用套式多聚酶链反应技术监测乙型肝炎病毒的母婴垂直传播

用套式多聚酶链反应（Ｎｅｓｔｅｄ－ＰＣＲ）技术对１６９对ＨＢｓＡｇ及ＨＢｓＡｇ／ＨＢｅＡｇ阳性孕妇及其新生儿外周血清进行了ＨＢＶ－ＤＮＡ检测。１０３对ＨＢｓＡｇ阳性孕妇及其新生儿外周血清中ＨＢＶ－ＤＮＡ阳性率分别为７２．８％和３３．０％;６６对ＨＢｓＡｇ和ＨＢｅＡｇ双阳性的孕妇及其新生儿外周血清中ＨＢＶ－ＤＮＡ阳性率分别为８６．４％和４３．９％。对５５例ＨＢｓＡｇ及ＨＢｓＡｇ／ＨＢｅＡｇ阳性产妇产后的初乳进行了ＨＢＶ－ＤＮＡ检测,结果ＨＢＶ－ＤＮＡ阳性率为３６．４％。结果表明ＨＢｓＡｇ和ＨＢｅＡｇ双阳性的孕妇及其新生儿外周血清ＨＢＶ－ＤＮＡ检出率较ＨＢｓＡｇ单阳性的孕妇及其新生儿要高,其初乳中ＨＢＶ－ＤＮＡ的检出率也高。还对１０５例注射了乙肝疫苗及高价乙肝特异性免疫球蛋白的６月龄婴儿的外周血清进行了ＨＢＶ－ＤＮＡ检测,结果有２３例阳性。     

乙型肝炎病人重叠感染丙型肝炎的评价

应用ＥＬＩＳＡ和ＰＣＲ法检测５０２例乙肝病人血清,４０１例ＨＢｓＡｇ阳性血清中,有１１４例（２８．４％）抗－ＨＣＶ和ＨＣＶＲＮＡ双项阳性,２５例（６．２％）ＨＣＶＲＮＡ单项阳性;２１例（５．２％）抗－ＨＣＶ单项阳性。将ＨＢｓＡｇ乙肝病人分成ＨＢＶＤＮＡ,ＨＢｅＡｇ阳性组和ＨＢＶＤＮＡ,ＨＢｅＡｇ阴性组。前者抗－ＨＣＶ阳性率为１１．６％～２０．５％,ＨＣＶＲＮＡ阳性率为１６．２％～２０．５％。后者抗－ＨＣＶ阳性率为２０．２％～５５．６％,ＨＣＶＲＮＡ阳性率为２３％～６０．３％。结果说明长期携带ＨＢＶ者和慢性乙肝病人均可重叠ＨＣＶ感染。ＨＢＶＤＮＡ阳性组抗－ＨＣＶ和ＨＣＶＲＮＡ阳性率明显高于ＨＢＶＤＮＡ阳性组     

HBsAg携带者重叠感染HCV、HDV的血清学调查

对３６２名无症状高滴度ＨＢｓＡｇ携带者用ＲＩＡ法检测ＨＢｅＡｇ、Ａｎｔｉ－ＨＢｅ、Ａｎｔｉ－ＨＣＶ、Ａｎｔｉ－ＨＤＶ。结果表明,ＨＢｅＡｇ阳性率随ＨＢｓＡｇ滴度的增高而增加,且有显著性差异（Ｐ＜０．０５）。重叠感染以ＨＢＶ＋ＨＣＶ最高,占２７．６％;其次是ＨＢＶ＋ＨＤＶ,占９．１％;ＨＢＶ＋ＨＣＶ＋ＨＤＶ最少,占６．４％。但是,以上重叠感染率均与ＨＢｓＡｇ滴度及／或ＨＢｅＡｇ阳性率高低无关（Ｐ＞０．０５）。调查显示,无症状ＨＢｓＡｇ携带者中ＨＢＶ＋ＨＣＶ,或ＨＢＶ＋ＨＤＶ,或ＨＢＶ＋ＨＣＶ＋ＨＤＶ的重叠感染均可发生。     

用套多聚酶链反应技术监测乙型肝炎病毒的母婴垂直传播

用套式多聚酶链反应（Ｎｅｓｔｅｄ－ＰＣＲ）技术对１６９对ＨＢｓＡｇ及ＨＢｓＡｇ／ＨＢｅＡｇ阳性孕妇及其新生儿外周血清进行了ＨＢＶ－ＤＮＡ检测,１０３对ＨＢｓＡｇ阳性孕妇及其新生儿外周务中ＨＢＶ－ＤＮＡ阳性率分别为７２．８％和３３．０％;６６对ＨＢｓＡｇ和ＨＢｅＡｇ双阳性的孕妇及其新生儿外周血清中ＨＢＶ－ＤＮＡ阳性率分别为８６．４％和４３．９％,对５５例ＨＢｓＡｇ及ＨＢｓＡｇ／ＨＢｅＡｇ阳性产妇产后     

反义寡聚硫代磷酸脱氧核苷抑制体外细胞培养系统中乙肝抗原表达的研究

设计合成了两个分别互补于乙肝病毒２．１ｋｂ ｍＲＮＡ起始区（片段Ａ）和增强子区（片段Ｂ）的硫代磷酸的ＤＮＡ片段,在经克隆ＨＢＶ ＤＮＡ转染ＨｅｐＧ２细胞建立的ＨＢＶ短暂表达系统及稳定产生ＨＢＶ的２２１５细胞中研究二者对ＨＢｓＡｇ及ＨＢｅＡｇ表达的抑制作用。结果表明反义寡聚物能不同程序抑制乙肝抗原表达,并与剂量呈一定正相关。在ＨｅｐＧ２细胞ＨＢＶ短暂表达系统中,６μｍｏｌ／Ｌ浓度时,片段Ａ、Ｂ对ＨＢ     

恩拉霉素抗乙型肝炎病毒的体外实验研究

以ＨｅｐＧ２．２．２．１５细胞株为模型,以其分泌的ＨＢｓＡｇ、ＨＢｅＡｇ、ＨＢＶＤＮＡ及细胞存活率为观察指标,综合评价天然多肽类抗生素恩拉霉素体外抗ＨＢＶ效果。结果表明恩拉霉素对ＨＢｓＡｇ和ＨＢｅＡｇ的５０％抑制浓度ＩＣ５０分别为２７μｇ／ｍＬ和３４μｇ／ｍＬ,治疗指数（ＴＩ）分别为５．９和４．６。Ｓｏｕｔｈｅｒｎ结果显示,５０μｇ／ｍＬ恩拉霉素对细胞内游离ＨＢＶＤＮＡ抑制率为５６．８％。     

两株乙型肝炎病毒基因组结构分析及其复制和抗原表达特性的比较

为从全基因组水平研究乙型肝炎病毒（ＨＢＶ）的核苷酸结构及复制和抗原表达特性,分别从２例ＨＢｓＡｇ和ＨＢｅＡｇ阳性、ＨＢＶ ＤＮＡ滴度为１０＾１４和１０＾１３拷贝／ｍｌ的慢性乙型肝炎患者（编号为５６和２－１８）血清中扩增、克隆了ＨＢＶ全基因组,并测定了核苷酸序列。两株病毒基因组转染ＨｅｐＧ２细胞的培养上清中ＨＢｓＡｇ水平基本相同,但＃５６毒株表达的ＨＢｅＡｇ约为＃２－１８株的３倍,Ｓｏｕｔｈｅｒｍ印     

不同DNA疫苗联合接种可有效增强免疫效果

造反乙型肝炎（乙肝）病毒核心抗原（ＨＢｃＡｇＡ）、ｅ抗原（ＨＢｅＡｇ）及单纯疱疹病毒ｇＤ抗原（ＨＳＶ－１－ｇＤ）基因为目的基因,进行ＤＮＡ疫苗联合免疫的研究。通过对不同基因片段的表达研究,选择了能在哺乳动物细胞中高效表达乙肝病毒核心抗原、ｅ抗原和单纯疱疹病毒ｇＤ抗原的质粒ＤＮＡ免疫Ｂａｌｂ／ｃ小鼠。结果显示：表达乙肝病毒核心抗原和单纯疱毒ｇＤ抗原的ＤＨＡ疫苗单独免疫,能有效刺激机体产生体液免疫和细     

喹诺酮类药物抗乙型肝炎病毒体外实验研究

本文以２．２．１５细胞株为模型,以ＨＢｓＡｇ、ＨＢｅＡｇ、ＨＢＶＤＮＡ、细胞存活率为观察指标,综合评价了喹诺酮类药物吡哌酸（ＰｉｐｅｍｉｄｉｃＡｃｉｄ）、氟哌酸（Ｎｏｒｆｌｏｘａｃｉｎ）、环丙氟哌酸（Ｃｉｐｒｏｆｌｏｓｘａｃｉｎ）、氟嗪酸（Ｏｆｌｏｘａｃｉｎ）体外抗ＨＢＶ效果。结果表明：吡哌酸、氟哌酸、环丙氟哌酸、氟嗪酸对ＨＢｓＡｇ、ＨＢｅＡｇ５０％抑制浓度（ＩＤ＿（５０））分别为１１μｇ／ｍｌ、６４μｇ／ｍｌ、９３μｇ／ｍｌ、１０５μｇ／ｍｌ和１９９μｇ／ｍｌ、１１１μｇ／ｍｌ、２４μｇ／ｍｌ、２１７μｇ／ｍｌ,细胞存活率为５０％时的药物浓度（ＣＤ＿（５０））分别为２１９μｇ／ｍｌ、９０μｇ／ｍｌ、１８１μｇ／ｍｌ、１６９μｇ／ｍｌ,在所选定的用药浓度范围内不同程度抑制培养上清液及细胞内ＨＢＶＤＮＡ及其复制中间体的产生。尤其对超螺旋结构ＤＮＡ（ｓｃＤＮＡ）有不完全抑制作用。     

HRP-HBVDNA探针在临检应用中的研究

本文介绍了一种简便的检测血清ＨＢＶＤＮＡ的方法。参照Ｒｅｎｚ等人的标记方法,构建了直接酶标ＨＲＰ ＨＢＶＤＮＡ探针。此探针经与固定在硝酸纤维素滤膜上的血清靶ＤＮＡ杂交后,可通过化学发光自显影检测技术观察结果。敏感度可检测０－１ｐｇ靶ＤＮＡ,相当于同位素探针的灵敏度。对６３份ＨＢｓＡｇＨＢｅＡｇ和Ａｎｔｉ ＨＢｃＥＬＩＳＡ阳性血清以及２４份ＨＢｓＡｇＡｎｔｉ ＨＢｃ阳性,ＨｂｅＡｇ阴性血清用ＨＲＰ ＨＢＶＤＮＡ探针进行检测,结果探针ＨＢＶＤＮＡ阳性率分别为１００％（６３）和５８％（１４）;对５０份ＨＢｓＡｇ,ＥＬＩＳＡ阴性和ＡＬＴ正常的血清,探针ＨＢＶＤＮＡ全部阴性。实验结果表明本方法具有很大的推广应用价值。     

Immunocytochemical investigation of hepatitis B virus-associated antigens in cases of liver cirrhosis and HBsAg antigenemia and their relationship to development of hepatocellular carcinoma

Summary Using light and ultrastructural immunoperoxidase techniques, we examined the distribution of hepatitis B virus (HBV)-associated antigens and the subcellular localization of hepatitis B surface antigen (HBsAg) in liver biopsies of HBsAg—positive patients with cirrhosis. The localization patterns of HBsAg in hepatocytes were membranous, cytoplasmic, festoon and inclusion body types. Cytoplasmic and festoon types were seen more often than the membranous type in pseudolobules, and hepatitis B core antigen (HBcAg)—positive cells with cytoplasmic type were distributed in the periphery of pseudolobules with active inflammation. Immunoelectron microscopy in the cytoplasmic or festoon type of HBsAg showed immunoreaction in the cisternae and on virus-like particles in the cisternae in patients with hepatitis B e antigen (HBeAg) antigenemia. Simultaneous staining of HBsAg and HBcAg revealed that hepatocytes with cytoplasmic or festoon type of HBsAg contained HBcAg—immunoreactivity. The inclusion body type of HBsAg was characteristic of liver cirrhosis with hepatocellular carcinoma (HCC); the subcellular localization of HBsAg was seen in clusters of the endoplasmic reticulum around the nucleus, and HBsAg—immunoreactivity was observed on many virus-like particles in most of the cisternae in those with HBeAg antigenemia. These findings suggest that the synthesis of HBsAg is active in patients with liver cirrhosis and that the formation of HBV is also active in those with HBeAg antigenemia and that HBV may be retained more in cirrhotic livers with hepatocellular carcinoma after proliferation than in those without it.     

肝硬化患者乙肝表面抗原的定量检测及意义

目的:探讨HBsAg定量测定在乙肝相关性肝硬化病程中的变化和意义。方法:选择乙肝相关性肝硬化患者60例纳入实验对象,根据2000年9月(西安)第10次全国病毒性肝炎学术会议修订的《病毒性肝炎防治方案》中的诊断标准分为代偿期组和失代偿期组,其中代偿期组35例,失代偿期组25例。另选取20例乙型肝炎病毒携带者作为对照组。应用电化学发光免疫分析法测定患者血清中HBsAg和HBeAg滴度,免疫荧光定量PCR法检测HBVDNA载量。结果:对照组、肝硬化代偿期组和肝硬化失代偿期组HBsAg滴度分别为:2574.73±3252.27COI、5494.35±2129.84COI和6921.25±1957.60COI,三组之间差别均有统计学意义(P<0.05)。肝硬化代偿期组中,HBsAg滴度与HBVDNA、HBeAg水平呈负相关性(P<0.05()r=-0.350;r=-0.514)。肝硬化失代偿期组中,HBsAg滴度与HBVDNA及HBeAg水平均无明显相关性(r=-0.020;r=0.154)。结论:肝硬化失代偿期HBsAg滴度明显高于肝硬化代偿期,代偿期HBsAg滴度高于HBV携带者组,即HBsAg滴度随肝脏疾病进展呈阶梯型递增。肝硬化代偿期,HBsAg滴度与HBVDNA、HBeAg水平呈负相关性,HBsAg水平可以作为评估病毒复制的参考指标。肝硬化失代偿期,HBsAg滴度与HBVDNA和HBeAg无相关性,不能反映病毒复制水平,不能作为评估病毒复制的参考指标。     

肝硬化患者乙肝表面抗原的定量检测及意义

目的：探讨HBsAg定量测定在乙肝相关性肝硬化病程中的变化和意义。方法：选择乙肝相关性肝硬化患者60例纳入实验对象,根据2000年9月（西安）第10次全国病毒性肝炎学术会议修订的《病毒性肝炎防治方案》中的诊断标准分为代偿期组和失代偿期组,其中代偿期组35例,失代偿期组25例。另选取20例乙型肝炎病毒携带者作为对照组。应用电化学发光免疫分析法测定患者血清中HBsAg和HBeAg滴度,免疫荧光定量PCR法检测HBVDNA载量。结果：对照组、肝硬化代偿期组和肝硬化失代偿期组HBsAg滴度分别为：2574.73±3252.27COI、5494.35±2129.84COI和6921.25±1957.60COI,三组之间差别均有统计学意义（P〈0.05）。肝硬化代偿期组中,HBsAg滴度与HBVDNA、HBeAg水平呈负相关性（P〈0.05（）r=-0.350;r=-0.514）。肝硬化失代偿期组中,HBsAg滴度与HBVDNA及HBeAg水平均无明显相关性（r=-0.020;r=0.154）。结论：肝硬化失代偿期HBsAg滴度明显高于肝硬化代偿期,代偿期HBsAg滴度高于HBV携带者组,即HBsAg滴度随肝脏疾病进展呈阶梯型递增。肝硬化代偿期,HBsAg滴度与HBVDNA、HBeAg水平呈负相关性,HBsAg水平可以作为评估病毒复制的参考指标。肝硬化失代偿期,HBsAg滴度与HBVDNA和HBeAg无相关性,不能反映病毒复制水平,不能作为评估病毒复制的参考指标。     

Enhanced HBsAg Synthesis Correlates with Increased Severity of Fibrosis in Chronic Hepatitis B Patients

Background and Aims

Little is known about whether low serum HBsAg levels result from impaired HBsAg synthesis or a reduced number of hepatocytes caused by advanced liver fibrosis. Therefore, we investigated the capacity for HBsAg synthesis in a cross-sectional cohort of treatment-naïve chronic hepatitis B patients.

Methods

Chronic hepatitis B patients (n = 362) were enrolled; liver biopsies were performed and liver histology was scored, and serum HBsAg and HBV DNA levels were investigated. In the enrolled patients, 183 out of 362 have quantitative serum HBsAg levels. Tissue HBsAg was determined by immunohistochemistry.

Results

A positive correlation between serum HBsAg and HBV DNA levels was revealed in HBeAg(+) patients (r = 0.2613, p = 0.0050). In HBeAg(+) patients, serum HBsAg and severity of fibrosis were inversely correlated (p = 0.0094), whereas tissue HBsAg levels correlated positively with the stage of fibrosis (p = 0.0280). After applying the mean aminopyrine breath test as a correction factor, adjusted serum HBsAg showed a strong positive correlation with fibrosis severity in HBeAg(+) patients (r = 0.5655, p<0.0001). The adjusted serum HBsAg values predicted ‘moderate to severe’ fibrosis with nearly perfect performance in both HBeAg(+) patients (area under the curve: 0.994, 95% CI: 0.983–1.000) and HBeAg(−) patients (area under the curve: 1.000, 95% CI: 1.000–1.000).

Conclusions

Although serum HBsAg levels were negatively correlated with fibrosis severity in HBeAg(+) patients, aminopyrine breath test-adjusted serum HBsAg and tissue HBsAg, two indices that are unaffected by the number of residual hepatocytes, were positively correlated with fibrosis severity. Furthermore, adjusted serum HBsAg has an accurate prediction capability.     

Clinical and Virological Characteristics of Chronic Hepatitis B Patients with Coexistence of HBsAg and Anti-HBs

Coexistence of hepatitis B surface antigen (HBsAg) and antibody against HBsAg (anti-HBs) comprises an atypical serological profile in patients with chronic hepatitis B virus (HBV) infection. In this study, in total 94 patients with coexisting HBsAg and anti-HBs and 94 age- and sex-matched patients with positive HBsAg were characterized by quantitatively measuring HBsAg and HBV DNA, sequencing large S genes, and observing clinical features. Compared with common hepatitis B patients, the patients with coexisting HBsAg and anti-HBs had lower HBsAg and HBV DNA levels. These two groups had similar rate of pre-S deletion mutations. However, in patients with coexisting HBsAg and anti-HBs, more amino acid substitutions in the a determinant of S gene were observed in HBV genotype C, but not in genotype B. Fourteen patients with coexisting HBsAg and anti-HBs were followed up for an average of 15.5 months. There were no significant changes in the levels of HBsAg, anti-HBs, HBV DNA and ALT over the follow-up period. Compared with the baseline sequences, amino acid substitutions in the MHR of HBsAg occurred in 14.3% (2/14) patients. In conclusion, coexistence of HBsAg and anti-HBs may be associated with higher frequency of mutations in the a determinant of HBV genotype C.     

乙型肝炎IgA类HBsAg循环免疫复合物的检测及意义

本文报道用捕捉法ELISA检测各型乙肝IgA型HBsAg循环免疫复合物。结果表明,慢性乙肝IgA型HBsAg循环免疫复合物检出率显著高于急性乙肝;在慢性乙肝中,IgA型HBsAg循环免疫复合物的出现与HBVe系统关系密切,主要存在于HBeAg阳性血清中,并与HBeAg滴度有关。故IgA型HBsAg循环免疫复合物可作为HBV慢性感染的血清诊断标志之一;也可作为反映HBV在增殖并有传播危险的标志之一。     

Monocytes from Chronic HBV Patients React In Vitro to HBsAg and TLR by Producing Cytokines Irrespective of Stage of Disease

Individuals who are chronically infected with the hepatitis B virus (HBV) are highly heterogenous with respect to serum levels of HBV DNA, HBV particles and viral proteins. Since circulating leukocytes, such as monocytes, are constantly exposed to these viral components, it is likely that the functionality of these cells is affected. However, at present, little information is available on the consequences of the interaction between monocytes and viral components. Therefore, we examined the in vitro effects of HBV surface antigen (HBsAg) on monocytes and evaluated whether these effects were reflected in vivo. We observed that in vitro HBsAg exposure of monocytes induced robust production of IL-6 and TNF. However, between chronic HBV patients with distinct levels of serum HBsAg, HBV early antigen (HBeAg), and HBV DNA, TLR-induced monocyte cytokine production did not differ. Importantly, HBsAg-induced cytokine production by monocytes was similar between patients and healthy controls showing that earlier in vivo exposure to HBsAg does not affect the in vitro response. Additionally, we show that IL-10 is able to inhibit cytokine production by HBsAg-induced monocytes. In conclusion, we demonstrate that monocytes can recognize and respond to HBsAg, resulting in vigorous pro-inflammatory cytokine production in vitro. However, phenotype and function of the monocyte compartment in chronic HBV patients are not influenced by differences in levels of serum viral components, suggesting that regulatory mechanisms are active to avoid excessive in vivo monocyte activation.