免疫因素及cccDNA 与HBV的持续感染

由于乙肝疫苗普遍接种,乙型肝炎的流行已经下降,但慢性乙型肝炎（CHB）仍是严重的全球性公共卫生问题。超螺旋共价闭合环状DNA（cccDNA）作为原始转录模板,逃避机体免疫及抗病毒药物清除,在HBV持续感染中发挥重要作用。基于调节患者对HBV的免疫功能研究新的治疗策略以清除细胞核内cccDNA可能成为根除HBV持续感染的途径。     

Ⅰ型前胶原氨基端肽化学发光免疫分析检测方法的建立及评价

为了建立定量检测人血清中Ⅰ型前胶原氨基端肽(Type Ⅰ procollagen N-terminal peptide,PINP)的化学发光免疫分析检测方法,首先在谷氨酸棒状杆菌中分泌表达了PINP-α1链重组蛋白,以其为免疫原制备单抗,获得了2B10、8C12和1F11共3株可稳定分泌抗PINP-α1链的单抗杂交瘤细...     

无偿献血者中隐匿性乙型肝炎病毒感染及表面抗原突变分析

采用多种免疫学检测和核酸检测相结合的方法调查了我国南方某城市无偿献血者中隐匿性乙型肝炎病毒(HBV)感染的存在情况。结果在9023例乙肝表面抗原(HBsAg)阴性的无偿献血者中,共发现17例HBV DNA阳性,隐匿性HBV感染者的发生率为0.19%(95%CI:0.11～0.30%)。序列分析显示其中6例在HBsAg"a"表位(aa124～aa147)存在不同程度氨基酸突变,突变发生率为42.9%(6/14,有3例未扩增出"a"表位片段序列),G145R突变是该地区隐匿性HBV携带者中发生频率最高的突变(4/6,66.7%)。隐匿性HBV感染者中基因型C的比例(10/17)显著高于HBsAg阳性的HBV感染者(0/15,P<0.01)。     

应用酶联免疫吸附试验检测不同类型乙型肝炎中激活补体类HBsAg循环免疫复合物

本文以抗人C_(?)的羊IgG为包被抗体,以HRP-HBs抗体为指示抗体,建立了可检测激活补体类HBsAg循环免疫复合物(HBsAg/C3-CIC)的C_3捕捉法酶联免疫吸附试验。检测了236例六种类型临床诊断为乙型肝炎的病人血清标本,其阳性率分别为:无症状携带者(ASC)12.9％(4/31),急性肝炎(AH)36.7％(22/60),慢性迁延性肝炎(CPH)33.3％(7/21),慢性活动性肝炎(CAH)59.6％(34/57),重型肝炎(SH)77.8％(14/18),肝炎后肝硬化(PLC)67.3％(33/49),阳性率与肝损严重程度明显相关(P<0.01)。认为HBs-Ag/C3-CIC可能在乙型肝炎病毒引起的慢性活动性肝炎、重型肝炎和肝炎后肝硬化的发病过程中起重要作用,并可作为乙型肝炎的诊断、临床分型和预后判断的指标之一。     

应用慢病毒载体携带HBV基因组DNA制备乙型肝炎病毒感染小鼠模型的影响因素分析

应用慢病毒载体构建不同HBV转导质粒,通过高压水动力法尾静脉注射小鼠,比较不同HBV转导质粒、剂量(5μg和10μg)、小鼠品系(Balb/c和C57BL/6)及鼠龄(6周龄和18周龄)对建立HBV感染模型的影响。不同的时间点尾静脉采血,ELISA检测血清HBsAg、HBeAg的表达水平及动力变化,Real-time PCR检测血清及肝组织病毒载量;免疫组织化学法检测肝组织HBcAg的定位与表达。1.3倍HBV基因组慢病毒载体转导质粒(pCSHBV1.3)优于1.1倍与1.2倍HBV基因组转导质粒(pCS-HBV1.1or pCS-HBV1.2);pCS-HBV1.3注射Balb/c小鼠后抗原表达维持时间短,抗体出现早;pCS-HBV1.3注射C57BL/6小鼠后,HBsAg、HBeAg抗原表达及血清HBV DNA水平维持时间长;且注射5μg质粒相对于10μg质粒注射小鼠后抗原表达维持时间更长;而6周龄和18周龄小鼠血清均可在较长时间内检测到HBsAg、HBeAg及HBV DNA的表达,但在注射后35周内,前者的表达量均高于后者;所有注射质粒的小鼠肝组织中均可检测到HBcAg的表达,且在血清HBV感染标志转阴时均可检测到肝内HBV DNA的存在。注射质粒的HBV基因组长度、剂量以及宿主的遗传背景均对建立乙肝成体转基因小鼠模型有影响,且发现以5μg含1.3倍HBV基因组的转导质粒pCS-HBV1.3注射6周龄C57BL/6小鼠,HBV抗原表达和HBV DNA水平维持时间长,更适合建立HBV持续感染模型。     

2018-2020年琼海地区女性社区获得性生殖道支原体感染情况及影响因素分析

目的 分析琼海地区2018-2020年女性社区获得性生殖道支原体感染情况、相关危险因素及对常用抗菌药物的耐药性,探讨对应策略及预防措施。方法 选取2018年1月至2020年12月琼海市中医院妇科疑似生殖道支原体感染的4 500例女性患者为研究对象,均行支原体培养及药敏鉴定,并整理所有患者的临床资料,统计分析女性泌尿生殖道支原体感染的相关危险因素。结果 4 500例疑似生殖道支原体感染的女性患者中,检出支原体感染患者2 164例,占48.09%。生殖道支原体感染的2 164例患者中共分离支原体2 352株。2018年检出支原体阳性498例,占50.02%,其中人型支原体、解脲支原体及混合感染分别为66例（6.63%）、356例（35.76%）和76例（7.63%）。2019年检出支原体阳性707例,占47.83%,其中人型支原体、解脲支原体及混合感染分别为92例（6.22%）、498例（33.69%）和117例（7.92%）。2020年检出支原体阳性959例,占46.87%,其中人型支原体、解脲支原体及混合感染分别为144例（7.04%）、 662例（32.36%）和153例（7.48%...     

2011—2015年不同年龄段男女患者泌尿生殖道支原体感染状况及耐药性调查

摘要：目的 了解本地区男女患者泌尿生殖道支原体感染状况及耐药特征,为临床诊疗及合理用药提供依据。方法 选取2011年1月—2015年12月门诊及住院患者,采集泌尿生殖道标本做支原体培养,并对阳性标本进行药敏试验,对阳性标本及其药敏结果进行分析。结果 2011年—2015年男女患者的感染率和总感染率呈逐年递增趋势（P＜0.01）,女性感染者高于男性,男女患者均以Uu单纯感染为主,不同年度均以21岁～30岁年龄段患者为主,占合计中51.0%,药敏试验表明Uu+Mh混合感染的耐药率明显高于Uu、Mh单纯感染,Uu+Mh混合感染对克拉霉素、阿奇霉素、罗红霉素、环丙沙星的耐药率均＞90.0%,Uu、Mh和Uu+Mh对美满霉素、强力霉素、交沙霉素的耐药率较低,均＜10.0%。结论 本地区支原体感染呈逐年上升趋势,女性感染率高于男性,年龄21～30岁患者居多,并以Uu单纯感染为主,治疗支原体感染首选美满霉素、强力霉素、交沙霉素。     

2019—2021年四川省血流感染病原真菌分布特征及药敏分析

目的 收集全国真菌病监测网四川省中心真菌血流感染数据,整理分析病原菌分布特点及抗真菌药物敏感性情况,为四川省真菌血流感染提供流行病学数据。方法 研究28家医院2019年1月1日—2021年12月31日门急诊及住院患者真菌血流感染的数据,采用Whonet 5.6及Microsoft Excle数据透视表功能分析真菌血流感染的临床资料及实验室信息。结果 2019年1月1日—2021年12月31日28家医院上报数据中的1 220株真菌中,念珠菌属占88.8%(1 083/1 220),以白念珠菌为主,占35.3%(431/1 220);新生隐球菌位于总分离株数的第5位,占8.3%(101/1 220)。男性占比56.6%(690/1220),女性患者相比较少(43.4%,530/1 220);其中中老年患者(>46岁)79.8%,34.8%来自于重症监护室。白念珠菌对氟康唑的敏感性最高(85.7%);热带念珠菌对氟康唑和伏立康唑的耐药率分别为43.4%和43.3%,且逐年上升。分离的101株新生隐球菌对两性霉素B、氟胞嘧啶、氟康唑、伏立康唑和伊曲康唑均存在不同的非野生株,比例分别为5....     

金黄色葡萄球菌所致肺部感染的耐药特点及其Panton—Valentine杀白细胞素基因的携带状况分析

目的分析金黄色葡萄球菌所致肺部感染的耐药性特点及其Panton—Valentine杀白细胞素基因的携带状况。方法回顾性调查了温州医学院第一附属医院2005年1月至2006年1月医院感染的金黄色葡萄球菌所致肺部感染患者132例,对其体外药敏试验进行分析;并利用多重PCR检测其PVL基因,应用多位点基因序列分型（multilocus sequence typing,MLST）技术对PVL基因阳性的菌株进行序列分型。耐甲氧西林金黄色葡萄球菌（methicillin-resistant Staphylococcus aureus,MRSA）的SCCmec基因分型采用多重聚合酶链反应。结果致肺部感染的132株金黄色葡萄球菌的耐药现象较为严重,仅对万古霉素、呋喃妥因及复方新诺明等药物的敏感率较高;其中经多重PCR筛选出10株携带PVL基因的金葡菌,全部为MRSA菌株,3株为ST239-SCCⅢ,2株为ST398-SCCmecⅢ,2株为ST398-SCCmecⅣ,ST25-SCCmecⅢ、ST59-SCCmecⅠ和ST88-SCCmecⅢ各1株。结论肺部感染的金黄色葡萄球菌对多种抗生素耐药,呈多重耐药性;其携带PVL基因占一定比例。     

Host genetic factors and vaccine-induced immunity to hepatitis B virus infection

Background

Vaccination against hepatitis B virus infection (HBV) is safe and effective; however, vaccine-induced antibody level wanes over time. Peak vaccine-induced anti-HBs level is directly related to antibody decay, as well as risk of infection and persistent carriage despite vaccination. We investigated the role of host genetic factors in long-term immunity against HBV infection based on peak anti-HBs level and seroconversion to anti-HBc.

Methods

We analyzed 715 SNP across 133 candidate genes in 662 infant vaccinees from The Gambia, assessing peak vaccine-induced anti-HBs level and core antibody (anti-HBc) status, whilst adjusting for covariates. A replication study comprised 43 SNPs in a further 393 individuals.

Results

In our initial screen we found variation in IFNG, MAPK8, and IL10RA to affect peak anti-HBs level (GMTratio of <0.6 or >1.5 and P≤0.001) and lesser associations in other genes. Odds of core-conversion was associated with variation in CD163. A coding change in ITGAL (R719V) with likely functional relevance showed evidence of association with increased peak anti-HBs level in both screens (1st screen: s595_22 GMTratio 1.71, P = 0.013; 2nd screen: s595_22 GMTratio 2.15, P = 0.011).

Conclusion

This is to our knowledge the largest study to date assessing genetic determinants of HBV vaccine-induced immunity. We report on associations with anti-HBs level, which is directly related to durability of antibody level and predictive of vaccine efficacy long-term. A coding change in ITGAL, which plays a central role in immune cell interaction, was shown to exert beneficial effects on induction of peak antibody level in response to HBV vaccination. Variation in this gene does not appear to have been studied in relation to immune responses to viral or vaccine challenges previously. Our findings suggest that genetic variation in loci other than the HLA region affect immunity induced by HBV vaccination.     

Protective immunity against hepatitis C virus infection

There is increasing evidence that a small percentage of individuals exposed to the hepatitis C virus have the capacity to generate a strong cellular immune response against the virus and avoid persistent infection, and perhaps do so repeatedly after re-exposure. This article reviews the evidence that the responses identified in this unique group of individuals represent the protective immunity that will need to be elicited by hepatitis C virus vaccines.     

Immunology of hepatitis B virus and hepatitis C virus infection

More than 500 million people worldwide are persistently infected with the hepatitis B virus (HBV) and/or hepatitis C virus (HCV) and are at risk of developing chronic liver disease, cirrhosis and hepatocellular carcinoma. Despite many common features in the pathogenesis of HBV- and HCV-related liver disease, these viruses markedly differ in their virological properties and in their immune escape and survival strategies. This review assesses recent advances in our understanding of viral hepatitis, contrasts mechanisms of virus-host interaction in acute hepatitis B and hepatitis C, and outlines areas for future studies.     

Comparison and significance of specific and non-specific cellular immunity in patients with chronic hepatitis B caused by infection with genotypes B or C of hepatitis B virus

The present study was designed to investigate possible relationships between the genotypes of hepa-titis B virus (HBV) and the HBV-specific cytotoxic T lymphocyte (CTL) responses. HBV genotypes, HBV specific CTL HBV DNA and other markers of HBV infection were determined in 138 patients with chronic hepatitis B. The results showed that the patients infected with genotype C (n=62) had a significantly lower HBV-specific CTL response than those who were infected with HBV genotype B (P<0.01). HBV DNA titer was higher in patients infected with HBV genotype C than in those infected with HBV geno-type B (P<0.01). Both alanine aminotransferase (ALT) and total bilirubin (TBIL) were higher in HBV genotype C infected patients than in those infected with genotype B (P<0.01 and <0.05, respectively). These results suggest that compared with CHB patients infected with HBV genotype B, the higher HBV DNA level and more severe liver damages in the patients infected with genotype C of HBV may be as-sociated with genotype C of the virus.     

Soluble CD40 ligand-activated B cells from patients with chronic hepatitis B virus infection as antigen presenting cells to induce hepatitis B virus specific cytotoxic T lymphocytes

Chronic hepatitis B virus (HBV) infection is the result of an inadequate antiviral immune response to the virus. In this study, we aimed to investigate whether the soluble CD40 ligand-activated B (CD40-B) cells could present antigen and induce specific cytotoxic T lymphocytes (CTLs) in patients with chronic HBV infection. We observed that after activated by sCD40L, the expression of CD80, CD86, major histocompatibility complex (MHC) I and II molecules on the CD40-B cells was significantly increased. Cytometry and fluorescence microscopy showed that more than 41.34% CD40-B cells were loaded by the HBcAg peptide. Furthermore, after been activated and HBcAg18–27 antigen peptide pulsed, B cells obtained from patients with chronic HBV infection could induce HBcAg18–27 specific CTLs in vitro. Taken together, our results show that B cells from patients with chronic HBV infection can be activated by sCD40L and may function as antigen presenting cells and induce HBV-specific CTLs.     

Strain-specific T-cell suppression and protective immunity in patients with chronic hepatitis C virus infection

Hepatitis C virus (HCV) frequently persists with an apparently ineffective antiviral T-cell response. We hypothesized that some patients may be exposed to multiple HCV subtypes and that strain-specific T cells could contribute to the viral dynamics in this setting. To test this hypothesis, CD4 T-cell responses to three genotype 1a-derived HCV antigens and HCV antibody serotype were examined in chronically HCV infected (genotypes 1a, 1b, 2, 3, and 4) and spontaneously HCV recovered subjects. Consistent with multiple HCV exposure, 63% of patients infected with genotypes 2 to 4 (genotypes 2-4) and 36% of those infected with genotype 1b displayed CD4 T-cell responses to 1a-derived HCV antigens, while 29% of genotype 2-4-infected patients showed serotype responses to genotype 1. Detection of 1a-specific T cells in patients without active 1a infection suggested prior self-limited 1a infection with T-cell-mediated protection from 1a but not from non-1a viruses. Remarkably, CD4 T-cell responses to 1a-derived HCV antigens were weakest in patients with homologous 1a infection and greater in non-1a-infected patients: proportions of patients responding were 19% (1a), 36% (1b), and 63% (2-4) (P = 0.0006). Increased 1a-specific CD4 T-cell responsiveness in non-1a-infected patients was not due to increased immunogenicity or cross-reactivity of non-1a viruses but directly related to sequence divergence. We conclude that the T-cell response to the circulating virus is either suppressed or not induced in a strain-specific manner in chronically HCV infected patients and that, despite their ability to clear one HCV strain, patients may be reinfected with a heterologous strain that can then persist. These findings provide new insights into host-virus interactions in HCV infection that have implications for vaccine development.     

Detection of hepatitis B virus in bone allografts from donors with occult hepatitis B infection

The implementation of nucleic acid testing in donor screening has improved the safety of tissue allografts. Although infectious disease transmission can be considered a rare event, the detection of occult hepatitis B infection remains challenging. The studies concerning this risk are mainly based on testing blood specimens. This work shows the correlation between results of samples obtained from donor blood and the corresponding tissue washing solution. Hepatitis B virus deoxyribonucleic acid was detected both in bone allografts from donors with serological profiles associated to active hepatitis B infection and occult hepatitis B infection. These results suggest that hepatitis B virus seems to concentrate in bone marrow even when a low viral load is present in peripheral blood. Even detection at molecular level is not enough to avoid the risk of hepatitis B virus transmission and a multiparametrical evaluation is required in tissue donor screening. The role of clinicians in recognition and reporting of allograft-associated infections is a major concern for the acquisition of experience to be applied in risk control of disease transmission.     

Mannose-binding lectin gene polymorphisms and hepatitis B virus infection in Vietnamese patients

Mannose-binding lectin (MBL) is a constituent of the human innate immune system which may play an important role in combating a variety of infectious diseases. We investigated the distribution of MBL gene mutations in a Vietnamese population, using polymerase chain reaction and DNA sequence analysis, and sought associations with the outcome of hepatitis B virus (HBV) infection. For this purpose we used samples from a total of 123 patients with confirmed, well-defined HBV infections, representing a full spectrum of clinical presentation from acute to chronic to malignant states, as well as from 112 healthy controls. The only MBL gene mutation found in this population, that at codon 54 of exon 1, was present at an overall frequency of 0.12, with a trend towards a higher frequency in the HBV-infected group compared with controls (0.15 versus 0.08, P = 0.079). Within the HBV-infected group there was a non-significant trend towards higher viral loads in those with this mutation, accompanied by significantly higher serum transaminase levels in the same individuals. Segregation according to clinical presentation showed that the mutation was present at a significantly higher frequency in the group with acute hepatitis B (AHB) compared with the healthy control group (0.25 versus 0.08, P = 0.01), and was associated with higher serum transaminase levels. Our results indicate that a mutation of the MBL gene might influence the clinical outcome of HBV infection in Vietnamese patients.     

Cellular immune response to hepatitis B virus-encoded antigens in acute and chronic hepatitis B virus infection

The proliferative response of PBMC to hepatitis B virus (HBV) envelope, core, and e Ag was analyzed prospectively in 21 patients with acute self-limited HBV infection and compared with the response of patients with chronic HBV infection and different levels of HBV replication (i.e., hepatitis e Ag (HBeAg)- or anti-HBe-positive) and liver damage (i.e., chronic active hepatitis or chronic asymptomatic carriers). Our results indicate that: 1) HBV-infected subjects who develop a self-limited acute hepatitis show a vigorous PBMC response to hepatitis B core Ag and HBeAg, as expression of T cell activation; 2) appearance of a detectable lymphocyte response to HBV nucleocapsid Ag is temporally associated with the clearance of HBV envelope Ag; 3) in patients with chronic HBV infection the level of T cell responsiveness to hepatitis B core Ag and to HBeAg is significantly lower than that observed during acute infection; 4) T cell sensitization to HBV envelope Ag in acute and chronic HBV infection is usually undetectable and when measurable is expressed transiently and at low levels. These results may reflect immune events of pathogenetic relevance with respect to evolution of disease and viral clearance.