广东省绿头鸭场鸭乙肝病毒自然携带状况调查

目的　调查两个鸭场携带乙肝病毒(DHBV)状况。方法　在对广东省家养绿头鸭分布状况进行系统调查的基础上,对南海市和顺镇、里水镇两个绿头鸭场作了随机抽样调查,采集了雏鸭、青年鸭和种鸭的血标本共519份,应用斑点分子杂交(DotBlot)测定法观察绿头鸭乙型肝炎病毒(DHBV)自然携带率。结果　两鸭场绿头鸭的DHBV自然携带率为36.0%(187/519),其95%可信限为31.0%～44.0%。不同鸭龄组绿头鸭DHBV自然携带比较,两鸭场同日龄绿头鸭DHBV自然携带率比较,绿头鸭DHBV自然携带率的性别比较,差异均无显著意义。不同鸭龄的绿头鸭DHBV-DNA含量定量分析(A值),差异有非常显著性(P＜0.01),其含量由高到低顺序为雏鸭＞种鸭＞青年鸭,和顺鸭场的绿头鸭DHBV-DNA含量高于里水鸭场。结论　两鸭场绿头鸭携带的DHBV可能源于不同的亚株。     

乙型肝炎病毒相关肾炎临床与病毒血清学特点关联研究

目的 研究乙型肝炎病毒（HBV）感染与肾小球肾炎的关系,探讨HBV复制在HBV相关肾炎发病中的作用。方法 对338例经肾穿刺证实的肾炎患者的临床病理和病毒血清学特点进行分析。结果 HBV相关肾炎占肾炎总数的5．3％。在血HBsAg( )的肾炎患者中,HBV相关肾炎发病与HBeAg相关（P＜0．05）,与血清HBV DNA含量（bDNA)显著相关（P＜0．01）。分支链DNA（bDNA)阳性率明显高于HBeAg阳性率（P＜0．05）。结论 bDNA是反映HBV复制的最佳指标。HBV相关肾炎与体内HBV复制程度密切相关,HBV在体内大量复制,可能通过循环中的病毒抗原沉积于肾脏和肾脏中该抗原原位表达而致病。     

Long-term persistent immunogenicity after successful standard and triple-dosed hepatitis B vaccine in hemodialysis patients: A 3-year follow-up study in China

BackgroundAlthough the efficacy of hepatitis B vaccines among hemodialysis patients has been documented, the long-term persistence of immunogenicity in this population remains largely unknown. We explored the long-term persistence of immunogenicity induced by different hepatitis B vaccine regimens in hemodialysis patients.MethodsIn initial study, we conducted a randomized, multicenter, double-blind, parallel-controlled trial among hemodialysis patients in 13 hospitals in Shanxi Province, China. A total of 352 hemodialysis patients were allocated to receive 3-dose 20 μg (IM20 group) and 3-dose 60 μg (IM60 group) recombinant hepatitis B vaccine at months 0, 1, and 6. Vaccine-induced immune responses were measured at month 7. In this study, the responders (anti-HBs ≥ 10 mIU/mL) were followed up at months 18, 24, 30, 36 and 42, respectively. We used the generalized log-rank test and generalized estimating equations (GEE) to analyze the long-term durability of responses and the kinetics of anti-HBs levels, respectively.ResultsA total of 284 patients were involved in the extended follow-up period. The duration of vaccine-induced response with 75% of patients maintained protective antibody were 12 months and 18 months in the IM20 group and IM60 group, respectively (P = 0.291). The long-term persistent immunogenicity induced by 3-dose 60 μg was more satisfactory than that by 3-dose 20 μg hepatitis B vaccine in patients with hemodialysis duration ≥ five years (P = 0.023). The peak anti-HBs levels in 100–1000 mIU/mL or ≥ 1000 mIU/mL were more likely to maintain long-term protective antibody compared to anti-HBs levels in 10–100 mIU/mL (P ＜ 0.05). The kinetic profile was similar between the two groups (P = 0.334).ConclusionHigh-dose 60 μg hepatitis B vaccine could lead a satisfactory long-term durability of immunogenicity among patients with hemodialysis duration of five years or more. Peak anti-HBs level after vaccination was associated with the long-term persistence of immunogenicity.     

Serological response with Heplisav-B® in prior Hepatitis B vaccine non-responders living with HIV

BackgroundAs people living with HIV (PLWH) are at risk for contracting Hepatitis B Virus (HBV), they should be screened for HBV and vaccinated if not immune. Seroconversion rates in PLWH receiving traditional recombinant HBV vaccines (Engerix-B® and Recombivax-HB®) have historically been low with at most 70% achieving immunity. In 2017, a recombinant, adjuvanted HBV vaccine (Heplisav-B®) was approved for use in HIV-negative patients.Heplisav-B® has shown superior seroprotection in this population compared to Engerix-B® and Recombivax-HB®, as well as interim analysis showing higher seropositivity rates in patients undergoing dialysis. However, its efficacy in PLWH is currently unknown. This study evaluates the rate of seroconversion following Heplisav-B® administration in PLWH with previous HBV vaccination failure.MethodsRetrospective, cross-sectional study at The Brooklyn Hospital Center’s HIV primary care clinic in Brooklyn, NY. HIV-positive adults who received at least two doses of Heplisav-B® and had previously failed to seroconvert after vaccination with Engerix-B® or Recombivax-HB® were included. The primary outcome is the percentage of PLWH who became seropositive following Heplisav-B®.ResultsA total of 67 patients met the inclusion criteria. Twenty-five (37.3%) PLWH had failed at least 2 courses of recombinant vaccines. Fifty-eight (86.6%) PLWH became seropositive (Anti-HBs > 10 mIU/mL) at least two months after completing Heplisav-B®. For the 9 (13.4%) patients that did not develop immunity, 3 (33%) had a detectable HIV RNA and 3 (33%) had a CD4 count < 200 cells/uL³.ConclusionsHeplisav-B® was highly effective in achieving immunity to HBV in PLWH who failed non-adjuvanted recombinant vaccines.     

Prevention of hepatitis B mother-to-child transmission in Namibia: A cost-effectiveness analysis

Despite access to a safe and effective vaccine, mother-to-child transmission (MTCT) of hepatitis B virus (HBV) persists in Africa. This is of concern since perinatally-infected infants are at highest risk of developing hepatocellular carcinoma, a life-threatening consequence of chronic HBV infection. While tools to prevent HBV MTCT are available, the cost implications of these interventions need consideration prior to implementation. A Markov model was developed to determine the costs and health outcomes of (1) universal HBV birth dose (BD) vaccination, (2) universal BD vaccination and targeted hepatitis B immunoglobulin (HBIG), (3) maternal antiviral prophylaxis using sequential HBV viral load testing added to HBV BD vaccination and HBIG, and (4) maternal antiviral prophylaxis using sequential HBeAg testing combined with HBV BD vaccination and HBIG. Health outcomes were assessed as the number of paediatric infections averted and disability-adjusted life years (DALYs) averted. Primary cost data included consumables, human resources, and hospital facilities. HBV epidemiology, transitions probabilities, disability weights, and the risks of HBV MTCT were extracted from the literature. Incremental cost-effectiveness ratios (ICERs) were calculated to compare successive more expensive interventions to the previous less expensive one. One-way sensitivity analyses were conducted to test the robustness of the model’s outputs. At the Namibian cost/DALY averted threshold of US$3 142, the (1) BD vaccination + targeted HBIG, and (2) maternal antiviral prophylaxis with sequential HBeAg testing interventions were cost-effective. These interventions had ICERs equal to US$1909.03/DALY and US$2598.90/DALY averted, respectively. In terms of effectiveness, the maternal antiviral prophylaxis with sequential HBeAg testing intervention was the intervention of choice. The analysis showed that elimination of HBV MTCT is achievable using maternal antiviral prophylaxis with active and passive immunization. There is an urgent need for low cost diagnostic tests to identify those women who will most benefit from drug therapy to attain this laudable goal.     

用单克隆抗体观察慢性肝炎患者细胞免疫状况的变化

本文用多种单克隆抗体对32例慢性肝炎患者的细胞免疫状况进行了研究。结果发现患者肝组织内淋巴细胞和单核、巨噬细胞浸润明显增加,坏死区浸润细胞主要是T_3~+和T_8~+细胞。B淋巴细胞浸润极少,浸润淋巴细胞表面IL—2受体阳性细胞与外周血淋巴细胞表面IL—2受体阳性细胞率均无改变。患者外周血单个核细胞改变为T_3~+下降,T_4/T_8比例下降,单核、巨噬细胞、B淋巴细胞及淋巴细胞表面HLA—DR、DP、DQ标志与正常人无差异。     

不同原料制备乙型肝炎病毒特异性转移因子的研究

目的　为临床治疗乙肝提供一种安全、有效的免疫调节剂。方法　用组织匀浆、反复冻融破碎细胞、透析灭活和过滤除菌等技术 ,获得乙型肝炎病毒特异性转移因子 (HBV STF) ;用Lowry法测多肽含量 ;用苔黑酚显色法测定核糖核酸 (RNA)含量 ,用氨基酸分析仪分析测定HBV STF的水解氨基酸总含量。结果　来源于HbsAg阳性胎盘和HbsAg阳性血液的多肽含量分别为 0 4 9± 0 0 14和 0 2 9± 0 0 13(P <0 0 1) ,RNA含量分别为 0 34± 0 0 10和 0 2 2± 0 0 0 8(P <0 0 1)氨基酸总含量为 198 6± 1 5 6 2和 12 3 4± 1 5 2 1(P <0 0 1)。结论　用HbsAg阳性胎盘制备的乙型肝炎病毒特异性转移因子质量优于HbsAg阳性血液。     

前S1蛋白在HBV指标中的重要意义

前S1蛋白是HBV衣壳蛋白的一部分，存在于大分子表面抗原蛋白之中，它是乙肝早期诊断的敏感指标，也反映了乙肝病毒的复制和乙肝病情的活动。本文研究显示，162例非乙肝病人血清中前S1蛋白全部阴性；311例乙肝患者中，前S1蛋白阳性率为38．9％，其中急性乙肝93．8％，慢性活动性肝炎51．2％，在乙肝二对半检测模式中，大三阳中该指标阳性率87．1％，小三阳为32．1％。以HBV DNA检测为标准，前S1蛋白的灵敏度为94．1％等，假阴性5．9％，总符合率93．9％。     

ASODN对白细胞抗原Ⅰ类基因表达的影响

目的为观察针对乙型肝炎病毒（ＨＢＶ）ｘ基因特异性反义核酸（ＡＳＯＤＮ）对２２１５细胞表面白细胞抗原Ⅰ类基因（ＨＬＡ－Ⅰ）表达的影响。方法人工合成互补于ｘ基因关键区的三段反义核酸，用流式细胞仪检测ＡＳＯＤＮ对２２１５细胞表面ＨＬＡ－Ⅰ表达的影响，细胞原位杂交观察作用细胞内ＨＬＡ－ⅠｍＲＮＡ含量变化，同时用ＰＡＰ－ＥＬＩＳＡ法检测作用细胞上清中ＨＢｘＡｇ的含量。结果三段ＡＳＯＤＮ均能抑制ＨＢｘＡｇ的表达，２２１５细胞表面ＨＬＡ－Ⅰ类抗原的表达及细胞内ＨＬＡ－ⅠｍＲＮＡ含量也降低。结论ＨＢｘＡｇ表达量的降低可能系ＡＳＯＤＮ序列特异性抑制作用所致，而ＨＬＡ－Ⅰ表达的降低可能是ＨＢｘＡｇ对ＨＬＡ－Ⅰ基因启动子的激发减少的间接结果。     

首次及重复感染HCV后抗体及HCV RNA的动态观察

本文报道对首次感染ＨＣＶ的１４人与重复输入含ＨＣＶ血的１１位感染者进行长达一年半的动态观察，总结出输入大量含ＨＣＶ血后导致的感染者在自然状态下ＨＣＶ ＲＮＡ及抗体变化的规律。７／８再次输入４００ｍｌ以上含ＨＣＶ血的感染者，其自身存在的高滴度抗体在受血后１～３个月下降０．５～１．０ＯＤ值。首次输出含ＨＣＶ血的感染者中，１１／１４的感染者３个月内ＡＬＴ高于参考值的３倍以上，而再次输入含ＨＣＶ血的患者中