人工肝支持系统联合熊去氧胆酸治疗急性重型戊型肝炎的临床分析

目的拟对急性重型戊型肝炎患者人工肝治疗后总胆红素指标及各临床指标进行研究,观察治疗前后临床症状、体征、血生化指标的变化,探讨人工肝-血浆置换(PE)和熊去氧胆酸联合治疗急性重型戊型肝炎的疗效,为临床治疗急性重型戊型肝炎提供客观依据。方法选择96例患者随机分为三组,所有患者入院后常规检测血生化、血常规、凝血酶原时间、心电图和腹部B超等。每次人工肝治疗前(当日晨空腹)后(次日晨空腹)抽血检测生化全套、凝血酶原时间等指标,分析术后总胆红素的清除率及凝血酶原时间改变。同时观察患者临床症状、体征变化。结果 A组及B组患者每次经过PE治疗后临床症状均有不同程度的缓解,乏力及恶心、腹胀症状减轻,食欲增加。PE治疗前后A组及B组多数患者胆红素明显下降,白蛋白有所增加,凝血酶原时间缩短,胆碱酯酶数值上升,经t检验治疗前后有高度显著的差异性(P<0.01)。PE治疗2周后A、B治疗组和对照组C组之间比较,A组、B组、C组患者治疗后总有效率分别为23%、29%,8%,B组高于A组,明显高于C组,经统计学χ2检验有显著差异性(P<0.001)。结论人工肝-血浆置换治疗后多数临床症状均经迅速缓解,术后检测血清胆红素明显降低、凝血酶原时间缩短、胆碱脂酶活力增加,提示肝脏功能改善明显。另外总有效率B组高于A组,提示加用熊去氧胆酸口服具有更好的保护肝细胞,促进胆汁排泄的作用。     

Hepatitis E: An emerging disease

Currently, the infection with the hepatitis E virus represents the most frequent cause for acute hepatitis and jaundice in the world. According to WHO estimations, around two billion people, representing one third of the world’s population, live in endemic areas for HEV and, therefore, are at risk of infection. In developed countries, the circulation of the virus in both human and animal (swine, boar, deer) sewage has been confirmed; however, the incidence rate is low compared to that of developing countries where outbreaks of acute hepatitis transmitted via the fecal-oral route are originated, more frequently in the flooding season or after natural disasters, combined with deficient sanitary conditions.There are currently 4 known genotypes of HEV. Genotypes 1 and 2 are isolated in all human epidemic outbreaks in developing countries, while genotypes 3 and 4 are isolated not only in humans but also in animals, in both developing and industrialized countries. These data support genotypes 3 and 4 having zoonotic nature. The diagnosis of this disease is based in the detection of anti-HEV IgG and IgM in blood serum using enzyme-linked immunosorbent methods. However, the method that best confirms the diagnosis is the RT-PCR, which detects HEV RNA in blood serum and also provides the genotype. The clinical course is generally that of an acute hepatitis which in some cases may require hospitalization and that, in transplant patients or HIV infected individuals can become a chronic hepatitis. Furthermore, the virus constitutes an important risk for pregnant women. The hepatitis E can present a wide range of symptoms, from a subclinical case to chronic liver disease with extrahepatic manifestations. For this reason, the diagnostic is challenging if no differential diagnosis is included. There is no specific antiviral drug for hepatitis E, but satisfactory results have been observed in some patients treated with pegylated interferon alfa2a and/or ribavirin.This revision is an update of all the molecular, epidemiological, clinic and preventive knowledge on this emergent disease up to date.     

北辰区2012年相关从业人员戊肝感染率调查

目的了解天津市北辰区相关从业人员戊肝的感染状况。方法以2012年在我中心进行相关预防性健康体检的相关从业人员为检测对象,并对检测结果进行分析。结果2012年相关从业人员健康体检人员共计17895人,其中戊肝检测阳性为15人,阳性率是0．084％。结论我区戊肝感染水平高于全国水平,应采取综合防治措施。     

Hepatitis E Outbreak in Jaipur due to Genotype IA

Purpose: Suddenly, many cases of fever with jaundice were reported from Sodala area at Jaipur. This outbreak of acute hepatitis at Jaipur Rajasthan was investigated for aetiology and subsequent phylogenetic analysis. Methods: Blood samples were collected from 106 symptomatic patients of acute hepatitis and 39 pregnant females (with or without symptoms of hepatitis) during an outbreak at Jaipur. The samples were tested for hepatitis A virus (HAV) and hepatitis E virus (HEV) by serological and molecular methods (polymerase chain reaction [PCR]). Sequencing of nested PCR product was done for phylogenetic analysis. Hepatitis B surface antigen (HBs antigen), anti-hepatitis C virus (HCV), anti-Leptospira and anti-scrub typhus IgM enzyme-linked immunosorbent assay (ELISA) was done for patients negative for HEV and HAV. Results: Among 106 symptomatic patients, HEV IgM was positive in 84/106 (79.2%) patients and HEV RNA in 72/106 (67.9%) patients. Among pregnant women, 6/39 (15.4%) were HEV IgM positive and 5/39 (12.8%) for HEV RNA. One (2.5%) pregnant woman died due to hepatitis. All the isolates belonged to genotype 1A of HEV. All HAV, HEV-negative samples were negative for HBs antigen, HCV antibody, Leptospira and scrub typhus IgM ELISA. Conclusion: The outbreak was due to HEV genotype 1A. The municipal water supply was contaminated and sanitary conditions and waste disposal were poor in the area. Boiling of drinking water, fixing the water supply pipes and frequent hand washing helped in controlling the outbreak.     

Estimation d’un risque transfusionnel émergent : l’exemple du VHE

BackgroundThe risk assessment for blood transfusion is an essential step that must precede any screening strategy of a pathogen transmitted by transfusion. After several cases of HEV transmission by transfusion in France, a risk assessment for this virus was performed.MethodsWe used a method based on the prevalence of HEV-RNA in plasmas collected for the preparation of SD-plasma. To estimate the rate of HEV-RNA positive among all blood donations, data on SD-plasma were adjusted on the following HEV risk factors: gender, age group and region of residence. We assumed that HEV risk factors were the same in plasma donors and whole blood donors.ResultsAmong 57,101 plasma donations tested for HEV-RNA in 2013, 24 were positive (crude rate of 4.2 per 10,000 donations). After adjustment, the total number of HEV-RNA positive blood donations was estimated at 788, accounting for a rate of 2.65 per 10,000 donations (95% CI: 1.6–3.7) or 1 in 3800 donations (1 in 6,200–1 in 2,700). This rate was 12 times higher in men than in women, increased with age, and varied according to region of residence.ConclusionThe risk of blood donation contamination by HEV has been estimated to be 1 in 3800 donations in 2013. An essential input is still missing to assess now the risk in recipients: the minimum infectious dose. Furthermore, the risk in recipients has to be analyzed according to characteristics of transfused patients: presence of anti-HEV immunity, existence of chronic liver disease or immunodeficiency.     

Unusual serological response to hepatitis E virus in plasma donors consistent with re‐infection

Hepatitis E virus (HEV)‐positive plasma donations, identified by a plasma mini‐pool screening approach, were analysed using serological methods for the presence of anti‐HEV IgM and IgG. Avidity testing was performed on the IgG‐reactive donations. Anti‐HEV IgG with high avidity was observed in two donors together with high viral loads, but with the absence of anti‐HEV IgM. These data are suggestive of re‐infection in a small proportion of plasma donors, which has not previously been reported.     

戊型肝炎病毒感染与胰腺癌发病的相关性临床分析

目的：分析戊型肝炎病毒（HEV）感染与胰腺癌发病的相关性。方法：以12例HEV感染的胰腺癌患者（感染组）和47例非HEV感染的胰腺癌患者（非感染组）为研究对象,收集相关临床资料包括胰腺、肝脏的病理表现等,分析HEV感染的胰腺癌患者的临床特征,并且用HEVRNA直接测序技术对合并HEV感染的胰腺癌患者的胰腺组织进行HEV定位分析。结果：感染组合并肝癌、肝硬化的概率高于非感染组,感染组胰腺癌发病的平均年龄较非感染组提前8.5年,2例HEV感染的胰腺癌患者的胰腺组织中检测到HEVORF2片段。结论：HEV感染与胰腺癌发病存在相关性。     

Isolation of human antibodies against hepatitis E virus from phage display library by immobilized metal affinity chromatography

Objective To isolate human antibodies against hepatitis E virus from phage display library by a new method of panning phage antibody library based on immobilized metal affinity chromatography （1MAC）. Methods Phage antibody library was allowed to mix with hex-His tagged expressed HEV specific antigen, NE2, in solution for adequate binding before affinity resin for hex-His was added. The non-specific phage antibodies were removed by extensive washing and the specific bound phage antibodies could then be eluted to infect TG1 or repeat the binding process for subsequent rounds of purification. The specificity of the selected human antibodies were tested by antigen competitive ELISA, human sera blocking ELISA, scFv expression, and sequence analysis. Results His-NE2 specific recombinant phages were successfully enriched after panning procedure. Two individual phage clones, 126 and 138, showed 50% inhibition in NE2 antigen competition ELISA and obvious blocking effect by HEV positive serum in blocking ELISA. Soluble scFv of 126, 138 bound to NE2 specifically. Conclusion Two specific human phage antibodies against hepatitis E virus （HEV） from phage display library were isolated by immobilized metal affinity chromatography. The immobilized metal affinity chromatography applied to phage antibody selection was a helpful supplement to the selection in solution.