IL28B Polymorphism Correlates with Active Hepatitis in Patients with HBeAg-Negative Chronic Hepatitis B

Background & Aims

The clinical relevance of single nucleotide polymorphisms (SNPs) near the IL28B gene is controversial in patients with hepatitis B virus (HBV) infection. This study aimed to investigate the role of viral and host factors, including IL28B genotypes, in the natural course of chronic hepatitis B (CHB).

Methods

The study enrolled consecutive 115 treatment-naive CHB patients. HBV viral loads, genotypes, precore and basal core promotor mutations, serum hepatitis B surface antigen (HBsAg) and interferon-gamma inducible protein 10 (IP-10) levels as well as four SNPs of IL28B were determined. Serial alanine transaminase (ALT) levels in the previous one year before enrollment at an interval of three months were recorded. Factors associated with active hepatitis, defined as persistent ALT >2× upper limit of normal (ULN) or a peak ALT level >5× ULN, were evaluated.

Results

The prevalence of rs8105790 TT, rs12979860 CC, rs8099917 TT, and rs10853728 CC genotypes were 88.3%, 87.4%, 88.4% and 70.9%, respectively. In HBeAg-positive patients (n = 48), HBV viral load correlated with active hepatitis, while in HBeAg-negative patients (n = 67), rs10853728 CC genotype (p = 0.032) and a trend of higher IP-10 levels (p = 0.092) were associated with active hepatitis. In multivariate analysis, high viral load (HBV DNA >10⁸ IU/mL, p = 0.042, odds ratio = 3.946) was significantly associated with HBeAg-positive hepatitis, whereas rs10853728 CC genotype (p = 0.019, odds ratio = 3.927) was the only independent factor associated with active hepatitis in HBeAg-negative population.

Conclusions

HBV viral load and IL28B rs10853728 CC genotype correlated with hepatitis activity in HBeAg-positive and HBeAg-negative CHB, respectively. Both viral and host factors play roles in disease activity during different phases of CHB.     

血清视黄醇结合蛋白4与慢性乙肝的相关性分析

目的:观察慢性乙肝患者血清视黄醇结合蛋白4(RBP4)、前白蛋白(PA)、血氨水平,分析RBP4与慢性乙肝的相关性。方法:采集90例慢性乙肝患者分为轻度组26例,中度组34例,重度组30例,另选择30例健康对照组。采用酶联免疫吸附法(ELISA)测定血清RBP4水平,采用免疫透射比浊法测定血清PA水平,用全自动生化分析仪测定血氨水平。结果:血清RBP4、PA在病例组中低于对照组,差异有统计学意义(P<0.05),血氨水平在病例组中高于对照组,差异有统计学意义(P<0.05)。血清RBP4、PA、血氨水平在轻度、中度、重度组内比较P<0.05,有统计学意义。经Pearson’s相关分析,血清RBP4与PA浓度呈显著正相关相关(r=0.896,P<0.01),与血氨浓度呈显著负相关(r=-0.781,P<0.01)。结论:RBP4与慢性乙肝存在一定的相关性,与肝脏的损伤程度有关,可作为预测肝脏损伤的血清标志物。     

血清视黄醇结合蛋白4与慢性乙肝的相关性分析

目的：观察慢性乙肝患者血清视黄醇结合蛋白4（RBP4）、前白蛋白（PA）、血氨水平,分析RBP4与慢性乙肝的相关性。方法：采集90例慢性乙肝患者分为轻度组26例,中度组34例,重度组30例,另选择30例健康对照组。采用酶联免疫吸附法（ELISA）测定血清RBP4水平,采用免疫透射比浊法测定血清PA水平,用全自动生化分析仪测定血氨水平。结果：血清RBP4、PA在病例组中低于对照组,差异有统计学意义（P〈0.05）,血氨水平在病例组中高于对照组,差异有统计学意义（P〈0.05）。血清RBP4、PA、血氨水平在轻度、中度、重度组内比较P〈0.05,有统计学意义。经Pearson＇s相关分析,血清RBP4与PA浓度呈显著正相关相关（r=0.896,P〈0.01）,与血氨浓度呈显著负相关（r=-0.781,P〈0.01）。结论：RBP4与慢性乙肝存在一定的相关性,与肝脏的损伤程度有关,可作为预测肝脏损伤的血清标志物。     

Prediction of Clinical Outcomes in Hepatitis B E Antigen Negative Chronic Hepatitis B Patients with Elevated Hepatitis B Virus DNA Levels

Objectives

We investigated whether long-term clinical outcomes such as disease progression or inactive hepatitis B virus (HBV) carrier state can be predicted by baseline factors in hepatitis B e antigen (HBeAg)-negative HBV infected patients with an elevated viral load.

Methods

A retrospective cohort of 527 HBeAg-negative chronic HBV infected patients with an elevated viral load (HBV DNA ≥ 2,000 IU/ml) was assessed for disease progression defined by the development of hepatocellular carcinoma (HCC) or cirrhotic complication, as well as becoming an inactive carrier.

Results

During a median 3.6 years of follow-up, disease progression was detected in 46 patients (40 with HCC, 6 with cirrhotic complication), and 31 of 309 non-cirrhotic patients became inactive carriers. Older age, male gender, cirrhosis, high HBV DNA levels at baseline, and short antiviral therapy duration were independent risk factors for HCC. Low HBV DNA and quantitative hepatitis B surface antigen (qHBsAg) levels were independent predictors for becoming inactive carriers in patients without cirrhosis. In non-cirrhotic patients with both low qHBsAg and HBV DNA levels, the 5-year cumulative incidence of an inactive carrier was 39.8%, while that of disease progression was 1.6%.

Conclusion

HBeAg negative patients without cirrhosis can be closely monitored for becoming an inactive carrier when both HBV DNA and qHBsAg levels are low, as the risk of disease progression is low while incidence of an inactive carrier is high.     

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.     

Hepatitis B e Antigen Status and Hepatitis B DNA Levels in Women of Childbearing Age with Chronic Hepatitis B Infection Screening for Clinical Trials

Background

Perinatal or mother-to-child transmission of hepatitis B virus (HBV) results in a high frequency of chronic infection. Risk of mother-to-child transmission is associated with maternal viral factors including hepatitis B e antigen (HBeAg) positivity and viral load.

Aim

To investigate associations between age, HBeAg status, HBV DNA levels and genotype in female patients screened for inclusion into two contemporary, randomized HBV trials.

Methods

Retrospective analyses focused on differences between women of childbearing age (≤44 years) and older women. Female patients (N = 355; 18–69 years) were included in the analysis: 41.7% of patients were Asian. In total, 44.4% were HBeAg-positive.

Results

Significantly more women aged ≤44 years were HBeAg-positive compared to women ≥45 years (57.2% versus 27.5%, respectively, p<0.0001), this proportion declined with increasing age. Younger women were significantly more likely to have high HBV viral load (HBV DNA>10⁸ copies mL: ≤44 years 46.0% vs ≥45 years 25.5%, respectively; p<0.0001), and this declined with increasing age. HBeAg positivity was slightly higher in Asian women, associated with a higher proportion of HBV genotypes B and C in this population. There was no obvious relationship between genotype and viral load.

Conclusions

Women of childbearing age with CHB are more likely to have high HBV viral load and HBeAg positivity than older women; this likelihood decreases with age. Maternal serological and virological status should therefore be established early in pregnancy, taking into account age and genotype, and a risk-reducing strategy implemented in any patient who is HBeAg positive and has a high viral load.     

Chronic Schistosoma japonicum Infection Reduces Immune Response to Vaccine against Hepatitis B in Mice

Background

Hepatitis B and schistosomiasis are most prevalent in Africa and Asia, and co-infections of both are frequent in these areas. The immunomodulation reported to be induced by schistosome infections might restrict immune control of hepatitis B virus (HBV) leading to more severe viral infection. Vaccination is the most effective measure to control and prevent HBV infection, but there is evidence for a reduced immune response to the vaccine in patients with chronic schistosomiasis japonica.

Methodology/Principal Findings

In this paper, we demonstrate in a mouse model that a chronic Schistosoma japonicum infection can inhibit the immune response to hepatitis B vaccine (HBV vaccine) and lead to lower production of anti-HBs antibodies, interferon-γ (IFN-γ) and interleukin-2 (IL-2). After deworming with Praziquantel (PZQ), the level of anti-HBs antibodies gradually increased and the Th2-biased profile slowly tapered. At 16 weeks after deworming, the levels of anti-HBs antibodies and Th1/Th2 cytokines returned to the normal levels.

Conclusions/Significance

The results suggest that the preexisting Th2-dominated immune profile in the host infected with the parasite may down–regulate levels of anti-HBs antibodies and Th1 cytokines. To improve the efficacy of HBV vaccination in schistosome infected humans it may be valuable to treat them with praziquantel (PZQ) some time prior to HBV vaccination.     

A Serum MicroRNA Signature Is Associated with the Immune Control of Chronic Hepatitis B Virus Infection

Background and Aims

The virus/host interplay mediates liver pathology in chronic HBV infection. MiRNAs play a pivotal role in virus/host interactions and are detected in both serum and HBsAg-particles, but studies of their dynamics during chronic infection and antiviral therapy are missing. We studied serum miRNAs during different phases of chronic HBV infection and antiviral treatment.

Methods

MiRNAs were profiled by miRCURY-LNA-Universal-RT-miRNA-PCR (Exiqon-A/S) and qPCR-panels-I/II-739-miRNA-assays and single-RT-q-PCRs. Two cohorts of well-characterized HBsAg-carriers were studied (median follow-up 34–52 months): a) training-panel (141 sera) and HBsAg-particles (32 samples) from 61 HBsAg-carriers and b) validation-panel (136 sera) from 84 carriers.

Results

Thirty-one miRNAs were differentially expressed in inactive-carriers (IC) and chronic-hepatitis-B (CHB) with the largest difference for miR-122-5p, miR-99a-5p and miR-192-5p (liver-specific-miRNAs), over-expressed in both sera and HBsAg-particles of CHB (ANOVA/U-test p-values: <0.000001/0.000001; <0.000001/0.000003; <0.000001/0.000005, respectively) and significantly down-regulated during- and after-treatment in sustained-virological-responders (SVR). MiRNA-profiles of IC and SVR clustered in the heatmap. Liver-miRNAs were combined with miR-335, miR-126 and miR-320a (internal controls) to build a MiR-B-Index with 100% sensitivity, 83.3% and 92.5% specificity (−1.7 cut-off) in both training and validation cohorts to identify IC. MiR-B-Index (−5.72, −20.43/14.38) correlated with ALT (49, 10/2056 U/l, ρ = −0.497, p<0.001), HBV-DNA (4.58, undetectable/>8.3 Log₁₀ IU/mL, ρ = −0.732, p<0.001) and HBsAg (3.40, 0.11/5.49 Log₁₀ IU/mL, ρ = −0.883, p<0.001). At multivariate analysis HBV-DNA (p = 0.002), HBsAg (p<0.001) and infection-phase (p<0.001), but not ALT (p = 0.360) correlated with MiR-B-Index. In SVR to Peg-IFN/NUCs MiR-B-Index improved during-therapy and post-treatment reaching IC-like values (5.32, −1.65/10.91 vs 6.68, 0.54/9.53, p = 0.324) beckoning sustained HBV-immune-control earlier than HBsAg-decline.

Conclusions

Serum miRNA profile change dynamically during the different phases of chronic HBV infection. We identified a miRNA signature associated with both natural-occurring and therapy-induced immune control of HBV infection. The MiR-B-Index might be a useful biomarker for the early identification of the sustained switch from CHB to inactive HBV-infection in patients treated with antivirals.     

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。     

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.     

High Hepatitis B Surface Antigen Levels Predict Insignificant Fibrosis in Hepatitis B e Antigen Positive Chronic Hepatitis B

Introduction

There is no data on the relationship between hepatitis B surface antigen (HBsAg) levels and liver fibrosis in hepatitis B e antigen (HBeAg)-positive patients with chronic hepatitis B (CHB).

Methods

Serum HBsAg and HBV DNA levels in HBeAg-positive CHB patients with liver biopsies were analyzed. The upper limit of normal (ULN) of alanine aminotransferase (ALT) was 30 and 19 U/L for men and women respectively. Histologic assessment was based on Ishak fibrosis staging for fibrosis and Knodell histologic activity index (HAI) for necroinflammation.

Results

140 patients (65% male, median age 32.7 years) were recruited. 56 (40%) had ALT ≤2×ULN. 72 (51.4%) and 42 (30%) had fibrosis score ≤1 and necroinflammation grading ≤4 respectively. Patients with fibrosis score ≤1, when compared to patients with fibrosis score >1, had significantly higher median HBsAg levels (50,320 and 7,820 IU/mL respectively, p<0.001). Among patients with ALT ≤2×ULN, serum HBsAg levels achieved an area under receiver operating characteristic curve of 0.869 in predicting fibrosis score ≤1. HBsAg levels did not accurately predict necroinflammation score. HBsAg ≥25,000 IU/mL was independently associated with fibrosis score ≤1 (p = 0.025, odds ratio 9.042).Using this cut-off HBsAg level in patients with ALT ≤2×ULN, positive and negative predictive values for predicting fibrosis score ≤1 were 92.7% and 60.0% respectively. HBV DNA levels had no association with liver histology.

Conclusion

Among HBeAg-positive patients with ALT ≤2×ULN, high serum HBsAg levels can accurately predict fibrosis score ≤1, and could potentially influence decisions concerning treatment commencement and reduce the need for liver biopsy.     

乙型病毒性肝炎患者血清HBV-LP与HBV-DNA水平表达的相关性及临床意义

目的:探讨乙型病毒性肝炎患者血清乙肝病毒外膜大蛋白(HBV-LP)与乙肝病毒脱氧核糖核酸(HBV-DNA)水平表达的相关性及临床意义。方法:选择2016年1月至2018年6月间我院收治的乙型病毒性肝炎患者148例,根据不同乙型肝炎血清标志物模式将患者分为A组18例、B组52例、C组41例、D组37例。根据不同HBV-DNA载量分为阴性组70例、低载量组21例、中载量组35例、高载量组22例。检测不同乙型肝炎血清标志物模式下HBV-LP、HBV-DNA阳性率及水平,比较不同HBV-DNA载量HBV-LP水平和肝功能指标,并分析其相关性。结果:C组、D组患者HBV-LP、HBV-DNA阳性率及水平均高于A组和B组(P<0.05),A组和B组、C组和D组患者HBV-LP、HBV-DNA阳性率及水平比较差异无统计学意义(P>0.05)。阴性组、低载量组、中载量组、高载量组天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、HBV-LP水平均呈逐渐升高的趋势,组间比较差异有统计学意义(P<0.05)。经Pearson相关性分析显示,乙型病毒性肝炎患者血清HBV-LP与HBV-DNA载量的对数值、ALT、AST呈正相关(P<0.05)。结论:乙型病毒性肝炎患者血清HBV-LP可以反映HBV复制情况,并于肝功能指标密切相关。     

Age as a Predictor of Significant Fibrosis Features in HBeAg-Negative Chronic Hepatitis B Virus Infection with Persistently Normal Alanine Aminotransferase

Background

Although alanine aminotransferase (ALT) levels reflect the degree of liver damage, not all patients with chronic hepatitis B virus (HBV) infection exhibit persistently elevated ALT levels. In the present study, we aimed to comprehensively evaluate the characteristics of histological abnormalities in a large population of Chinese patients with chronic HBV and persistently normal ALT levels.

Methods

In total, 2303 consecutive patients who underwent liver biopsy were screened. Of these patients, 273 were categorized as having persistently normal ALT levels (PNALT), whereas 618 were categorized as having persistently or intermittently elevated ALT levels (PIALT). All these patients had at least three ALT values recorded in the year prior to the baseline liver biopsy.

Results

Significant necroinflammation was observed in 9.7% (11/113) patients with PNALT, 23.3% (42/180) patients with PIALT (ALT 1–2× upper limit of normal [ULN]), and 27.8% (42/151) patients with PIALT (ALT > 2× ULN), whereas significant fibrosis was observed in 8.8% (10/113) patients with PNALT, 27.8% (42/151) patients with PIALT (ALT 1–2× ULN), and 21.2% (32/151) patients with PIALT (ALT > 2× ULN). Multiple logistic regression analysis indicated that age parameters were associated with significant histological abnormalities in patients with PNALT. The area under the curve showed that age was associated with significant fibrosis characteristics in patients with hepatitis B extracellular antigen (HBeAg)-negative PNALT.

Conclusion

Significant histological abnormalities are not often observed in Chinese patients with PNALT. Interestingly, age appears to be a predictor of significant fibrosis in patients with HBeAg-negative PNALT.     

Host Genetic Factors Affecting Spontaneous HBsAg Seroclearance in Chronic Hepatitis B Patients

Spontaneous clearance of hepatitis B surface antigen (HBsAg) in chronic hepatitis B (CHB) patients usually indicates a remission of hepatitis activity and a favorable outcome. Two single nucleotide polymorphisms (SNP), rs3077 near HLA-DPA1 region and rs9277535 near HLA-DPB1 region, have been shown to be associated with HBV persistence after acute HBV infection. However, little is known about the impact of these 2 SNPs on spontaneous HBsAg clearance in CHB patients. In this case-control study, a total of 100 male HBeAg-negative chronic HBV carriers who cleared HBsAg spontaneously (case group) and 100 age-matched HBeAg-negative male patients with persistent HBsAg positivity (control group) were enrolled. We investigated the relationship between these 2 SNPs and HBsAg clearance. There was a higher frequency of rs9277535 non-GG genotype in the case group (57% vs. 42%). Patients with rs9277535 non-GG genotype had a higher chance to clear HBsAg [Odds ratio (OR): 1.83, 95% confidence interval (CI): 1.04∼3.21, P = 0.034]. Compared to GG haplotype of rs3077 and rs9277535, GA haplotype had a higher chance of achieving spontaneous HBsAg loss (OR: 2.17, 95% CI: 1.14∼4.16, P = 0.030). In conclusion, rs9277535 non-GG genotype is associated with a higher likelihood of spontaneous HBsAg seroclearance in CHB patients.     

乙肝免疫标志物与乙肝病毒核酸含量与肝功能的关系研究

目的:研究乙肝免疫标记物(HBV-M)与乙肝病毒脱氧核苷酸(HBV-DNA)载量与肝功能的关系。方法:检测104例乙肝患者HBs Ag、HBe Ag、HBc Ab、HBs Ab、HBe Ab5种HBV-M;用PCR法检测HBV-DNA含量;同时检测天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、胆碱酯酶(CHE)等肝功能指标,对三者关系采用Spearman相关性分析。结果:HBs Ag、HBc Ab、HBe Ag阳性组HBV-DNA阳性率及载量均大于其余组(P0.05);HBe Ag含量、ALT浓度与HBV-DNA载量均呈正相关(r=0.48,P0.05)、(r=0.36,P0.05);AST、CHE与HBV-DNA含量无明显相关性,但在无病毒载量与有病毒载量组之间AST比较有统计学意义(P0.05)。结论:HBV-M、HBV-DNA与肝功能之间有一定的相关性,但HBe Ag阴转不代表病毒复制停止,HBV-DNA也不能完全反应肝损害程度,临床应加大重视。     

乙型肝炎疫苗与卡介苗、百白破、脊髓灰质炎疫苗联合免疫的免疫应答观察

本文报道在对婴幼儿实施基础免疹(BCC、DPT和TOPV)的同时,接种国产血源乙肝疫苗的免疫应答。对八月龄的婴儿血清学检测结果表明:乙肝疫苗接种组1(10μg)、2(20μg)抗-HBs达到临界保护(P/N≥10.0)的分别为80.65％,78.49％,未检出HBV感染标志物;未接种乙肝疫苗组的HBV感染率边10.5％。血清学检测还表明乙肝疫苗与BCG、DPT和TOPV等生物制品联合免疫应答是好的,各抗原间无干扰作用,提示乙肝疫苗可列入扩大免疫规划,并将有效地控制乙肝病毒感染。     

Immune Activation Response in Chronic HIV-Infected Patients: Influence of Hepatitis C Virus Coinfection

Objectives

We have analyzed the parameters (bacterial translocation, immune activation and regulation, presence of HCV coinfection) which could be implicated in an inappropriate immune response from individuals with chronic HIV infection. The influence of them on the evolution of CD4+ T cell count has been investigated.

Patients and methods

Seventy HIV-infected patients [monoinfected by HIV (n = 20), HCV-coinfected (with (n = 25) and without (n = 25) liver cirrhosis)] and 25 healthy controls were included. Median duration of HIV infection was 20 years. HIV- and HCV-related parameters, as well as markers relative to bacterial translocation, monocyte and lymphocyte activation and regulation were considered as independent variables. Dependent variables were the increase of CD4+ T cell count during the follow-up (12 months).

Results

Increased values of bacterial translocation, measured by lipopolysaccharide-binding protein, monocyte and lymphocyte activation markers and T regulatory lymphocytes were detected in HIV-monoinfected and HIV/HCV coinfected patients. Serum sCD14 and IL-6 were increased in HIV/HCV-coinfected patients with liver cirrhosis in comparison with those with chronic hepatitis or HIV-monoinfected individuals. Time with undetectable HIV load was not related with these parameters. The presence of cirrhosis was negatively associated with a CD4+ T cell count increase.

Conclusion

In patients with a chronic HIV infection, a persistent increase of lipopolysaccharide-binding protein and monocyte and lymphocyte modifications are present. HCV-related cirrhosis is associated with more elevated serum concentrations of monocyte-derived markers. Cirrhosis influences the continued immune reconstitution of these patients.     

胸腺法新联合恩替卡韦治疗慢性病毒性乙型肝炎的疗效及对患者血清HA、Ⅳ-C、LN和免疫功能的影响

目的:探讨胸腺法新联合恩替卡韦(ETV)治疗慢性病毒性乙型肝炎(CVHB)的临床效果及对患者血清透明质酸(HA)、Ⅳ型胶原(Ⅳ-C)、层黏蛋白(LN)水平和免疫功能的影响。方法:选取我院2013年6月～2016年7月收治的102例CVHB患者,采取随机数字表法均分为两组。对照组(51例)予以恩替卡韦抗病毒治疗,观察组(51例)在此基础上加用胸腺法新治疗。比较两组的临床疗效,治疗前后血清HA、Ⅳ-C、LN水平及外周血T细胞亚群水平的变化和不良反应的发生情况。结果:治疗48周后,观察组总有效率为84.3%,较对照组明显升高(66.7%,P0.05)。与治疗前相比,两组治疗48周后血清HA、Ⅳ-C、LN水平均显著降低(P0.01),外周血CD3~+、CD4~+、CD4~+/CD8~+水平较治疗前均显著提高(P0.01),且观察组血清HA、Ⅳ-C、LN水平显著低于对照组(P0.01)。外周血CD3~+、CD4~+、CD4~+/CD8~+水平较对照组显著升高(P0.01)。治疗过程中,对照组和观察组不良反应率分别为7.8%和11.8%,差异无统计学意义(P0.05)。结论:与单用ETV治疗相比,胸腺法新联合ETV治疗CVHB更能有效消除/缓解患者的症状体征,提高其免疫功能和疗效,且安全性高,可能与其降低血清HA、Ⅳ-C、LN水平有关。     

慢性乙型肝炎及肝硬化患者幽门螺杆菌感染的临床特征分析

目的:分析慢性乙型肝炎及肝硬化患者幽门螺杆菌感染的临床特征。方法:选取2013年5月到2014年5月我院收治的胃镜检查患者58例,其中肝硬化患者17例(肝硬化组),慢性乙型肝炎患者22例(慢性乙型肝炎组),普通患者19例(普通组),根据肝硬化门脉高压的严重程度将患者分为轻型(5例)、中型(7例)和重型(5例),比较各组幽门螺杆菌的感染情况。结果:肝硬化组、慢性乙型肝炎组及普通组幽门螺杆菌感染率分别为23.5%,22.7%,21.1%,三组比较差异无统计学意义(x2=2.872,P=0.072);肝硬化轻、中、重患者幽门螺杆菌感染率分别为20.0%、28.6%、20.0%,三者比较无统计学意义(x2=1.892,P=0.082)。结论:慢性乙型肝炎、肝硬化及普通患者幽门螺杆菌感染情况相似,且幽门螺杆菌感染对肝硬化门静脉高压无影响。     

新疆生产建设兵团儿童乙型肝炎血清免疫抗体水平调查

目的:了解新疆生产建设兵团儿童乙型肝炎血清免疫学状况。方法:采用分层按比例抽样方法随机抽取各年龄组人群,调查后对采集血样进行酶联免疫吸附试验(ELISA)检测,HBsAg、HBsAb。实验结果用SPSS13.0统计软件进行统计学处理。结果:(1)HBsAg阳性率为1.6%(标准化率为2.34%);HBsAb阳性率为60.1%(标准化率为55.33%);(2)HBsAg阳性率7-15岁儿童高于6岁及以下儿童(x2=7.644,P=0.006);HBsAb阳性率7-15岁儿童低于6岁及以下儿童(x2=31.406,P<0.01)。(3)HBsAg、HBsAb阳性率性别间差别没有统计学意义。(4)HBsAg阳性率南疆高于北疆(x2=9.548,P=0.002<0.01)、HBsAb阳性率南疆低于北疆(x2=199.3,P<0.01)。结论:兵团儿童乙型肝炎防治工作在新疆地区取得较好效果,仍低于全国平均水平。