日照市12年食品从业人员HBsAg携带情况分析

为了解食品从业人员HBsAg携带情况及其分布规律,防上疾病传播,和为制定食品卫生监督管理措施提供科学依据,现将1987～1998年94071名食品从业人员健康检查中HBsAg携带情况分析如下。1 对象及方法1.1 对象系日照市1987～1998年历年食品从业人员94071名。1.2 检测方法 HBsAg采用反向间接血凝法(RPHA)测定。中和试验1:8以上定为阳性,HBeAg采用ELISA(酶联免疫吸附测定)法。试剂均为北京生物制品研究所产品,在有效期内使用。     

乙肝前S1抗原临床应用价值的探索

目的 探索不同乙肝标志物适用对象.方法 对我院2009年1月至2009年10月2012例体检和乙肝患者PreSl抗原和其他相关项目结果进性回顾性分析.结果 体检人群中HBsAg阳性率为8.3%,而"大三阳"仅为1.2%,PreSl抗原阳性率为1.4%.在HBV-DNA超过103copies/ml时,HBeAg特异性为75.6%.灵敏度为84.4%,而PreSl抗原特异性为57.6%,灵敏度为86.7%.结论 PreSl抗原与HBeAg有一定的互补性.但可能存在过高假阳性.健康体检人群可以只查肝表面抗原(HBsAg),PreSl抗原应根据表面抗原的结果而定;而HBeAg仍然是评估慢性乙肝复制的常用指标,但针对HBeAg阴性患者有必要进行PreSl抗原检查.但是PreSl抗原检查也不能取代HBeAg.     

Endpoints of hepatitis B treatment

Summary. The goal of hepatitis B treatment is to prevent the development of cirrhosis, liver failure, and hepatocellular carcinoma. Ideally, clinical studies should demonstrate that hepatitis B therapies can prevent liver‐related complications; however, these clinical endpoints evolve over years or decades. Therefore, clinical trials have relied on intermediate endpoints to evaluate the efficacy of treatment and to determine when treatment can be stopped. Intermediate endpoints that have been used include biochemical, histological, virological, and serological endpoints. This review will discuss the validity of these intermediate endpoints as surrogates of clinical endpoints, and the rates at which these intermediate endpoints can be achieved with currently available therapies.     

前S1抗原、HBV—DNA和乙肝病毒血清标志物联合检测的临床意义

[目的]了解乙肝两对半（主要是HBeAg）、乙肝病毒DNA（HBV—DNA）与乙肝前S1抗原（Pre—S1）检测三者之间的关系以及它们的临床应用价值。[方法]采用酶联免疫吸附实验（ELISA）方法对273例乙肝患者血清进行乙肝两对半、Pre—S1抗原的测定，用荧光PCR技术对HBV—DNA进行测定，并分析3者之间的关系。[结果]HbeAg阳性组Pre—S1抗原、HBV—DNA的阳性率分别为85．09％、91．23％。说明Pre—S1抗原与HBV—DNA一样可较好的反映乙肝病毒在体内的活动及复制情况；HbeAg阴性组中Pre—S1抗原与HBVDNA的阳性率分别为37．11％、37．11％，说明在HbeAg阴性组患者仍有病毒复制，不能完全以HbeAg来判断病毒复制与否；与HBV—DNA的检测结果相比较，Pre—S1抗原检测的检出率为88．95％，特异性为87．32％，总符合率为88．28％，HBVDNA与Pre—S1抗原的阳性检出率没有差别（P〉0．05）。[结论]Pre—S1抗原能较好的反映HBV病毒感染及复制情况，三者联合检测互相补充，更有助于临床疾病的诊治。     

不同HBV感染模式产妇乳汁中HBV-DNA载量及肝功能分析

目的研究乙型肝炎阳性产妇感染模式,以及血清中乙型肝炎病毒(HBV)-DNA载量与乳汁中HBV-DNA载量的关系,乳汁中HBV-DNA载量与产妇肝功能的关系,评价母乳喂养的安全性。方法对267例HBV携带产妇,用酶联免疫吸附试验(ELISA)法检测乙型肝炎表面抗原(HBsAg)和乙型肝炎e抗原(HBeAg),用荧光定量PCR技术检测血清中和乳汁中HBVDNA载量,采用速率法检测丙氨酸氨基转移酶(ALT)。结果 109例HBsAg和HBeAg双阳性的产妇,其乳汁HBV-DNA阳性率为76.1%,158例HBsAg阳性而HBeAg阴性产妇乳汁HBV-DNA阳性率为3.2%,差异有统计学意义(P0.05)。观察产妇其血清中携带不同载量的HBV-DNA,分别为HBV-DNA500、500~1.0×10~5、1.0×10~5 copies/mL 3组,其两两比较乳汁中HBV-DNA载量差异有统计学意义(P0.05),且血清中HBV-DNA载量与乳汁中HBV-DNA载量呈正相关关系;乳汁中HBVDNA阳性与乳汁中HBV-DNA阴性产妇血清ALT进行比较,差异有统计学意义(P0.05)。结论 HBsAg和HBeAg双阳性和血清中HBV-DNA1.0×10~5 copies/mL的产妇不宜母乳喂养,同时乳汁中HBV-DNA载量较高的产妇应同时密切监测肝功能,以防发生肝损伤。     

Correlation between clinical indication for treatment and liver histology in HBeAg‐negative chronic hepatitis B: a novel role of α‐fetoprotein

Background: It is unclear whether clinical indication for antiviral treatment is in agreement with histological indication in HBeAg‐negative chronic hepatitis B (CHB). This study aimed to clarify this relationship and identify factors associated with liver histology. Patients and methods: We investigated 152 consecutive, treatment‐naïve, HBeAg‐negative CHB patients who had undergone liver biopsies at a tertiary medical centre in Taiwan. Clinical indications for treatment included a serum alanine aminotransferase level more than twice the upper limit of normal and an hepatitis B virus DNA level >2000 IU/ml. Factors associated with the histological indication (Ishak's grade ≥7 and/or stage ≥2) were analysed. Results: The association between the clinical and the histological indications was significant (P=0.011). However, the agreement was poor (κ value=0.197). In patients satisfying the clinical indication, age >52 years [odds ratio (OR)=2.669, P=0.042], serum α‐fetoprotein (AFP) level >7 ng/ml (OR=7.070, P<0.001) and platelet count <130 × 10⁹/L (OR=11.720, P=0.025) were identified to be independent factors associated with histological indication. In patients who did not satisfy the clinical indication, multivariate analysis revealed that only an AFP level >7 ng/ml (OR=10.345, P=0.021) was independently associated with histological indication. Combining the clinical indication and/or AFP level >7 ng/ml to predict liver histology, the sensitivity and the negative predictive value could improve from 86 to 94.4% and 66.7 to 81% respectively. Conclusion: AFP level is associated with liver histology in HBeAg‐negative CHB. Serum AFP level can serve as a surrogate indicator to identify patients who need antiviral treatment.     

Increasing hepatitis B viral load is associated with risk of significant liver fibrosis in HBeAg‐negative but not HBeAg‐positive chronic hepatitis B

Background/aims: To evaluate the association between demographical features, serum ALT and HBV DNA and the prevalence of significant fibrosis and inflammation on liver biopsy in patients with chronic hepatitis B. Methods: In this cross‐sectional study of patients on St Vincent's Hospital HBV database, patients were classified into three groups on the basis of HBeAg status and HBV DNA level and the prevalence of significant (F2/3/4) fibrosis and (A2/3) inflammation in each group was established. Patients were also divided into HBeAg‐positive and ‐negative groups and examined for the prevalence of significant fibrosis/inflammation in the strata of HBV DNA and ALT. Predictors of significant fibrosis and inflammation in HBeAg‐positive and ‐negative patients were examined by logistic regression. Results: Three hundred and ninety four patients (HBeAg positive=198; HBeAg negative=196) with liver biopsy were identified. Fifty‐eight percent of HBeAg‐negative patients with HBV DNA >25 000 IU/ml had F2/3/4 fibrosis. HBV DNA and F2/3/4 were positively correlated in HBeAg‐negative patients [odds ratio (OR) 1.42, P=0.001] but inversely correlated in HBeAg‐positive patients (OR 0.71, P=0.03). HBV DNA was an independent predictor of significant fibrosis in HBeAg negative (P=0.03) but not HBeAg‐positive patients. In HBeAg‐positive patients, age was the only predictor of significant fibrosis (P=0.001) and ALT the only predictor of significant inflammation (P=0.003). In the whole cohort there was a close positive association between inflammation and fibrosis. Conclusion: Increasing levels of HBV DNA are associated with increasing prevalence of significant fibrosis only in patients with HBeAg‐negative CHB.     

Current treatments for patients with HBeAg‐positive chronic hepatitis B virus infection: a comparison focusing on HBeAg seroconversion

HBeAg seroconversion, in association with undetectable levels of hepatitis B virus DNA as determined by polymerase chain reaction, is an important goal in the treatment of patients with HBeAg‐positive chronic hepatitis B (CHB). Achievement of sustained HBeAg seroconversion at an early age (<40 years) is associated with a reduced incidence of hepatic complications, increased rates of HBsAg loss and seroconversion and improved survival rates, whether the seroconversion is spontaneous or treatment induced. Patients with HBeAg‐positive CHB who achieve sustained HBeAg seroconversion and complete 6–12 months of consolidation therapy are eligible for stopping therapy. In randomized clinical studies involving patients with HBeAg‐positive CHB, treatment with pegylated interferon (PegIFN)‐ α is associated with higher and more durable HBeAg seroconversion rates than are lamivudine and adefovir. More recently, newer generation oral nucleos(t)ide analogs (NAs) have become available. These include entecavir, telbivudine and tenofovir, and they demonstrate superior antiviral potency and efficacy. This review examines the importance of HBeAg seroconversion as an end point for therapy in the treatment of patients with HBeAg‐positive CHB, and examines the rates and durability of HBeAg seroconversion with PegIFN and oral NA therapy. The mechanisms for enhanced HBeAg seroconversion rates with new‐generation NAs are also discussed.     

恩替卡韦与阿德福韦酯治疗慢性乙型肝炎患者12周和24周疗效的Meta评价

目的比较恩替卡韦与阿德福韦酯治疗核苷类初治的HBeAg阳性慢性乙型肝炎患者的疗效。方法检索2003年1月-2010年5月公开发表的有关恩替卡韦与阿德福韦酯治疗HBeAg阳性的核苷类初治的慢性乙型肝炎患者的随机对照临床研究论文。采用检验分析研究间的异质性,以相对危险度为疗效分析统计量进行合并分析并绘制森林图。疗效判定指标包括血清HBVDNA检测不到(阴转)、血清ALT复常和血清HBeAg转阴。结果共检索到212篇文献,经筛选最终纳入1篇英文文献和3篇中文文献。分析结果显示,恩替卡韦治疗12周患者血清HBVDNA阴转率(P=0.0002,RR=1.74)、ALT复常率(P=0.04,RR=1.34)显著高于阿德福韦酯治疗组;恩替卡韦治疗24周患者血清HBVDNA阴转率(P=0.20)、血清HBeAg转阴率(P=0.27)与阿德福韦酯组无统计学差异。结论恩替卡韦的起效较快,但在治疗24周时,两药的抗病毒效果已无显著性差异。     

阿德福韦酯治疗HBeAg阳性慢性乙型肝炎101例临床观察

目的观察阿德福韦酯治疗HBeAg阳性慢性乙型肝炎和拉米夫定治疗无效的慢性乙型肝炎患者,单药连续144周治疗,停药后监测96周疗效和药物安全性。方法初始治疗69例,拉米夫定治疗无效再治疗32例共101例,采用单药阿德福韦酯(ADV)10mg,每日1次口服,连续治疗144周,疗程结束继续监测到240周。结果阿德福韦酯初治组和复治组经144周连续治疗和停药后监测至240周血清ALT累积复常率分别为91.3%和90.6%,血清HBV DNA转阴率分别为88.4%和84.3%,HBeAg转阴率分别为34.7%和28.1%,HBeAg/HB-eAb血清转换率分别为55.0%和53.1%,HBsAg/HBsAb血清学转换均在停药后不同时间段发生,初治组为7.2%,复治组为6.3%。经144周连续治疗和停药后随访期间血、尿常规和肾功能,均无与治疗相关的异常发现。结论阿德福韦酯单药10mg每日1次口服治疗HBeAg阳性慢性乙型肝炎患者,有显著抑制HBV DNA复制,对拉米夫定治疗无效患者,可获得同样疗效,长期服药无明显耐药性,安全性好。