乙型肝炎病毒受体研究进展

乙型肝炎(乙肝)病毒(hepatitis B virus,HBV)是嗜肝DNA病毒科的原型病毒.目前,对HBV的基因组成、复制过程、抗原结构及生物学特性等已有相当程度的了解[1].但由于缺乏合适的感染系统,对HBV感染的早期过程,如病毒如何结合靶细胞上的受体最终进入细胞等,仍不很清楚.     

乙型肝炎病毒核心蛋白变构调节剂的研究进展

由于乙型肝炎病毒(hepatitis B virus,HBV)的共价闭合环状DNA的持续存在和病毒介导的宿主免疫反应钝化,导致慢性乙型肝炎病毒感染很难治愈。现有的核苷(酸)类似物或聚乙二醇干扰素疗法难以实现高比率的HBV表面抗原清除。目前正在研发的核心蛋白变构调节剂有望大幅度降低血清表面抗原。本文就HBV核心蛋白的结构、功能以及核心蛋白变构调节剂的分类、应用前景等方面进行综述。     

乙型肝炎病毒e抗原定量检测的性能验证和临床应用探索

乙型肝炎病毒e抗原(hepatitis B e antigen, HBeAg)的定量检测对乙型肝炎临床诊疗具有一定的重要性,但其定量检测还未成为常规检验项目。本研究对HBeAg定量检测系统进行性能验证,比较HBeAg定量和定性检测的相关性和一致性,分析HBeAg定量结果和乙型肝炎病毒DNA(hepatitis B virus DNA, HBV DNA)的关系,为HBeAg定量检测在临床诊疗的应用提供依据。通过收集710例2019年3月至5月于复旦大学附属华山医院就诊的慢性乙型肝炎患者血清样本,参照美国临床实验室标准化协会(The Clinical & Laboratory Standards Institute, CLSI)相关文件的要求,对雅培ARCHITECTi4000SR全自动免疫分析仪检测的HBeAg定量试剂的精密度、分析灵敏度、线性范围/可报告范围、携带污染率进行验证和评价;采用化学发光微粒子免疫检测技术(chemiluminescence microparticle immuno assay, CMIA)对618例患者进行HBeAg定性和定量检测;采用荧光定量PCR对慢性乙型肝炎患者进行HBV DNA检测,比较HBV DNA和HBeAg定量结果的相关性。本研究证实HBeAg定量试剂检测性能验证结果良好;HBeAg定量和定性检测相关性良好;126例同时有HBeAg定量检测和HBV DNA定量检测的结果显示,两种方法呈正相关且一致性良好。HBeAg定量检测可用于常规实验室检测来辅助HBV感染的临床诊疗。     

乙型肝炎病毒共价键闭环DNA的表观遗传调控研究进展

乙型肝炎病毒(hepatitis B virus,HBV)感染仍然是威胁全球人类生命与健康的重要危险因素。虽然目前的抗病毒治疗药物在控制乙型肝炎进展有显著疗效,但却始终无法达到根治HBV感染的目标。HBV共价闭合环状DNA(HBV cccDNA)是HBV转录复制的原始模板,也是HBV持续感染的关键因素。但由于缺少有效的完全清除HBV cccDNA的治疗方法,慢性乙型肝炎患者需长期服药以防治疗后停药复发。研究证实HBV cccDNA的转录受表观遗传机制调控,其中cccDNA甲基化、组蛋白修饰、miRNA、染色质重塑等均影响HBV cccDNA的功能。本文就HBV表观遗传调控的最新研究进展进行综述。     

联合检测血清及外周血单个核细胞HBV DNA的意义

乙型肝炎病毒(HBV)属于嗜肝DNA病毒,主要侵犯肝脏,因其对人类的危害重大而受到重视,慢性乙型肝炎(chromic hepatitis B,CHB)患者肝脏存在不同程度的炎症,有的甚至发展为肝硬化乃至肝癌。该研究对66例慢性乙肝患者联合检测血清及外周血单个核细胞中HBV DNA含量,以探讨其内在的相关性。     

两种抽提乙型肝炎病毒共价闭合环状DNA方法的效果比较

乙型肝炎病毒(hepatitis B virus,HBV)作为一种嗜肝DNA病毒,在感染肝细胞后会在细胞核中形成病毒转录复制的模板和基因储存库--共价闭合环状DNA(covalently closed circular DNA, cccDNA),其持续存在是乙型肝炎慢性化和难以治愈的核心,也是此研究领域内的重点。从细胞样品中稳定抽提获取cccDNA对于保证cccDNA检测的准确性至关重要。Hirt法是一种抽提真核细胞染色体外DNA的方法,被用于HBV cccDNA的抽提,但存在操作复杂和耗时长等问题。为简化操作,有研究对Hirt法进行改良,结合硅胶膜离心柱来抽提染色体外DNA,但尚不清楚该法用于HBV cccDNA抽提与传统Hirt法的效果差异。本研究基于HBV cccDNA细胞转染系统、HBV复制细胞系及感染系统,以DNA印迹(Southern blot)和定量聚合酶链式反应(quantitative polymerase chain reaction, qPCR)作为检测评价手段,平行比较了传统Hirt-酚/氯仿法与改良Hirt-过柱法抽提HBV cccDNA的效果。结果表明,两种方法具有相当的抽提效率和抽提特异性,而改良Hirt-过柱法耗时更短,提示在进行细胞HBV cccDNA抽提时可选择改良Hirt-过柱法以提高实验效率。     

土拨鼠肝炎病毒感染模型在乙型肝炎研究中的应用

乙型肝炎病毒(hepatitis B virus, HBV)是嗜肝DNA病毒的原型,HBV感染所致的乙型肝炎是严重危害我国人民身体健康的公共卫生问题。现有的抗乙肝药物包括核苷类似物和干扰素均难以达到临床治愈,研究新的抗乙肝药物、评价新的联合治疗策略均离不开合适的动物模型。土拨鼠肝炎病毒(woodchuck hepatitis virus, WHV)于1978年美国费城动物园患肝癌的土拨鼠中首次被发现,因其基因组结构、复制周期与HBV高度近似,被归类为嗜肝DNA病毒。WHV感染土拨鼠后的自然史与HBV感染人高度近似,因此土拨鼠模型很早就被用于乙肝DNA疫苗、抗HBV药物的评价。近年来土拨鼠多种细胞因子及其受体、免疫细胞表面标志先后被克隆和鉴定,T细胞应答的检测方法包括淋巴细胞增殖实验、CD107a脱颗粒实验逐步被建立,大大促进了土拨鼠模型在HBV发病机制及免疫调节治疗中的应用。本文主要综述了WHV感染土拨鼠模型的免疫学特征,以及该模型在抗乙肝病毒药物评价和免疫调节治疗中的应用。     

乙型肝炎病毒相关性肾炎发病机制研究进展

乙型肝炎病毒相关性肾炎(hepatitis B virus-associated glomerulonephritis,HBV-GN)的发病机制尚未完全清楚,主要包括:①免疫复合物沉积介导的肾损伤是公认的主要发病机制。②乙型肝炎病毒(hepatitis B virus,HBV)直接感染肾脏,可原位表达其HBV抗原(HBAg)及其他产物介导肾损伤。③HBV感染后可导致宿主免疫功能缺陷,病毒不能被清除,体内持续存在的病毒可造成肾脏损伤迁延进展。④HBV基因变异可导致病毒致病力改变,并影响机体清除病毒。⑤遗传因素相关研究表明存在HBV-GN的易感基因。     

microRNA在乙型肝炎病毒感染及相关疾病中的作用

乙型肝炎病毒(hepatitis B virus,HBV)是一种嗜肝性DNA病毒,感染后可导致急性和慢性肝炎,而慢性感染是导致肝硬化、肝癌和肝衰竭的主要病因。在乙型肝炎病毒复制、转录和相关疾病进程中,microRNA(miRNA)扮演着重要的角色。乙型肝炎病毒感染肝细胞后能引起细胞内microRNA表达谱的改变:一方面,microRNA能促进乙型肝炎病毒的转录和诱导宿主细胞向肿瘤细胞转化;另一方面,microRNA也能抑制乙型肝炎病毒包装和复制。重要的是,乙型肝炎病毒的感染能影响宿主血清microRNA的表达。因此,这类特殊的microRNA今后可成为乙型肝炎病毒相关疾病诊断的潜在生物标记物。将对乙型肝炎病毒与宿主microRNA之间相互作用及其相关生物学效应作一综述。     

慢性乙型肝炎潜在治疗靶点和新药研发进展

尽管预防性疫苗显著减少了乙型肝炎病毒(hepatitis B virus,HBV)新发感染,但目前全球仍有超过2.4亿慢性HBV感染者,其中每年因HBV感染相关的终末肝病和肝癌引起的死亡人数高达68万。目前用于慢性乙型肝炎(chronic hepatitis B,CHB)治疗的抗病毒药物包括干扰素和核苷/核苷酸类似物两大类,但均难以实现理想的临床治疗终点,即乙肝表面抗原(HBsAg)阴转或血清学转换。针对CHB患者尚未被满足的巨大医疗需求,国内外团队正在针对HBV生活周期的各个关键步骤以及潜在的宿主因子,尝试研发更为有效的CHB治疗药物,本文简要综述了当前处于临床开发阶段以及部分临床前阶段的CHB候选药物研发进展。     

Prevalence of occult hepatitis B virus infection in kidney transplant recipients

In this cross-sectional study, 207 hepatitis B surface antigen (HBsAg)-negative kidney transplant recipients were evaluated based on demographic and epidemiological data and on the levels of serological markers of hepatitis B virus (HBV) and hepatitis C virus infection and liver enzymes. Patients with HBV or human immunodeficiency virus infection were excluded. Sera were analysed for the presence of HBV-DNA. HBV-DNA was detected in two patients (1%), indicating occult hepatitis B (OHB) infection (the HBV-DNA loads were 3.1 and 3.5 IU/mL in these patients). The results of the liver function tests were normal and no serological markers indicative of HBV infection were detected. The prevalence of OHB infection was low among kidney transplant recipients, most likely due to the low HBsAg endemicity in the general population of the study area.     

儿童与成人慢性乙型肝炎患者乙型肝炎病毒Core基因区准种特征及正选择压力差异分析

儿童与成人慢性乙型肝炎患者的临床特征差异明显。乙型肝炎病毒(Hepatitis B virus, HBV)病毒准种特征与其致病特性紧密相连,HBV病毒Core 基因区富含免疫表位,该区域的准种特征直接反映病毒变异与病毒应对宿主免疫压力间的动态过程。文章通过扩增170名儿童慢性乙型肝炎患者及121名成人慢性乙型肝炎患者病毒Core基因区,按照病毒基因型以及病毒e抗原(Hepatitis B virus e antigen, HBeAg)状态进行分组,使用序列复杂度、多样性、非同义突变率(Non-synonymous substitution ratio,dN)、同义突变率(Synonymous substitution ratios , dS)等指标衡量不同组别之间的病毒准种特征;使用不同模型计算不同组别中受到正选择压力的位点,进一步结合HBV Core基因区免疫表位信息,进行正选择位点的定位分析。结果发现,儿童乙型肝炎病毒患者体内病毒Core基因区序列复杂性和多样性低于成人患者,且前者Core基因区正选择位点个数显著低于后者,这说明儿童慢性乙型肝炎患者体内病毒受到的选择压力低于成人患者。在儿童及成人慢性感染病人组中,HBeAg阳性病人体内病毒受到的选择压力低于HBeAg阴性病人。儿童及成人慢性感染患者体内病毒存在13个正选择位点,大多数正选择位点位于已知的抗原表位上。本研究从分子进化角度揭示了儿童与成人慢性乙型肝炎病例体内病毒Core基因区序列准种差异,为两类病人显著不同的临床表征提供了群体遗传学的解释。     

Consolidation treatment needed for sustained HBsAg-negative response induced by interferon-alpha in HBeAg positive chronic hepatitis B patients

Hepatitis B surface antigen (HBsAg) clearance is considered as functional cure in patients with chronic hepatitis B (CHB). This study aimed to assess the durability of HBsAg clearance achieved by interferon-based therapies in patients with CHB who were originally positive for hepatitis B envelope antigen (HBeAg). In this prospective study, HBeAg-positive CHB patients with confirmed HBsAg loss under interferon-based therapies were enrolled within 12 weeks from end of treatment and followed up for 48 weeks. Virological markers, biochemical indicators, and liver imaging examinations were observed every 3-6 months. Sustained functional cure was analysed as primary outcome. Factor associated with sustained HBsAg loss or reversion was also investigated. The rate of HBsAg loss sustainability was 91.8% (212/231). Patients receiving consolidation treatment for 12-24 weeks or ≥ 24 weeks had higher rates of sustained HBsAg negativity than those receiving consolidation treatment for < 12 weeks (98.3% and 91.2% vs. 86.7%, P=0.068), and the former groups had significantly higher anti-HBs levels than the later (P < 0.05). The cumulative incidence of HBsAg reversion and HBV DNA reversion was 8.2% and 3.9%, respectively. Consolidation treatment of ≥ 12 weeks[odd ratio (OR) 3.318, 95% confidence interval (CI) 1.077-10.224, P=0.037) was a predictor of sustained functional cure, and HBeAg-positivity at cessation of treatment (OR 12.271, 95% CI 1.076-139.919, P=0.043) was a predictor of HBsAg reversion. Interferon-alpha induced functional cure was durable and a consolidation treatment of ≥ 12-24 weeks was needed after HBsAg loss in HBeAg-positive CHB patients.     

抗原抗体复合物型治疗性疫苗(乙克)临床研究中患者血清乙型肝炎病毒表面抗原下降的分析与启示

近年来全球慢性乙型肝炎(chronic hepatitis B,CHB)防治指南提出了“功能性治愈”(functional cure)的概念,即患者经过治疗达到血清乙型肝炎病毒表面抗原(hepatitis B virus surface antigen,HBsAg)消失,但现有抗病毒治疗很难实现这一目标。本研究对既往临床试验中经抗原抗体复合物型治疗性疫苗(乙克)治疗后的CHB患者HBsAg下降情况进行了归纳分析,结果显示,经乙克治疗随访后达到乙型肝炎e抗原(hepatitis B e antigen,HBeAg)血清学转换者的HBsAg下降高达0.95log₁₀IU/mL,显著高于未达到HBeAg血清学转换者的0.32log₁₀IU/mL(P<0.01),而经氢氧化铝佐剂治疗随访后发生HBeAg血清学转换(0.49log₁₀IU/mL)者与未发生HBeAg血清学转换者(0.36log₁₀IU/mL)之间HBsAg下降无统计学差异。乙克组治疗过程中,丙氨酸氨基转移酶(alanine aminotransferase,ALT)骤升(ALT flare)在HBsAg下降>1.0log₁₀IU/mL者中较多见,氢氧化铝组未观察到此现象。回归分析显示,乙克治疗后HBsAg下降的影响因素有患者出现HBeAg血清学转换、感染的HBV为B基因型、治疗过程中ALT出现10倍增高,以及基线血清HBsAg为高水平。结果提示,乙克诱导的特异性免疫对降低CHB患者血清HBsAg水平有一定效果,采用“抗病毒药物治疗＋针对HBsAg的中和性抗体被动免疫＋乙克主动免疫”的“三明治”治疗策略可能会提高“功能性治愈”率。     

Targeting cIAPs,a New Option for Functional Cure of Chronic Hepatitis B Infection?

正Hepatitis B virus (HBV) infection causes a wide spectrum of liver diseases in more than 240 million people world-wide (Ott et al. 2012). Patients with chronic hepatitis B(CHB) may progress to HBV-related end-stage liver diseases, such as hepatic failure, cirrhosis or hepatocellular     

Nucleotide sequences in human chromosomal DNA from nonhepatic tissues homologous to the hepatitis B virus genome

DNA extracted from human nonhepatic tissues (placenta and kidney) have been digested with restriction endonucleases and examined by the Southern procedure with cloned 32P-labelled DNA of hepatitis B virus (HBV). In placental DNAs of women with the history of a hepatitis B infection and in one out of four cases of patients with no known HBV exposure or manifestation, HBV-related chromosomal nucleotide sequences were detected. The integration of HBV-related sequences was observed also in human kidney DNA. Moreover, in the placenta of women who had hepatitis B infection prior to delivery, unusual unintegrated forms of HBV have been found. We conclude that HBV sequences can be found not only in hepatic tissue but also in placental and kidney DNA, both of HBV-exposed and in one case even of a nonexposed patient.     

Hepatitis B infection among patients attending a sexually transmitted diseases clinic in Rio de Janeiro, Brazil

Hepatitis B virus (HBV) has a low endemicity in Rio de Janeiro, Brazil. Sexual transmission must play an important role in this virus, but the prevalence and risk factors have never been properly investigated. The aim of this paper is to determine the prevalence and risk factors for HBV infection in patients attending a Sexually Transmitted Diseases Clinic of the Universidade Federal Fluminense, from the State of Rio de Janeiro, Brazil. In a retrospective study, HBV seroprevalence was investigated in 440 patients. Serum of each patient was assayed for antibodies against hepatitis B core antigen (anti-HBc), hepatitis B surface antigen (HBsAg) and antibodies against hepatitis B surface antigen (anti-HBs). Demographic and risk factor data were extracted from clinic notes. The overall seroprevalence of exposure markers for HBV (anti-HBc, HBsAg and anti-HBs) were 13%, 3.4% and 8.5% respectively. Homo/bisexual behaviour, anal intercourse, HIV infection, positive serology for syphilis and blood transfusion were predictors of the HBV exposure. Among demographic data, age and place of birth were associated with the anti-HBc seropositivity.     

The relationship between core promoter mutation of hepatitis B virus, viral load and hepatitis B e antigen status in chronic hepatitis B patients

The aim of this study is to detect the possible association of hepatitis B virus (HBV) core mutation, hepatitis B e antigen (HBeAg) status and the viral load in chronic hepatitis B (CHB) patients. Sixty-six patients with CHB were enrolled. Hepatitis markers and hepatitis C virus antibody (HCV-Ab) were tested using micro particle enzyme immunoassay kits. Viral load was measured by real-time polymerase chain reaction (PCR) and the mutation was analyzed by nested PCR followed by restriction fragment length polymorphism. Most of CHB patients were HBeAg (-ve). The HBeAg status did not have an influence on the presence or absence of T1762/A1764 mutation. HBV-DNA serum level was not significantly different in patients with core mutation and patients without core mutation in HBeAg (-ve) group, while in HBeAg (+ve) group HBV-DNA serum level was significantly higher in patients with core mutation. This study reports the predominance of HBeAg (-ve) and HBV core promoter mutation.     

乙型肝炎病毒体外感染和复制的细胞模型

慢性乙型肝炎病毒(Hepatitis B virus,HBV)感染是严重威胁人类生命健康的世界性公共卫生问题。基于现有抗HBV药物的治疗策略,仅能在极少部分患者中实现慢性乙肝的功能性治愈。发展更为有效的抗HBV药物,需要更加透彻全面地认识各个病毒组分和关键宿主因子在HBV感染和复制生命周期中发挥的功能和机制,并在此基础上发现鉴定新的治疗靶点。支持HBV体外感染和复制的细胞模型,是研究HBV生活史的重要工具,并在治疗新靶点的发现和候选药物功效评估等研究工作中发挥关键作用。本文对支持HBV感染和复制细胞模型的新近研究进展进行梳理分析,并对这些模型的应用特点和局限性、新近研究进展和未来发展方向进行系统阐述和讨论。