丙型肝炎病毒流行现状

近年来,我国丙型肝炎病毒（HCV）感染目益多见,新报告病例不断增加。HCV经典的传播途径为经血液或血液制品传播,但仍有部分HCV感染者传播途径未明。多数HCV感染者呈慢性携带状态,临床症状轻微,常进展为肝硬化和肝细胞癌,对患者的健康危害极大。HCV已成为严重的社会公共卫生问题。文章对HCV从病原体、全球流行状况、感染的高危人群等方面进行综述。     

聚乙二醇化干扰素治疗乙型肝炎病毒e抗原阳性慢性乙型肝炎患者乙型肝炎病毒表面抗原消失的相关因素

目的 探讨聚乙二醇化干扰素（PEG-IFN α-2a）治疗HBeAg阳性慢性乙型肝炎(CHB)患者过程中预测HBsAg消失的相关因素。方法 对72例HBeAg阳性CHB患者,应用PEG-IFN α-2a 180 μg,每周1次,共48周。每3个月检测ALT、AST及HBV DNA、HBeAg和H BsAg定量,对48周治疗结束时HBsAg消失与基线、12周、24周的HBV DNA、HBeAg和HBsAg定量的相关关系进行分析。计数资料行Fisher精确检验及受试者工作特征(ROC)曲线分析。结果65例HBeAg阳性CHB患者完成本研究,其中7例HBsAg消失。48周时HBsAg的消失与治疗12周时H BeAg水平有关（Fisher确切概率法,P=0.023）,与治疗24周时HBeAg水平高度相关 （Fisher确切概率法,P=0.004）,与12周或24周时HBsAg＜250 IU/mL相关(Fisher确切概率法,P=0.001,P=0.002)。与12周时HBV DNA阴转相关（Fisher确切概率法,P=0.039）,而与24周时HBV DNA是否阴转无关（Fisher确切概率法,P= 0.130）。经ROC曲线分析显示,12周、24周HBsAg及24周HBeAg曲线下面积(AUC)分别为0.8584(P=0.0021)、0.9606(P=0.001)及0.8350(P=0.040)。结论 联合应用24周HBeAg和HBsAg定量水平可能是预测48周疗程结束时是否发生HBsAg消失的有效指标。     

莆田市某村庄丙型肝炎高发流行病学调查

目的了解本地丙型肝炎高发村庄人群感染情况。方法选择HCV感染率较高的一个自然村作为调查点,2岁以上人群为主要调查对象,填表并采集血样3～5ml,分离血清置-80℃冰箱中备用,采用ELISA方法初筛抗-HCV,初筛阳性者用Abbott试剂复查,复查阳性者定为感染者;以莆田市中心血站2004～2006年义务献血者抗-HCV筛查阳性率作为对照。部分标本进行HCV基因型测定。结果该自然村2岁以上现居住人口1106人,抽样调查1050人,抽样率94.94%;抽样年龄2～86岁,平均（32.8±19.4）岁,中位年龄33岁。抗-HCV阳性者303例,阳性率28.86%;其中男性117例,阳性率25.27%,女性186例,阳性率31.69%,男女阳性率有显著统计学意差异（χ2=5.191,P＆lt;0.05）。抗-HCV阳性者平均年龄（47.6±14.5）岁,与阴性患者间有显著统计学差异（t=18.01,P＆lt;0.001）。抗-HCV阳性率随年龄增长而增加,有明显家庭聚集现象。＆lt;10岁者抗-HCV阳性率为0.91%,≥10岁者为2.85%,≥20岁者为9.78%,≥30岁者为33.91%,≥40岁者为53.69%,≥50岁者为55．24％,≥60岁者为58．46％,≥70岁者为66．67％,≥80岁者为45．45％。而莆田市2004～2006年义务献血者中抗一HCV阳性率仅0．22％。108例行HCV基因分型,其中1b型96例,2a型12例。结论福建省莆田市部分沿海自然村一般人群存在较高的HCV感染率,以基因1b型为主;抗一HCV阳性率随年龄增长而增加,有明显家庭聚集现象;感染与职业献血、输血、输血制品、静脉滥用药物的关系并不明显,高感染原因有待进一步调查。     

乙型肝炎病毒基因型、基础核心启动子和C区变异与干扰素疗效的观察

目的 探讨HBV基因型、基础核心启动子(BCP)和C区变异与IFNα抗病毒疗效的相关性.方法 选择IFNα-1b治疗6个月的HBeAg阳性慢性乙型肝炎(CHB)患者,随访6个月.应用限制性片段长度多态性(RFLP)法检测HBV基因型,PCR测定BCP、前C/C区核苷酸序列.计量资料采用t检验、方差分析,计数资料采用卡方检验、Fisher确切概率法,并进行多因素条件Logistic回归分析.结果 共39例CHB患者完成观察,治疗结束时,应答16例,占41.0%;随访结束时,应答者中持续应答12例,占30.8%,复发4例,占10.3%.其中B基因型29例,占74.4%,C基因型10例,占25.6%.基因型型别差异与IFNα-1b疗效无关.8例患者BCP区T1762/A1764双变异,占20.5%,与IFNα-1b疗效无相关.8例患者检出A1896变异,占20.5%,随访结束时获得疗效的3例A1896变异株感染者均复发.C区非淋巴细胞表位测序发现,15例患者L60V变异,占38.5%,14例为I97L变异,占35.9%.与60V比较,表现为60L的患者在随访结束时的HBeAg血清学转换率和HBV DNA阴转率明显低(Fisher确切概率法,P=0.0126、0.0069).与97L比较,表现为97I的患者在治疗结束时和随访结束时的HBV DNA阴转率明显低(Fisher确切概率法,P=0.0484、0.0024).Logistic回归分析显示,基因型、C区变异与IFNα-1b疗效无相关.结论 HBV基因型、BCP双变异与IFNα的疗效无关,C区非淋巴细胞表位L60V及I97L变异可能有利于IFNα的治疗.

Abstract：

Objective To investigate the association between hepatitis B virus (HBV)genotype, the mutations in HBV basic core gene promoter(BCP), pre C/C gene region and treatment response to interferon (IFN)α-1b. Methods Hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB) patients were treated with IFNα-Ib for 6 months and were followed up for 6 months after the end of treatment. Restriction Fragment Length Polymorphism (RFLP) was used for determining HBV genotype. HBV DNA was amplified by polymerase chain reaction (PCR) and analyzed for BCP and pre C/C gene region by sequencing. Measurement data were compared using t test and analysis of variance. Enumeration data were compared using chi-square test, Fisher exact probability test.Logistic regression analysis was utilized for multi-factor analysis. Results There were 39 patients who completed the treatment and follow up in this study. At the end of treatment, 16(41.0%) patients showed response to the IFNα-lb treatment. At the end of follow-up, four out of 16 patients who achieved on treatment response relapsed. Among 3a patients, 29 (74.4 %) were infected with genotype B and 10 (25. 6%) with genotype C. The treatment response rates were not significant different between the groups with different genotypes. The double mutation pattern (T1762/A1764) was found in eight (20. 5%) patients. The response rates to IFNα-lb treatment were not significant different between the group with and without double mutation pattern. A1896 mutation was detected in eight patients at baseline. Three of them became HBeAg negative at the end of treatment and returned to HBeAg positive during follow-up. The non-lyphocyte epitope mutations, L60V and I97L, were found in 15 patients (38. 5%) and 14 patients (35.9%), respectively. At the end of follow-up, the patients with 60V had a significantly lower HBeAg seroconversion rate and HBV DNA undetectable rate compared to the patients with 60L (Fisher exact probability test; P = 0.0126 and 0.0069,respectively). The HBV DNA undetectable rates in the patients with 97I were significantly lower than those in patients with 97L both at the end of treatment and the end of follow-up (Fisher exact probability test; P= 0.0484 and 0. 0024, respectively). Logistic regression analysis results showed that there was no association between the above viral mutations and the treatment response to IFNαlb. Conclusions There is no association between HBV genotype, BCP double mutation pattern and IFN-α treatment response. The non-lyphocyte epitope mutations, L60V and I97L, may have impact on IFN-α treatment response.     

用内窥镜治疗儿童误吞多枚磁铁异物的应用

目的:探讨内窥镜在胃肠道多枚磁铁异物的应用。方法:收集2015年1月至2020年1月在福建省妇幼保健院接受诊治的9例误食多枚磁铁异物患儿的临床资料。其中,男3例,女6例;年龄范围为1~4岁,发病时间为2 h至2周;主述症状以无症状为主,其次为腹痛、呕吐和发热;磁铁异物数量范围为4~25枚。手术治疗方法包括：开腹肠切除吻...     

简易重症手足口病评分标准研究

目的 探讨简易重症手足口病评分标准,为临床医师早期评估病情提供依据.方法 选择福建省妇幼保健院2009年危重症手足口病例,并选择部分轻症病例作为对照.参照相关资料制定简易重症手足口病评分标准并对病例进行评分.用ROC曲线对评分标准的诊断价值进行评价.结果 重症病例评分≤80分有14例(87.5％),轻症病例评分＞80分有117例(69.7％).重症病例的ROC曲线下面积为0.885.以≤80分定义为重症,其敏感性为0.875,特异性为0.697,约登指数为0.572.结论 简易重症手足口病评分标准可早期量化评估病情严重程度,为手足口病分级诊治提供依据.     

e抗原定量对聚乙二醇干扰素治疗HBeAg阳性慢性乙型肝炎e抗原血清学转换的预测

目的 评估聚乙二醇化干扰素α-2a( PEG-IFNα-2a)治疗HBeAg阳性慢性乙型肝炎患者过程中,HBeAg定量预测HBeAg血清转换的价值.方法 HBeAg阳性慢性乙型肝炎(CHB)患者,采用PEG-IFNα-2a每次180 μg,皮下注射,每周1次,治疗48周.用HBV血清学检测试剂和i2000免疫发光检测系统检测HBeAg、抗-HBe,实时荧光定量PCR检测HBV-DNA载量.分析治疗12周、24周及48周的病毒学应答率(HBV-DNA<1.0×103拷贝/mL),HBeAg血清转换率及影响HBeAg血清转换的因素.受试者工作特征(ROC)曲线用于比较HBeAg和HBV-DNA水平作为HBeAg血清转换预测指标的相对敏感性和特异性.结果 65例完成48周疗程的HBeAg阳性CHB患者,19例(29.23%) 出现HBeAg阴转、17例(26.15%)出现HBeAg的血清转换.48周时HBeAg血清转换与基线HBeAg定量相关(P=0.003),与基线时的年龄、性别、ALT水平及HBV-DNA载量无关.依据基线、12周和24周的HBeAg定量获得的ROC曲线,以12周时 HBeAg 61 s/co为界值(AUC=0.705,P=0.042),其48周时HBeAg血清转换的阳性预测值(PPV)、阴性预测值(NPV)分别为0.361、0.862,敏感性与特异性分别为0.765 和 0.521;若以24周时 HBeAg 15 s/co为界值(AUC=0.828,P=0.001),其48周时HBeAg血清转换的阳性预测值(PPV)、阴性预测值(NPV)分别为0.452、0.912,敏感性与特异性分别为0.824 和0.646.与基线比较,12周和24周HBeAg下降的幅度(75%)与HBeAg血清转换相关;治疗过程中HBV-DNA变化与HBeAg血清转换无关.结论 HBeAg定量变化是聚乙二醇化干扰素α-2a治疗CHB过程中预测HBeAg血清转换的有价值的指标.