血制品有关；慢性及重型肝炎、肝硬化及肝癌主要由ＨＢＶ所致。     

HBV感染与肝癌患者血清可溶性IL—2受体及T淋巴细胞亚群的变化及意义

用ＥＬＩＳＡ及ＡＰＡＡＰ法分别检测了３９例乙型肝炎病毒（ＨＢＶ）感染者、１５例者ＨＢＶ感染的肝癌患者及２０例正常人的血清可溶性白细胞介素－２受体（ＳＩＬ－２Ｒ）和外周血Ｔ淋巴细胞亚群结果显示,肝癌及ＨＢＶ感染者（Ｐ〈０．０１）。吕患者及ＨＢＶ感染者ＣＤ３、ＣＤ４、ＣＤ８、ＣＤ４／ＣＤ８与对照相比均有显著差异（Ｐ〈０．０５）,而肝癌与ＨＢＶ感染者相比无显著差异（Ｐ〉０．０５）。提示ＨＢＶ感染者及肝癌     

慢性肝病肿瘤坏死因子α水平及其与发病机制的关系

检测外周血肿瘤坏死因子α（ＴＮＴα）水平，显示２１例慢性迂延性肝炎（ＣＰＨ）、４２例慢性活动性肝炎（ＣＡＨ）、１０６例肝硬化（ＬＣ）及１１０例原发性肝癌（ＰＨＣ）之ＴＮＦα均显著高于正常对照（Ｐ＜０．０１）。慢性肝炎中ＡＬＴ升高及胆红素＞１００μｍｏｌ／Ｌ者其ＴＮＦα水平显著上升。乙型肝炎病毒（ＨＢＶ）合并丙型肝炎病毒（ＨＣＶ）／丁型肝炎病毒（ＨＤＶ）感染时ＴＮＦα水平亦显著高于单纯ＨＢＶ感染。ＰＨＣ患者ＴＮＦα水平与甲胎蛋白（ＡＦＰ）浓度无相关性。提示ＴＮＦα参与肝脏的活动性病变过程。     

慢性乙丙型肝炎重叠感染后血清病毒标志物的变化

目的为了探讨病毒之间的干扰现象，作者对慢性乙丙型病毒性肝炎重叠感染患者的血清肝炎病毒标志物的变化进行研究。方法１９９２年１月＿１９９４年１０月连续在我院住院确诊的慢性乙丙型病毒性肝炎重叠感染患者６０例，同期连续收住院的单纯慢性乙型肝炎患者１１０例作为对照组，比较两组患者入院时的血清乙型肝炎病毒标志物，并对观察组中２０例患者进行了随访，随访期０．５＿３年。结果入院时观察组ＨＢｅＡｇ和抗＿ＨＢｃＩｇＭ阳性率较对照组显著减少（１９／６０对５２／１０６，８／６０对２９／１１０，Ｐ＜０．０５），ＨＢｓＡｇ阴性率和抗＿ＨＢｅ阳性率显著增高（１０／／６０对５／１１０，Ｐ＜０．０１；３８／６０对４８／１０６，Ｐ＜０．０５）。观察组２０例随访发现，ＨＢＶ＿ＤＮＡ阳性及ＨＢＶ＿ＤＮＡ，ＨＣＶ＿ＲＮＡ二项同时阳性例数都比入院时明显减少（４／２０对１０／２０，Ｐ＜０．０５；１／２０对７／２０，Ｐ＜０．０５）。结论慢性乙丙型病毒性肝炎重叠感染时存在病毒干扰现象     

输血传播病毒研究的进展

自从１９８９年应用分子生物学技术发现丙型肝炎病毒后,人们认识到至少有５种嗜肝病毒是病毒性肝炎的原因：甲型肝炎病毒（ＨＡＶ）、乙型肝炎病毒（ＨＢＶ）、丙型肝炎病毒（ＨＣＶ）、丁型肝炎病毒（ＨＤＶ）、戊型肝炎病毒（ＨＡＶ）。除了这些肝炎病毒外,还有一些非嗜肝病毒,例如巨细胞病毒（ＣＭＶ）,或Ｅｐｓｔｅｉｎ－Ｂａｒｓ病毒（ＥＢＶ）和其它原因引起的肝脏炎症,例如酒精、药物、代谢性疾病以及免疫性和原发性胆道疾病等。ＨＣＶ感染是输血后肝炎和不明原因散发性肝炎的主要病因,虽然已有多种敏感的检测方法,但是临床上…     

HBV 侵犯PBMC致线粒体功能改变

目的探讨ＨＢＶ侵犯外周血单个核细胞（ＰＢＭＣ）后对其线粒体功能的影响．方法ＨＢｓＡｇ阳性６个月以上，无肝炎症状及体征，肝功正常患者５８例．多聚酶链反应检测ＰＢＭＣ中ＨＢＶＤＮＡ，噻唑兰（ＭＴＴ）比色法测线粒体功能．ＨＢｓＡｇ、ＨＢｅＡｇ检测用固相放免法检测．结果慢性ＨＢＶ感染者５８例，ＰＢＭＣ中检出ＨＢＶＤＮＡ３１例（５３５％），ＰＢＭＣ中ＨＢＶＤＮＡ阳性组ＭＴＴ比色法查线粒体功能的Ａ（ＯＤ５００ｎｍ）值明显低于ＨＢＶＤＮＡ阴性组（００５±００３ｖｓ０２９±００７，Ｐ＜００１）．结论慢性ＨＢＶ感染时，ＨＢＶ常侵犯ＰＢＭＣ，并导致ＰＢＭＣ线粒体功能降低、能量代谢异常．这可为ＨＢＶ慢性感染免疫功能异常的原因之一．     

基因型和核苷酸序列分析研究丙型肝炎病毒母婴传播

为研究丙型肝炎病毒（ＨＣＶ）的母婴传播，应用ＥＩＡ方法检测１８１６例孕妇血清抗－ＨＣＶ抗体。结果抗体阳性者１６例（０．８８％），进一步用逆转录－套式－聚合酶链反应（ＲＴ－Ｎｅｓｔｅｄ－ＰＣＲ）检测病毒核酸（ＨＣＶＲＮＡ）１４例孕妇为阳性，对其中１３例孕妇所生１３例婴儿随访至出生后６个月，３例婴儿检出ＨＣＶＲＮＡ，其中２例为短暂ＨＣＶ感染者，１例为慢性ＨＣＶ感染者伴ＡＬＴ异常，母婴传播率为２３．０％     

周围血白细胞的复制型丙型肝炎病毒RNA的检测及临床意义

用简并引物作套式反转录。聚合酶链反应检测正、负链丙型肝炎病毒（ＨＣＶ）ＲＮＡ。显示３０例急、慢性丙型肝炎患者的血清及血浆中，７例无症状抗－ＨＣＶ阳性者的血清、血浆及周围血白细胞（ＰＢＬ／Ｃ）中，均未检出负链ＨＣＶＲＮＡ。慢性丙型肝炎者ＰＢＩ（中正、负链ＨＣＶＲＮＡ的检出率高于急性丙型肝炎及无症状抗－ＨＣＶ阳性者（Ｐ＜０．０５～０．００１）。１７例经肝组织学检查的患者中，急性肝炎（ＡＨ）者ＰＢＬ／Ｃ的正、负链ＨＣＶＲＮＡ检出率低于慢性活动性肝炎（ＣＡＨ）者（Ｐ＜０．０５）。１例ＡＨ及６例ＣＡＨ患者肝组织内正、负链ＨＣＶＲＮＡ全部阳性。证实丙型肝炎患者的ＰＢＬ／Ｃ确可被ＨＣＶ感染，病程越长，被ＨＣＶ感染的可能性越大；病情活动者，ＰＢＬ／Ｃ中负链ＨＣＶＲＮＡ的检出率越高。提示ＨＣＶ不仅可以感染ＰＢＬＣ，而且可在其中复制；负链ＨＣＶＲＮＡ的出现与病情活动有关。     

病毒性肝炎和原发性肝癌患者血清IL2相关指标的意义

目的研究病毒性肝炎和原发性肝癌（ＨＣＣ）患者ＩＬ２，ｓＩＬ２Ｒ，ＩＬ６，Ｔ细胞亚群的变化意义．方法采用双抗体夹心ＥＬＩＳＡ法，ＡＢＳＥＬＩＳＡ法和红细胞花环实验对９４例各型病毒性肝炎和１０例ＨＣＣ进行了ＩＬ２，ＩＬ６，ｓＩＬ２Ｒ和Ｔ细胞亚群的测定，并与６６例健康献血员进行了对照．结果急性肝炎（ＡＨ）ＩＬ２水平增高，恢复期下降；而慢性肝炎（中重）、肝炎肝硬变（ＬＣ）、ＨＣＣ患者血清ＩＬ２水平明显低于慢性肝炎（轻）（Ｆ＝２０２６，Ｐ＜００１）和正常对照（ＮＣ）组．在乙型肝炎、ＨＢＶＤＮＡ阳性组的ＩＬ２水平显著低于ＨＢＶＤＮＡ阴性组．在ＣＨ，ＬＣ，ＨＣＣ组，ＩＬ２与ＣＤ＋４／ＣＤ＋８比值正相关，在各型肝炎和ＨＣＣＩＬ２与ｓＩＬ２Ｒ，ＩＬ６无相关关系．ＨＣＣ组的ＩＬ６水平高出正常１０倍以上，较各型肝炎组也明显升高（Ｆ＝３００７，Ｐ＜００１）．结论在病毒性肝炎和ＨＣＣ存在免疫功能紊乱和低下，淋巴因子网络失衡，这与肝炎和ＨＣＣ的病理生理机制有关，也为临床ＩＬ２治疗提供了理论依据．ＩＬ６的极显著增高有助于ＨＣＣ的诊断．     

广州市自然人群病毒性肝炎血清流行病学研究

目的了解广州市自然人群病毒性肝炎的血清流行病学特征。方法采取分层多级整群系统随机抽样方法抽取研究对象,对其作流行病学个案调查,并应用酶联免疫吸附试验（ELISA法）检测病毒性肝炎各感染标志物。结果广州市自然人群HAV、HBV、HCV、HDV、HEV、HGV感染率分别为74．47％、64．10％、0．65％、0．13％、1．69％和0．65％;HAV、HBV和HEV的感染率在老城区、新城区和郊市区中的差异有高度显著性意义（P〈0．01）,而HCV、HDV和HGV的差异无显著性意义（P〉0．05）;HBV感染率在男女之间差异有高度显著性意义（P〈0．01）,HCV感染率在男女之间差异有显著性意义（P〈0．05）,而HAV、HDV、HEV和HGV的感染率则无性别差异（P〉0．05）;HAV、HBV、HCV、HDV、HEV、HGV最低感染年龄分别为2岁、2岁、20岁、31岁、5岁和13岁,最高感染年龄分别为90岁、86岁、46岁、67岁、74岁和71岁;HAV、HBV和HEV感染率均与年龄呈正相关（P〈0,01、P〈0,01和P〈0．05）。结论广州市自然人群各型病毒性肝炎感染具有不同的流行病学特征,其中HAV和HBV的感染率较高,HCV、HDV、HEV和HGV的感染水平则较低。     

各型肝炎病毒单纯及重叠感染的研究

目的 探讨病毒性肝炎患者甲～戊，庚型肝炎病毒(HAV-HEV，HGV)单纯感染及重叠感染情况。方法 采用EIA法检测病毒性肝炎患者血清抗-HAV IgM，HBV标志物、抗-HCV IgM、抗-HDV IgM、抗-HEV IgM、抗-HGV IgM。结果 共检测210例病毒性肝炎患者HAV-HEV、HGV血清标志物，20例未检出(9．5％)，190例患者检出标志物阳性(90．5％)。HBV感染率89，5％(188／210，其中有34例为既往感染，占16．2％，现症感染154例，占73．3％)；HAV感染率29．0％(61／210)，HCV、HDV感染率均为8．1％(17／210)、HEV、HGV感染率依次为10．0％(21／210)、7．1％(15／210)。各临床类型中单纯感染占61．4％(129／210)，二重感染占32．4％(68／210)，以HAV HBV、HBV HDV、HBV HEV感染模式最常见，三重感染占6．2％(13／210)，以HAV HBV HDV感染模式最常见；临床上以肝炎肝硬化、重型肝炎重叠感染常见，急性肝炎最少见。结论 病毒性肝炎中HBV感染最常见，其次为HAV感染；单纯感染、二重感染多见，三重感染少见；重叠感染发生率随病情加重而增加。     

Virushepatitis A–E

Five hepatotropic hepatitis viruses have been identified: hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV) and hepatitis E virus (HEV). HAV and HEV are transmitted orally, HBV, HCV and HDV via blood and other body fluids. This review summarizes the biological characteristics of the different viruses and the established means of preventing infection.     

Diagnostic and prognostic value of virologic tests in vertical transmission of hepatitis C virus infection: results of a large prospective study in pregnant women

BACKGROUND/AIMS: This study aimed to evaluate the value of virologic tests for the diagnosis and prognosis of hepatitis C virus (HCV) vertical transmission in a large cohort of human immunodeficiency virus (HIV)-seronegative pregnant women. METHODOLOGY: HCV RNA and viral load were tested at the first and third trimester of pregnancy as well as at time of delivery, and from their newborns at birth and after 6, 12, 24, and 36 months. Viral genotype was determined in both viremic mothers and newborns. RESULTS: Antibodies to HCV were detected in 119 mothers (0.57%), whereas serum HCV RNA tested positive in 67% of them. Interestingly, presence of serum HCV RNA was only observed in 2 babies born to 80 HCV RNA-positive mothers (transmission rate: 2.4%), appearing immediately after birth and remaining positive during the entire follow-up (36 months). These two babies raised serum transaminase levels and had the same HCV genotype (1b) as their respective mothers who had intermediate or low viral load. CONCLUSIONS: Vertical HCV transmission is an infrequent event among HIV-negative HCV-infected mothers, and the presence of serum HCV RNA immediately after birth had a high diagnostic and prognostic value, as identified those newborns who developed chronic hepatitis C.     

Analysis of serum α‐fetoprotein concentration in patients with viral hepatitis

OBJECTIVE: To investigate serum α‐fetoprotein (AFP) concentrations in patients with viral hepatitis. METHODS: Serum concentrations of total bilirubin (TB), alanine aminotransferase (ALT), aspartate amino­transferase (AST), albumin, globulin, AFP and viral markers were determined in 310 patients with pathologically proven viral hepatitis. The relation between the concentration of AFP and clinical manifestation, pathology, family history of liver malignant disease and virus type was studied. RESULTS: Serum AFP concentrations were elevated in 115 of the 310 patients (37.1%). According to the pathological diagnosis, the lowest positive rate of AFP was in acute hepatitis (11.7%), the highest was in chronic severe hepatitis (66.7%), the second highest in liver cirrhosis (57.5%), and chronic hepatitis was intermediate (34.2%). If the diagnosis was based on the clinical manifestation, the highest positive rate was found in chronic severe hepatitis, the lowest in chronic hepatitis, and acute hepatitis was intermediate. The positive rate of serum AFP by virus type was 35.5% for hepatitis B (HBV), superinfected with HAV or with HEV was 62.8%, and with HCV was 27.3%. Only one in six patients with HCV infection and none with simple HAV or HEV infection were positive for AFP. In patients with a family history of liver cancer, the positive rate of AFP was higher than in those without such a history (57.9%vs 38.2%; P = 0.75). CONCLUSIONS: The results indicate that AFP positivity is not uncommon in patients with viral hepatitis and if the patient has an elevated concentration, it is highly likely to be HBV infection or HBV super­infected with HAV or HEV.     

Current issues in the management of paediatric viral hepatitis

Viral hepatitis poses important problems for children. In preschoolers, hepatitis A virus (HAV) infection frequently causes acute liver failure. Vaccinating toddlers against HAV in countries with high endemicity is expected to decrease mortality. HAV vaccine demonstrates efficacy (comparable to immunoglobulin) as post‐exposure prophylaxis. A recently developed vaccine against hepatitis E virus (HEV) may benefit fetal health, because pregnant women are most prone to acute liver failure as a result of HEV. Hepatitis B vaccine continues to demonstrate value and versatility for preventing serious liver disease. With chronic infection, undetectable levels of serum HBV DNA complement e‐seroconversion as the preferred outcome measure; suppressed viral load correlates with long‐term complications better than HBeAg status. Among Taiwanese children, low pretreatment HBV DNA (<2 × 10⁸ copies/ml) strongly predicted response to interferon‐α. Future paediatric studies must incorporate HBV DNA levels. The rationale for routine treatment of immunotolerant hepatitis B during childhood remains uncertain. Any treatment of chronic hepatitis B in childhood requires consideration of the risks and benefits. Childhood hepatitis C virus (HCV) infection results mainly from mother‐to‐infant transmission. Babies of HCV‐infected women should be tested for serum HCV RNA at 1 month of age. If negative, confirmatory anti‐HCV antibody testing may be performed between 12 and 15 months of age. Children with chronic hepatitis C may develop progressive fibrosis/cirrhosis, particularly in the setting of obesity and insulin resistance. Treatment of children chronically infected with genotype 2 or 3 is highly successful: combination therapy of pegylated interferon‐α and ribavirin is well tolerated and superior to pegylated interferon‐α alone.     

ALT异常对HBsAg阳性孕妇妊娠过程与结局的影响

目的探讨孕期异常的ALT对HBsAg阳性的孕妇妊娠并发症及妊娠结局的影响。方法将327例HB-sAg阳性孕妇根据孕期ALT水平分为ALT正常组（n=251）和ALT异常组（n=76）,比较两组的妊娠期并发症和最终的妊娠结局。结果与ALT正常组比较,ALT异常组早产、胎儿窘迫和产后出血发生率明显升高（P均〈0.05）;ALT异常组低体重儿发生率高于ALT正常组（P〈0.05）;ALT异常组所分娩新生儿体质量、胎龄、出生后1 min Ap-gar评分均低于ALT正常组（P均〈0.01）。结论 HBsAg阳性的孕妇若妊娠期出现ALT异常,更易增加妊娠期并发症并影响妊娠结局。     

Hepatitis e virus infection in fulminant hepatitis patients and an apparently healthy population in Bangladesh

This is the first study comparing hepatitis E virus (HEV) infection in Bangladesh in fulminant hepatitis (FH) patients presumed to have a viral cause and in the apparently healthy population. Sera from 22 FH patients were analyzed for antibodies to hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C and D viruses, and HEV and for hepatitis B surface antigen (HBsAg). Anti-HEV immunoglobulin M (IgM) was detected in the sera of 63.6% of patients, whereas 35.7% were positive for HBsAg. A high prevalence of HEV infection (83.3%) was noted in the HBV carriers. Serum samples from 273 apparently healthy individuals were tested for antibodies to HAV and HEV. Anti-HEV IgM was detected in 7.3% of the samples. The seroprevalence of HAV differed from that of HEV in the same population because all samples were negative for anti-HAV IgM. These data indicate that HEV infection is highly endemic in Bangladesh.     

Spectrum of viral hepatitis in thalassemic children receiving multiple blood transfusions.

AIM: To investigate the prevalence of infection with hepatitis viruses in children with thalassemia receiving multiple blood transfusions. METHODS: Sera from 50 children with thalassemia aged 5-15 years (30 boys), who had each received over 80 units of blood, were evaluated for the presence of markers for hepatitis A virus (HAV; IgG and IgM anti-HAV), hepatitis B virus (HBV; HBsAg, and IgG and IgM anti-HBc), hepatitis C virus (HCV; IgG and IgM anti-HCV, and HCV RNA) and hepatitis E virus (HEV; IgG and IgM anti-HEV). IgM anti-hepatitis D virus (HDV) was looked for only in HBsAg or IgM anti-HBc positive sera. RESULTS: No child had evidence of recent HAV or HDV infection. IgG anti-HAV was positive in 12 children. One patient had acute HBV infection. Nine patients were HBsAg-positive. HCV infection was present in 15 cases; six of them were HCV RNA positive, and three had superinfection with hepatitis B. Recent HEV infection was present in 5 cases. CONCLUSION: Thalassemic patients receiving multiple blood transfusions often acquire hepatitis B (20%) and C (30%) infections. Recent hepatitis E infection was documented in 10% in this one-point study.