206例HIV感染者中乙肝病毒、丙肝病毒、梅毒检测结果分析

目的:了解感染了人类免疫缺陷病毒(HIV)人群中的乙肝病毒、丙肝病毒和梅毒的携带情况.方法:采用酶联免疫吸咐试验(ELISA)检测206例(男性138例,女性68例)H1v阳性血清中HBV、HCV,采用TPPA法进行梅毒试验,比较HIV感染者及不同性别感染者HBV、HCV、梅毒感染率.结杲:206例患者HCV感染率(3...     

Viral hepatitis and hepatitis B antigen: recent advances

Recent advances in hepatitis research have shed new light on the etiology, pathogenesis, epidemiology and prevention of type B hepatitis infection. The so-called ‘Dane’ particle is probably the complete hepatitis B virion; its outer coat is the hepatitis B (Australia) antigen (HB Ag) and its inner core is an immunologically distinct particle. Subtypes of HB Ag (a, d, y, w and r) are useful indices for epidemiological surveys. Concepts of epidemiology have changed: type B hepatitis is transmissible by contact as well as by inoculation. The presence of HB Ag in blood is indicative of the presence of hepatitis B virus. Tests to detect antigen and use of voluntary blood donors have played a major role in the decreased incidence of post transfusion hepatitis. A special hepatitis B gammaglobulin preparation and a heat-inactivated hepatitis B vaccine have proved to be effective in preliminary studies.     

824例肝硬化病因及相关分析

目的探讨近年来我国肝硬化病因的特点及其变化。方法回顾性分析我院1994年1月～2004年12月824例肝硬化出院患者的病因。结果乙型肝炎后肝硬化504例（61．17％）,酒精性肝硬化73例（8．86％）,乙型病毒性肝炎合并酒精性肝硬化152例（18．45％）,自身免疫性肝硬化19例（2．31％）,非酒精性脂肪性肝硬化者31例（3．76％）。按时期分为前6年和后5年分别分析。显示乙型肝炎肝硬化由66．67％下降到57．65％,随时间呈下降趋势。酒精性肝硬化由2．49％增加到12．92％,非酒精性脂肪性肝硬化由1．56％增加到5．19％,自身免疫性肝硬化由1．25％增加到2．98％,均随时间呈增加趋势。本组患者中139例（16．87％）合并原发性肝癌,其中128例为乙肝后肝硬化,9例酒精性肝硬化,1例非酒精性脂肪性肝硬化。结论虽然乙型病毒性肝炎仍然为我国肝硬化的主要病因,但是酒精性肝硬化和非酒精性脂肪性肝硬化随时间呈上升趋势,且非酒精性脂肪性肝硬化的预后与乙肝后肝硬化比较差异无统计学意义,应该引起足够重视。     

Importance of markers of hepatitis B virus in alcoholic liver disease

To determine the importance of the presence of serological markers of hepatitis B virus infection in patients with alcohol related liver disease we compared cumulative alcohol intake and clinical and histological features in patients with markers of hepatitis B virus infection and in those without. Hepatitis B surface antigen (HBsAg) was detected in five (2%) out of 285 patients studied and antibody to HBsAg (anti-HBs) in 41 (14%); one patient had antibody to hepatitis B core antigen alone. The combined prevalence of markers of hepatitis B virus infection was similar in patients with alcoholic cirrhosis (18%) and precirrhotic liver disease (13%). Two patients positive for HBsAg had histological features of both alcoholic liver disease and chronic active hepatitis, with stainable HBsAg. Patients with anti-HBs were, however, histologically indistinguishable from patients without markers, and the mean cumulative alcohol intake of patients with anti-HBs was similar to or even higher than that of patients with liver disease of comparable severity who had no evidence of previous infection. The presence of markers of hepatitis B virus infection was related to former residence in countries with a high prevalence of the infection and to previous parenteral treatment and blood transfusions. Infection with hepatitis B virus does not enhance the development of chronic liver disease in heavy drinkers, except in the small number who remain positive for HBsAg.     

幽门螺杆菌感染与肝源性胃病的关系

目的探讨幽门螺杆菌（Helicobacter pylori,Hp）感染与肝源性胃病的关系。方法慢性乙型肝炎患者265例,乙型肝炎后肝硬化患者263例,非慢性肝病患者158例,均行快速尿素酶试验及^14C-尿素呼气实验。结果慢性乙型肝炎、乙型肝炎后肝硬化及非慢性肝病对照组的Hp感染率分别为48．3％、41．8％和81．6％。肝源性溃疡Hp感染率为48．1％,而对照组消化性溃疡Hp阳性率为90．6％。结论慢性乙型肝病患者的Hp感染率与对照组相比较低,Hp感染不是肝源性溃疡发生的重要原因。     

Treatment of viral hepatitis in children

Hepatitis B and hepatitis C are important causes of chronic liver disease in children and adolescents, and later on for potential cirrhosis and primary hepatocellular carcinoma. The risk of developing chronic hepatitis B (HB) infection ranges from 90% in neonates to <5% in adults. Hepatitis C induces chronic infection in at least 85% of affected persons. HBV and HCV associated liver damage appears to be less severe in children than in adults. At the present time, lamivudine and a combination of interferon and lamivudine seem to be the best options for HB infection treatment in the pediatric population, even though they induce the presence of drug-resistant mutations, and new therapies have to be developed to improve reduction and cessation of viral replication and decrease the emergence of mutations. Therapy with interferon and ribavirin seems to offer the best results for children and adolescents. Results from a study on pegylated interferon in a pediatric population might lead to better therapeutic responses. Cost of treatment for chronic viral hepatitis is very high and efforts have to continue to extend hepatitis B vaccination to the general population worldwide to reduce vertical and horizontal transmission of hepatitis C.     

Epidemiology and prevention of hepatitis B virus in China

Hepatitis B virus （HBV） infection is prevalent in China. Approximately 600 million people have ever been infected by HBV. About 130 million are HBV chronic carders and 30 million HB patients. Among them, 50% of HBV carriers are caused by carrier mothers to born infants. Around 300 000 people died of liver disease including liver cirrhosis and primary hepatocellular carcinoma each year and 50% of them died of primary hepatocellular carcinoma. HBV infection is not only the health problem but also becoming a social problem. HBV chronic carriers and patients have endured the great pressure from disease burden and social discrimination. According to the report of the national screening program of HBV released by the ministry of health in 2008, China has taken many effective measures to control the HBV infection, including vaccine immunization program, strengthening the management of blood sources and blood productions, prevention of nosocomial HBV infection, strengthening health education on HBV infection and safe injection techniques. The implementation of HB vaccine immunization program, which China officially introduced into the national immunization program since 1992, has dramatically reduced the incidence of HBV infection among infants and children. Integrated with other interventions, the rate of HBV infection decreased gradually. According to the survey of the national screening program of HBV in 2006, compared with the incidence of HBV in 1992, the incidence rate of HBsAg positive has decreased 26.36%, the number of children who have ever been infected by HBV decreased 80 million since 1992. However some problems are still existing. The solutions of low rate of vaccination in rural areas and migration population, lacking of practical measures on management of hepatitis B patients, the occurrence of health care acquired HBV infection, and low rate of vaccination among high risk groups have also been recommended.     

乙型肝炎肝硬化患者HBV DNA和肿瘤标志物相关性分析

目的 探讨乙型肝炎(以下简称乙肝)肝硬化患者HBV DNA和肿瘤标志物相关性,为早期肝癌的诊断提供指导.方法 选取60例乙肝肝硬化和60例肝癌患者分别作为肝硬化组和肝癌组,采用PCR法检测HBV DNA,采用酶联免疫法检测甲胎蛋白异质体3(AFP-L3)和高尔基蛋白73(GP73).结果 肝硬化组的HBV DNA、AFP-L3和GP73的表达均明显低于肝癌组,差异有统计学意义(P<0.05),但HBV DNA和GP73阳性表达率与肝癌组相比,差异无统计学意义(P>0.05),AFP-L3的阳性率比较差异有统计学意义(P<0.05);Pearson相关分析显示HBV DNA定量与AFP-L3和GP73表达无明显相关性(rAFP-L3=0.422,P=0.192;rGP73=0.349,P=0.228);HBV DNA、AFP-L3、GP73和联合诊断的灵敏度、特异度和准确度分别为86.67%、20.00%、53.33%,68.33%、90.00%、79.17%,78.33%、30.00%、54.17%,68.33%、91.67%、80.00%.结论 乙肝肝硬化患者HBV DNA与AFP-L3、GP73表达无明显相关性,AFP-L3可用于鉴别肝癌和肝硬化,HBV DNA和GP73并不能区分乙肝病毒所致肝癌和肝硬化.     

HBV感染各阶段血清乙肝表面抗原与HBV DNA及年龄的相关性分析

目的:探析未接受抗病毒干预治疗的慢性乙型肝炎病毒(HBV)感染者各阶段的血清乙肝表面抗原(HBsAg)定量值与HBV DNA及患者年龄的关系.方法:2015年3月~2016年12月在我院就诊但未接受抗病毒治疗的498例慢性HBV感染患者的临床资料.根据临床诊断结果,将入选者分成非活动性HBsAg携带组(145例)、慢性HBV携带组(57例)、乙型肝炎E抗原(HBeAg)(+)慢性乙型肝炎(CHB)组(151例)、HBeAg(-)CHB组(65例)、HBeAg(-)乙肝肝硬化(LC-B)组(43例)和HBeAg(+)LC-B组(37例)6组.对血清HBsAg定量与血清HBV DNA及患者年龄进行相关性分析.结果:各组间的HBsAg定量值有统计学差异,其中HBeAg(-)、(+)的CHB组间HBsAg水平差异显著.除外非活动性HBsAg携带的HBV感染者的HBV DNA与血清HBsAg定量值呈显著正相关性.HBV感染者的血清HBsAg定量值与其年龄间存在显著负相关性.年龄>40岁的非活动性HBsAg携带者血清HBsAg定量值明显低于同年龄段的HBeAg(-)CHB患者.结论:HBV感染各阶段的血清HBsAg水平各不相同,该水平与患者的年龄及HBV DNA关系密切,是区分年龄超过40岁的非活动性HBsAg携带者与HBeAg(-)CHB患者的一个重要预测指标.     

肝硬化及乙型肝炎患者血清肿瘤坏死因子水平的研究

采用ELISA方法检测22例肝硬化及110便乙型肝炎患者血清肿瘤坏死因子（TNF）含量。结果显示：肝硬化病人血清TNF水平最高;乙肝慢性迁延型,急性乙肝,乙肝慢性活动性,急性重症乙肝和慢性重症乙肝血清TNF水平则依次升高,与对照组比较均有显著性差异（P＜0．01）,并发现肝硬化和慢性重症乙肝合并腹腔感染者血清TNF水平也显著高于未合并感染者（P＜0．01）。结果揭示血清TNF水平与肝硬化和乙肝类型密切相关,血清TNF水平对肝硬化和乙肝类型的诊断,疗效判断均具有一定的参考价值。     

维生素D受体基因TaqⅠ、FokⅠ单核苷酸多态与HBV感染结局关联探讨

目的 探讨维生素D受体（VDR）基因TaqⅠ T／C和FokⅠ C／T多态性是否与HBV感染结局之间存在关联。方法 采用病例-对照研究方法,募集212例HBV自限性感染者、244例无症状HBsAg携带者和391例慢性乙型肝炎患者作为研究对象,应用聚合酶链反应-限制性片段长度多态性（PCR-RFLP）方法对VDR基因TaqⅠ和FokⅠ基因进行分型测定。结果慢性乙肝组VDR-FokⅠ C等位基因频率为45．8％,显著高于自限性感染组的38．2％（x^2=6．43,P=0．01）。慢性乙型肝炎组VDR-FokⅠ的TT、TC及CC基因型频率分别为30．7％、47．1％和22．2％,与自限性感染组的基因型频率41．0％、41．5％和17．5％相比差异有统计学意义（x^2=6．76,P=0．03）。单因素分析显示,携带CC／CT基因型的个体感染HBV后,增加发生慢性乙型肝炎的风险（OR=1．57,P=0．01）,经Logistic回归分析,控制性别的混杂作用后,携带FokⅠ CC／CT基因型者发生慢性乙肝的风险是TT基因型携带者的1．7倍（OR=1．70,P=0．021）。未发现VDR-TaqⅠ T／C多态性与HBV感染结局存在显著关联。单体型分析显示,TaqⅠ T-Fok C在慢性乙型肝炎组的频率为2．3080％,显著高于HBV自限性感染组的0．5391％（x2=6．08,P=0．01）;TaqⅠ T-FokⅠ T在慢性乙型肝炎组的频率为1．5283％,显著低于HBV自限性感染组的3．7061％（x^2=5．65,P=0．02）和显著低于HBV携带组的3．4820％（x^2=5．12,P=0．02）。结论 VDR基因多态性可能是影响HBV感染结局的因素之一。     

Prospective evaluation of seropositive occult hepatitis B viral infection in lymphoma patients receiving chemotherapy

OBJECTIVE. To serially evaluate the viral kinetics of occult hepatitis B virus infection in lymphoma patients and perform a correlation with clinical outcomes. DESIGN. Case series with 1-year follow-up. SETTING. Regional hospital, Hong Kong. PATIENTS. Consecutive patients who were newly diagnosed to have lymphoma in the hospital between 1 April 2007 and 31 March 2008 were tested for hepatitis B (HB) surface (s) antigen (Ag), anti-HBs antibody (Ab) and anti-HB core (c) Ab. Seropositive occult hepatitis B patients as defined by being negative for HBsAg but positive anti-HBsAb and/or anti-HBcAb without a hepatitis B vaccination history were recruited. Serum HBsAg, anti-HBsAb, anti-HBcAb, hepatitis B virus deoxyribonucleic acid (DNA) level, and liver biochemistry were checked at baseline and every 4 weeks during and after chemotherapy until 12 months after the completion of chemotherapy or death. Entecavir was started if patients developed biochemical flare-up of hepatitis B associated with virological rebound. The prevalence and course of hepatitis B virus-related hepatitis, as well as any temporal relationship to viral kinetics and clinical hepatitis, were assessed. RESULTS. Of 47 patients tested, 10 (21%) with lymphoma were seropositive occult hepatitis carriers. Their median baseline hepatitis B virus DNA level was 89 IU/mL (range, <34-807 IU/mL). Virological rebound (as defined by a 10-fold increase in serum hepatitis B virus DNA level from pre-chemotherapy level persisted for 4 weeks) occurred in one of the 10 patients, followed by biochemical reactivation. Whereupon entecavir treatment was started and no liver failure ensued. Regarding the other seropositive occult patients, their serum hepatitis B virus DNA levels fluctuated, but there was no associated biochemical reactivation. CONCLUSION. Detectable baseline serum hepatitis B virus DNA is not uncommon in patients with occult hepatitis B who receive chemotherapy. Transient elevation in serum hepatitis B virus DNA levels does not predict biochemical reactivation, but antiviral treatment might be considered if virological rebound persists.     

肝炎病毒感染与酒精性肝硬化关系的研究(附182例酒精性肝病临床病例报告)

目的：研究肝炎病毒感染与酒精性肝硬化的关系。方法：回顾分析182例年龄为25～75岁男性酒精性肝病患者的临床资料。结果：患酒精性肝病患者人数占同年慢性肝病患者的比例呈增高趋势．由1991年的4．2％增至1995年的17．5％及1996年的21．3％。患者饮酒量与其肝硬化的发展密切相关，而且并发肝炎病毒感染者的肝硬化发生率明显高于未并发感染者。结论：中国酒精性肝病患者的发病率逐年增加；并发肝炎病毒感染加速酒精性肝病的发展。     

中国北方汉族人群白细胞抗原DRB1及DQA1区基因多态性与乙型肝炎病毒感染结局的关系

目的探讨中国北方汉族人群白细胞抗原(HLA)DRB1及DQA1区等位基因多态性与乙型肝炎病毒(HBV)感染不同结局的关系,分析基因—环境交互在慢性乙肝发生中的作用。方法采用病例—对照研究(慢性乙肝患者207人,HBV携带者212人,自限性HBV感染者148人)方法,比较3组人群检测的HLA等位基因频率并应用交互相乘模型分析基因—环境交互作用。结果慢性乙肝组HLA-DQA1*0301等位基因频率(14·81%)显著低于HBV携带组(25·24%)和自限性HBV感染组(25·00%)(Pc=0·002;Pc=0·007);自限性HBV感染组HLA-DQA1*0102等位基因频率(8·78%)显著高于HBV携带组(1·89%)和慢性乙肝组(2·18%)(Pc=0·000;Pc=0·000);自限性HBV感染组HLA-DQA1*0302等位基因频率(4·05%)显著低于慢性乙肝组(11·41%)(Pc=0·005)。经多元logistic回归分析调整年龄、性别、吸烟和饮酒的混杂效应后,HLA-DQA1*0302仍是发展为慢性乙肝的危险因素(OR=3·913,P=0·0006),HLA-DQA1*0102和HLA-DQA1*0301是HBV感染后的保护因素(OR=0·200,P=0·0004;OR=0·258,P=0·0000)。饮酒与HLA-DQA1*0102[交互指数(Ⅱ)=1·49]、HLA-DQA1*0302(Ⅱ=12·12)在慢性乙肝的发生中可能存在正交互作用,与DQA1*0301存在负交互作用(Ⅱ=0·78)。结论携带HLA-DQA1*0302等位基因者感染HBV后可能增加慢性乙肝发生的风险,而携带HLA-DQA1*0301和HLA-DQA1*0102者可能降低慢性乙肝发生的风险;基因—环境交互作用可能影响HBV感染的结局。     

乙型肝炎患者血清抗：HCV临床意义探讨

应用第二代抗─ＨＣＶ酶免疫试验检测了１９４例各型乙型肝炎患者血清丙型肝炎病毒抗体（抗─ＨＣＶ），结果抗─ＨＣＶ阳性率为２３．２％，其中，重型肝炎（ＳＨ）者为４４．４％、原发性肝癌（ＰＨＣ）者为３７．５％、肝硬化（ＣＩＲ）者为３６．６％、慢活肝（ＣＡＨ）者为２６．１％、慢迁肝（ＣＰＨ）者为１６．７％、急性肝炎（ＡＨ）者为７．１％、无症状ＨＢｓＡｇ携带者（ＡＳＣ）的为６．７％，提示肝病越严重，其抗─ＨＣＶ的阳性率就越高。还发现重叠感染ＨＣＶ的乙型肝炎患者之ＨＢＶ复制率较低。     

重叠感染SEN病毒对乙肝后肝硬化发展的影响

目的：通过检测慢性乙型肝炎和乙肝肝硬化患者SEN病毒（SENV）的感染情况，了解重叠感染SENV对乙肝后肝硬化发展的影响。方法：采用巢式聚合酶链反应（nPCR）对148例慢性乙型肝炎患者、119例乙肝肝硬化患者和80例健康体检者进行SENV—D／H亚型的检测，并对部分阳性血清的PCR产物进行测序。结果：SENV—H在乙肝肝硬化患者血清中的检出率（为37．8％）高于慢性乙型肝炎患者（为26．4％），两者差异有显著性（P〈0．05），而SENV—D的检出率分别为34．5％和30．4％，两者差异无显著性（P〉0.05）；健康体检者血清中，SENV—H和D的检出率分别为13．8％和16．3％，与上述两组患者相比差异有显著性（P〈0.05）；此外，在77例有输血史患者和190例无输血史患者血清中，SENV的总检出率分别为53．2％和55．8％，两者差异无显著性（P〉0.05）。结论：重叠SENV—H感染可能对乙肝后肝硬化发展具有一定的影响，并且SENV的主要传播方式除输血外可能还存在其他途径。     

一起幼儿园的乙型肝炎流行

报告一起幼儿园乙型肝炎流行,工作人员的罹患率为18.2％;儿童中HBV感染率49.6％。5例儿童的血清学结果呈现乙肝急性感染的动态变化。随访发现,1例成人转为HBsAg携带者。表明,乙型肝炎在地方性流行区只要条件适宜,也能发生流行。     

艾滋病合并乙、丙型病毒性肝炎96例分析

目的探讨艾滋病病毒重叠乙型肝炎病毒和或丙型肝炎病毒感染相互之间对疾病的进程的影响。方法对96例艾滋病合并乙、丙型病毒性肝炎的临床及实验室检查资料进行回顾性分析。结果96例艾滋病合并病毒性肝炎中，乙型病毒性肝炎17（17．7％）倒，丙型病毒性肝炎76（79．16％）例，乙肝重叠丙肝3（3．12％）例，均为静脉共用针头吸毒患者。96例艾滋病合并乙、丙型病毒性肝炎中，大部分为轻度或肝功能正常患者，肝硬化发生率低。从有性接触或静脉共用针头吸毒开始到发病住院时间均超过6年以上。结论艾滋病患者中，乙型肝炎病毒感染远低于丙型肝炎病毒，与丙型肝炎易慢性化有关；当人体同时感染了艾滋病病毒、乙型肝炎病毒、丙型肝炎病毒后，相互之间对疾病的进程无明显影响。     

慢性乙肝和乙肝肝硬化消化性溃疡患者幽门螺杆菌感染率观察

目的探讨幽门螺旋杆菌感染与慢性乙型肝炎消化性溃疡及乙肝肝硬化消化性溃疡的相关性。方法胃镜检查并取胃窦黏膜组织活检后行快速尿素酶实验,对慢性乙型肝炎消化性溃疡患者及乙肝肝硬化消化性溃疡患者幽门螺旋杆菌感染情况进行分析对比。结果慢性乙型肝炎消化性溃疡组,幽门螺旋杆菌（Helicobacter Pylori,HP）阳性率70%,乙肝肝硬化消化性溃疡组,HP阳性率23.8%。慢性乙型肝炎消化性溃疡组中胃溃疡47例,HP阳性率10.6%,十二指肠溃疡113例,HP阳性率94.7%;乙肝肝硬化消化性溃疡组中胃溃疡68例,HP阳性率17.6%,十二指肠溃疡16例,HP阳性率50%。结论慢性乙型肝炎十二指肠溃疡与幽门螺旋杆菌感染有相关性;慢性乙型肝炎胃溃疡、乙肝肝硬化胃溃疡与幽门螺旋杆菌感染无明显相关性。     

Hepatocellular carcinoma with cardiac cirrhosis

Hepatocellular carcinoma is a recognized complication of hepatic cirrhosis, most commonly associated with alcohol excess, haemochromatosis and chronic hepatitis B infection. Long-standing hepatic venous congestion may cause cirrhosis. A search of the literature has not revealed a case of hepatocellular carcinoma complicating cardiac cirrhosis. A case is described and the association is discussed.