丙型肝炎六例报告及随访观察

本文首次报告新疆6例丙型肝炎。对20例病毒性肝炎病人血清进行抗HCV检测,结果6例阳性。结合临床及化验检查,可诊断为丙型肝炎。对此6例进行分析,结果表明:本病多发生在输血后,临床表现不重,肝功能检查主要是ALT反复波动不降,易致慢性。     

易善复加丹参治疗病毒性肝炎合并脂肪肝疗效观察

目的　评价易善复加丹参在病毒性肝炎合并脂肪肝的临床疗效。方法　选择病毒性肝炎合并脂肪肝 98例 ,随机分成治疗组和对照组 ,治疗组 68例 ,应用易善复加丹参治疗 ,疗程 3个月。结果　治疗组血脂 (TC、TG)、肝功能 (ALT、γ -GT)、B超脂肪肝图象及临床症状等项目的改善均明显优于对照组 (P <0 .0 1～ 0 .0 5) ,且无明显副作用。结论　易善复加丹参治疗病毒性肝炎合并脂肪肝对促进肝脏脂肪代谢、降低血脂、修复损伤的肝细胞 ,且阻止或改善肝纤维化均有明显的功效     

拉米夫定治疗慢性乙肝的疗效及乙肝病毒YMDD变异的研究

目的评价拉米夫定治疗慢性乙肝病人的1年疗效、乙肝病毒YMDD变异率、变异与治疗前HBV-DNA、ALT水平的联系。方法治疗组按入选标准随机选择32例慢性乙型肝炎患者给予拉米夫定100 mg/d并随访1年,并于治疗开始后3、6、9、12个月检测肝功能、HBV-M、HBV-DNA、YMDD变异。对照组随机选择36例从未接受抗病毒治疗的HBV-DNA阳性、ALT异常的慢性乙型肝炎患者,检测YMDD变异株。结果①拉米夫定治疗一年,HBV-DNA转阴率71.88%(23/32),HBeAg/HBeAb血清转换率18.52%(5/27),ALT复常率62.5%(20/32);治疗前及治疗12个月后ALT水平分别为132.59±66.07、49.78±27.94,治疗前后差别有统计学意义(P<0.001)。②治疗组在治疗前未发现YMDD变异,治疗6个月发现2例YMDD变异,变异率6.25%,治疗12个月发现5例YMDD变异,变异率15.63%;对照组36例从未接受抗病毒治疗的慢性乙型肝炎病人中检测出2例YVDD变异株与野生株共存。③治疗前ALT<3×ULN组及≥3×ULN组YMDD变异率分别为11.76%、20.00%,两组差别无统计学意义(P=0.645);治疗前HBV-DNA<106copies/mL组及≥106copies/mL组YMDD变异率分别为5.88%、26.67%,两组差别无统计学意义(P=0.161)。结论拉米夫定能迅速抑制乙肝病毒复制、改善肝功能;治疗前HBV-DNA水平及ALT水平不足以预见YMDD变异的发生;乙肝病毒YMDD变异株存在于未使用拉米夫定的慢性乙肝患者中,建议在抗病毒治疗前对YMDD变异进行常规检测。     

Peripancreatic lymphoadenopathy and extrahepatic immunological manifestations in chronic hepatitis C

Abstract. The aim of the study was to determine the role of peripancreatic lymph node swelling in systemic immunological alterations during chronic hepatitis C (HC). The prospective study was carried out as a clinical study in a university hospital. Clinical, haematochemical and ultrasonographic findings in 182 patients were studied. Ultrasonography was performed by the same operator and the findings were evaluated blind without the operator knowing the clinical and haematochemical parameters. Hepatitis B virus (HBV) markers, anti-HCV antibodies. LKMl, cryoglobulinaemia, rheumatoid factor and anti-tissue antibodies were determined. Liver biopsy was carried out in 43 of the 182 patients. One or two pathological peripancreatic lymph nodes (PLNs) were present in 30 of the 182 patients and, of the 30, 28 were anti-HC positive. Only one patient in the non-PLN group was positive for anti-HCV, there being statistical significance ( P <0.0001) between the PLN and non-PLN groups. In HCV-positive patients, extrahepatic immunological manifestations were observed (cryoglobulinaemia; positivity to anti-smooth muscle, antinuclear and antimitochondrial antibodies; positivity to rheumatoid factor and LKMl). In five patients the presence of focal lymphocytic aggregates was detected by biopsy, whereas one patient presented typical ocular lesion of Mikulicz's syndrome. Our results may confirm the marked lymphotropism shown by the HC virus and indicate more complex immune system involvement, especially in view of the coexisting signs of immune system involvement related to the presence of intrahepatic cellular aggregates detected in our study. We believe that the peripancreatic adenopathy in chronic HCV hepatitis is an important diagnostic sign and may indicate an involvement of the C virus in the still unexplained extrahepatic immunological disorders.     

IgM抗-HD检测及其临床意义的探讨

建立了检测IgM抗-HD的酶联免疫法(ELISA,捕捉法),经验证该检测方法具有良好的特异性。文中还对119例HBV/HDV感染者进行了IgM抗-HD检测并在此基础上对IgM抗-HD的分子类型进行了研究,结果提示IgM抗-HD的检测有助于HDV与HBV同时感染与重叠感染的鉴别;文中所选HDV感染者的IgM抗-HD均发19S IgM抗-HD为主,是HDV感染急性期的标志,反映我省HDV感染者多为近期感染。     

化疗对淋巴瘤伴乙肝病毒感染患者肝功能影响的回顾性分析

目的研究化疗对淋巴瘤伴乙肝病毒感染患者肝功能的影响。方法回顾性病例分析，比较50例HBsAg（-）、20例HBsAg（＋）和18例小三阳的恶性淋巴瘤患者化疗后肝功能变化情况。结果HBsAg（-）组、HBsAg（＋）组和小三阳组化疗后Ⅲ级以上肝功能损害分别是0％、15％、55％。结论伴乙肝病毒感染的淋巴瘤患者化疗后肝功能损害明显，尤其小三阳患者损害更为严重，甚至死亡。     

A 1-year study of the epidemiology of hepatitis A virus in Tunisia

This 1-year (September 2000 to August 2001) prospective study investigated the presence of hepatitis A virus (HAV) in the population of Monastir, Tunisia (86 serum samples), in the influents and effluents of two wastewater treatment plants, and in shellfish harvested in the coastal areas of Monastir, Bizerte and Sfax (January 2001 to May 2001). The virus was detected by RT-PCR using primers targeted at the VP3-VP1 region. An epidemic of HAV infection was observed during the winter months, with a peak in January. The presence of the virus was relatively constant in the influents and effluents of the wastewater treatment plants, and the virus was found in shellfish from the Monastir area during the months of January and February. The genotype IA strain was recovered most frequently from human serum and wastewater samples. The observation that the peak of the epidemic was during the winter months suggests that transmission of HAV is related to climatic factors and, presumably, to shellfish consumption.     

新型壳聚糖对血浆胆红素和细胞因子吸附性能的体外筛选初步研究

目的观察各类新型吸附剂对重型肝炎患者血浆中的胆红素和细胞因子的吸附性能。方法第一步,收集第一组重型肝炎患者的血浆各3ml,以8种不同的吸附剂(1#～3#为致孔剂浓度分别为3%、1%、5%的壳聚糖,4#为胺基化壳聚糖,5#为苯乙烯/二乙烯苯聚合物,6#为后交连苯乙烯/二乙烯苯聚合物,7#为壳聚糖-苯乙烯/二乙烯苯聚合物,8#为壳聚糖-后交连苯乙烯/二乙烯苯聚合物)各1ml进行吸附,检测对胆红素的吸附能力,做吸附剂筛选实验和吸附实验。第二步,用以上筛选出吸附率较好的两种吸附剂各1ml对第二组患者血浆(各3ml)进行胆红素和细胞因子的吸附实验。结果第一步实验显示胺基壳聚糖(4#)和苯乙烯/二乙烯苯聚合物(5#)有较好的吸附效果,4#吸附剂对总胆红素(TBiL)、直接胆红素(DBiL)、间接胆红素(IBiL)的吸附率分别为50.5%±3.4%、57.0%±11.3%、39.0%±7.2%;5#分别为30.1%±2.5%、32.6%±3.0%、27.6%±2.9%。第二步实验显示4#胺基化壳聚糖吸附后血浆中TBiL、DBiL、IBiL、白细胞介素6(IL-6)和肿瘤坏死因子α(TNF-α)水平下降比5#明显,有统计学意义(P<0.001)。结论胺基化壳聚糖(4#)体外吸附重型肝炎患者血浆中胆红素、细胞因子效果有明显优势。     

重型病毒性肝炎医院感染病原微生物的检测

①目的 了解重型病毒性肝炎病人医院感染病原微生物的分布及耐药情况。②方法 对595例重型病毒性肝炎住院病人进行医院感染的调查分析，并用分离培养法鉴定感染菌，使用E-test法进行耐药谱的检测。③结果 在595例病人中，有182例发生医院感染，感染率为30.6%，感染部位以腹腔为主，占49.7%，共分离出病原菌188株，以革兰阴性杆菌为主，占75.4%，多数感染菌对常用抗生素耐药。④结论 重型病毒性肝炎医院感染发生率较高，应引起足够重视。