慢性乙肝重叠戊肝病毒感染临床分析及病毒间干扰

目的;探索慢性乙肝重叠戊肝病毒感染后其临床表现、肝功能及对ＨＢＶ的影响。方法：对３０例慢性乙肝重叠戊型肝炎病毒感染后对临床表现、肝功能以及ＨＢＶ复制指标（ＨＢｅＡｇ,ＨＢＶ－ＤＮＡ）与单纯乙肝和戊肝病人进行对比观察。结果：发现慢性乙肝重叠戊型肝炎病毒感染后其临床类型偏中,重型多,与单纯慢性乙肝,戊肝血清总胆红素,ＡＬＴ、ＡＳＴ比较明显增高,与单纯乙肝比较,ＨＢｅＡｇ和ＨＢＶ－ＤＮＡ阳性率显著降低,     

乙型肝炎患者血清丁型肝炎病毒标志的研究

目的 研究ＨＤＶ重叠ＨＢＶ感染对乙型肝炎患者病情和血清学指标的影响。方法 采用ＥＬＩＳＡ法检测ＨＤＶ血清标志ＨＤＡｇ、抗ＨＤ、抗ＨＤＩｇＭ和ＨＢＶ血清标志ＨＢｓＡｇ、抗ＨＢｓ、ＨＢｅＡｇ、抗ＨＢｃ、抗ＨＢｃｌｇＭ,ＰＣＲ法检测ＨＢＶＤＮＡ。结果 ３１６例乙型病毒性肝炎中６０例重叠ＨＤＶ感染,重叠感染率为１８．９８％;ＣＨ和ＦＨ组ＨＤＶ感染率显著高于ＡＨ,ＦＨ组ＨＤＶ复制指标阳性率显著高于ＣＨ及ＡＨ     

特殊人群血清抗-HCV检测及甲、乙、丙型肝炎重复感染分析

目的 阐明特殊人群甲、乙、丙型肝炎病毒重复感染状况。 方法 采用ELISA法对4587例血清进行抗-HAV-IgM,HBsAg,抗-HBs,HBeAg,抗-HBe,抗-HBc,抗-HBcIgM及抗-HCV病毒标记检测。 结果 抗-HCV总阳性率为22.5％。献血员为23.1％,PTH为58.3％,AVH为4.7％,CPH为8.9％,CAH15.3％,SHF59.5％,CHF57.1％,LC22.9％和HCC31.8％;反复接受输血的血液病、尿毒症和血液透析患者阳性率分别为46.4％,23.8％和35.3％;性病为10.7％。668例肝病中HC重复感染HB阳性率为12.9％,且随肝损害程度而增高。 结论 HCV重复感染HBV,会加重肝损害,促使病情加剧。输血、使用血制品和血液透析术,是感染HCV的主要途径。     

Acute exacerbation in patients with liver cirrhosis: a clinicopathological study

ABSTRACT— The incidence, clinicopathologic features and etiology of acute exacerbation occurring in patients with liver cirrhosis were assessed prospectively among 332 hepatitis B surface antigen (HBsAg) positive and 71 HBsAg negative patients. During an 11-year period and a mean follow-up duration of 26.8 months, 148 acute exacerbation occurred in 107 HBsAg positive patients and 32 episodes occurred in 18 HBsAg negative patients. The calculated annual incidence was 11.5%. The clinical, laboratory and histologic features were similar to those in patients with chronic hepatitis. Confluent hepatic necrosis and alphafetoprotein elevation over 100 ng/ml occurred frequently, particularly in HBeAg positive patients. In general, acute exacerbations in HBsAg negative patients were less severe than their HBsAg positive counterparts. Of the exacerbations in HBsAg positive patients, 54.8% of the HBeAg positive ones and 38.6% of the HBeAg negative ones were attributable to hepatitis B virus reactivation, while 4.8% and 7.9%, respectively, were due to hepatitis delta virus superinfection. The others might be the results of hepatitis non-A, non-B virus superinfection or increased piecemeal necrosis. The immediate outcome of acute exacerbations in cirrhotic patients was usually good, although 13.8% developed hepatic decompensation and 4.4% died. Further follow-up study is required to evaluate the long-term effect of the frequent occurrence of bridging hepatic necrosis, high elevation of alphafetoprotein and hepatic decompensation during acute exacerbation in cirrhotic patients.     

HBV、HCV、HBV和HCV重叠感染与HCC发生关系的研究

目的:探讨HBV、HCV、HBV和HCV重叠感染及复制与广西HCC发生的关系.方法:在肝癌高发区和低发区分别选择符合全国诊断标准的HCC病人78例作为病例A组(肝癌高发区组)、B组(肝癌低发区组),并分别选择相同乡镇、生活习惯、生活水平、年龄±5岁、同性别的原籍健康人群2组分别78人作为对照组C组(肝癌高发区正常人组)和D组(肝癌低发区正常人组),应用PCR法检测研究对象血清中的HBVDNA、HCVRNA,并对阳性率进行比较.结果:HBVDNA、HCVRNA、HBVDNA HCVRNA阳性率分别为:A组69.2%(54/78)、20.5%(16/78)、16.7%(13/78);B组52.6%(41/78)、6.4%(5/78)、5.1%(4/78);C组18.0%(14/78)、7.7%(6/78)、3.8%(3/78);D组10.3%(8/78)、2.6%(2/78)、1.3%(1/78);其中A组与C组,A组与B组组间的阳性率比较差异均有统计学意义(均P＜0.05),B组与D组中HBVDNA阳性率比较差异也有统计学意义(均P＜0.01).结论:HBV、HCV、HBV和HCV的重叠感染及复制与广西肝癌高发区的肝癌发生有密切关系,其中HBV的感染及复制在肝癌的发生中最为重要,高发区中HCV、HBV和HCV的重叠感染的致癌作用也是不容忽视的.     

住院肝炎患者病毒检测及重叠感染状况分析

目的了解上海地区以往肝炎患者的肝炎型别和重叠感染状况。方法采用ELISA法对从复旦大学公共卫生学院血清库中抽取的上海某区医院90年代初期肝炎患者的血清进行HAV IgM、HCV IgG、HEV IgM和HEV IgG的检测。结果在上海1143名肝炎患者中，HAV IgM、HBV、HCV IgG、HEV IgM和HEV IgG的阳性率分别为52．1％，53．6％，1．3％，17．8％和70．4％，有多重感染的患者数为746人，约占总病例数的65．4％，其中甲、乙、丙、戊型肝炎的重叠感染率分别为61．4％，69．3％，0．9和17．4％。结论肝炎患者的多重感染情况普遍存在。甲乙型重叠感染可能影响乙型肝炎病毒感染的复制，对健康的危害较为严重。     

Direct evidence for GB virus C/hepatitis G virus (GBV-C/HGV) superinfection: elimination of resident viral strain by donor strain in a patient undergoing liver transplantation

The viral genome of GB virus C/hepatitis G virus (GBV-C/HGV), a single-strand RNA virus, is subject to considerable variability and at least four genotypes have been suggested based on phylogenetic analysis. While co-infection of GBV-C/HGV with other infectious agents such as hepatitis C virus (HCV) has been frequently observed, there is no report whether or not co-infection and/or superinfection occurs among different GBV-C/HGV strains. By studying a GBV-C/HGV positive recipient/donor pair in the context of undergoing liver transplantation, we have sequenced multiple clones derived from serum samples serially collected over four years. Detailed phylogenetic analyses have been performed with these sequences. The donor was infected with GBV-C/HGV genotype 1 and this strain completely replaced recipient GBV-C/HGV strain (genotype 2) after liver transplantation. The recipient's original viral strain became undetectable during follow-up. Sequence analysis failed to identify genetic recombination between the two genotypes, at least in whole structural domain. This study, therefore, provides direct evidence for GBV-C/HGV superinfection of one strain by another with one of them predominating probably due to replication competition.     

反复呼吸道双重感染患儿的免疫学特征

目的研究柯萨奇B组病毒（CVB）及肺炎支原体（MP）双重感染对反复呼吸道感染（RRI）小儿免疫学特征的影响。方法选择RRI住院患儿132例。根据MP-IgM抗体及CVB特异性IgM抗体检测结果分为阴性对照组、MP感染组、CVB感染组及双重感染组。4组均测定ESR、CRP;采用酶联免疫吸附试验（ELISA）测定CVBIgM抗体;采用琼脂单向扩散法定量测定IgG、IgA、IgM;流式细胞仪检测外周血T细胞亚群。结果CVB感染主要见于1～3岁患儿,阳性率为32.1%;MP感染主要见于3岁以上患儿,阳性率为22.7%;双重感染10例,占患儿总数的7.6%。CVB及MP双重感染组IgG有升高趋势,IgA有下降趋势,双重感染组IgM较阴性对照组及MP感染组明显升高（Pa〈0.05）。各组T细胞亚群中CD3比例无明显差异;MP感染组及双重感染组CD4较阴性对照组明显降低（Pa〈0.05）;4组CD8无显著差异;CD4/CD8值双重感染组较阴性对照组明显下降（P〈0.05）。CVB感染组NK细胞较阴性对照组明显升高（P〈0.05）。结论CVB及MP感染均使RRI患儿体液及细胞免疫调节功能紊乱,双重感染使上述免疫失衡加重。     

庚型肝炎病毒感染与肝损伤的相关性

目的 探讨ＨＧＶ感染与肝损伤的关系。方法 检测４４２例各类肝病患者的甲￣戊和庚型肝炎病毒血清学标志,其中１５４例为ＨＧＶ和ＨＢＶ感染者,对单独ＨＧＶ感染、ＨＧＶ和ＨＢＶ重叠感主单独 者的临床资料进行对比分析。结果 ２１单独ＨＧＶ感染者中有９例（４２．８６％）肝功能轻度异常。单独ＨＧＶ感染与ＨＧＶ和ＨＢＶ重叠感染比较,肝功能异常程度无显著性差异;而重叠感民单独ＨＢＶ感染比较,肝功能异常率和重型肝炎发