重庆地区乙肝血清特殊模式患者HBV基因分型及临床自然病程分析

目的了解重庆地区乙肝病毒（HBV）血清学标志物为特殊模式的HBV感染患者病毒基因型的分布情况,分析其临床特征及自然病程。方法从1000例HBV感染者中检测到48例乙肝病毒血清学标志物为特殊模式的患者（HBsAg与抗一HBs同时阳性,HBeAg与抗一HBe同时阳性）。采用巢式聚合酶链式反应（nPCR）对特殊模式患者的HBV进行基因分型,同时对两组特殊模式患者的临床资料和HBV感染的自然史进行分析。结果48例乙肝病毒血清学标志物为特殊模式的HBV感染者中,36例患者HBsAg与抗-HBs同时阳性,12例患者HBeAg与抗-HBe同时阳性。HBeAg＋／抗-HBe＋患者组的年龄较HBsAg＋／抗-HBs＋患者组的小（P〈0．05）。HBsAg＋／抗-HBs＋患者中,3例（8．3％）为B2亚型,12例（33．3％）为c2亚型,21例（58．4％）未分型;HBeAg＋／抗-HBe＋患者中,8例（66．7％）为B2亚型,1例（8．3％）为c2亚型,3例（25．0％）未分型,两组在HBV基因型的分布上差异具有统计学意义（Y2=17．44,P〈0．05）。在HBsAg＋／抗-HBs＋患者中,2例（4．2％）处于免疫清除期,14例（29．2％）处于低复制期,7例（14．6％）处于再活动期。HBeAg＋／抗-HBe＋患者中,5例（10．4％）处于免疫清除期。两组在HBV感染的自然病程中的分布差异具有统计学意义（X2=18．26,P〈0．05）。结论重庆地区乙肝病毒血清学标志物为特殊模式的慢性HBV感染者中,HBeAg与抗-HBe同时阳性的HBV感染者中B2亚型为优势基因型;HBsAg与抗-HBs同时阳性的HBV感染者中,HBV基因型以C2亚型为主。     

上海地区人类免疫缺陷病毒/艾滋病合并乙型、丙型肝炎病毒感染的临床流行病学研究

目的 研究人类免疫缺陷病毒1型(HIV-1)感染者中乙型肝炎病毒(HBV)和(或)丙型肝炎病毒(HCV)感染的流行现状及其特点。方法 对上海市(复旦大学附属)公共卫生中心就诊的170例HIV-1感染者采集血标本,使用微粒子酶联免疫法(MEIA)检测HIV-1感染者血清的乙型肝炎二对半(HBsAg、抗-HBs、HBeAg、抗-HBe、抗-HBc),应用酶联免疫吸附试验(ELISA)检测HCV抗体。结果 170名HIV-1感染者中,男性146人,女性24人,最小年龄16岁,最大年龄74岁,平均年龄41±13岁;HBsAg阳性患者19人(11．2％),抗-HBs阳性者87人(51．2％),HBeAg阳性者7人(4．1％)．抗-HBe阳性者49人(28．8％),抗-HBc阳性者111人(65．2％);抗-HCV阳性者77人(45．3％)。HIV-1、HBV和HCV三重感染者9人,约占5．3％。结论 HIV-1感染者HBsAg阳性率与普通人群相近,但HIV-1与HCV混合感染的比例显著高于普通人群。     

乙肝病毒与原发性肝癌的相关风险研究

为了解慢性乙型肝炎病毒感染与原发性肝癌的关系,本文采用回顾性研究方法对 328 例原发性肝癌病人与同期收治的 340 例非肝癌的其他消化道肿瘤病人的乙型肝炎病毒感染血清标志物(HBV M)及肝功能检测结果进行对比分析。结果显示肝癌组乙肝表面抗原(HBsAg)阳性率(63.11%)显著高于非肝癌组(消化道其他肿瘤对照组)(11.47%)。肝癌组慢性乙型肝炎病毒感染“HBsAg、抗-HBe 和抗-HBc 三者均表达为阳性者”(37.2%)显著高于“HBsAg、HBeAg 和抗-HBc 三者均表达为阳性者”(6.4%)。肝功能检测结果,“HBsAg、HBeAg 和抗-HBc三者均表达为阳性组”与“HBsAg、HBeAg 和抗-HBc 三者均表达为阳性组”比较无显著性差异(P>0.05),而肝癌组与非肝癌组比较,肝癌组肝损害显著高于非肝癌组(P<0.01)。表明慢性乙型肝炎病毒感染在原发性肝癌病因学中起着十分重要的作用,“HBsAg、抗-HBe 和抗-HBc 三者均表达为阳性者”是原发性肝癌的高危人群。     

乙肝病毒与原发性肝癌的相关风险研究

为了解慢性乙型肝炎病毒感染与原发性肝癌的关系,本文采用回顾性研究方法对328例原发性肝癌病人与同期收治的340例非肝癌的其他消化道肿瘤病人的乙型肝炎病毒感染血清标志物(HBV M)及肝功能检测结果进行对比分析.结果显示肝癌组乙肝表面抗原(HBsAg)阳性率(63.11%)显著高于非肝癌组(消化道其他肿瘤对照组)(11.47%).肝癌组慢性乙型肝炎病毒感染"HBsAg、抗-HBe和抗-HBc三者均表达为阳性者"(37.2%)显著高于"HBsAg、HBeAg和抗-HBc三者均表达为阳性者"(6.4%).肝功能检测结果,"HBsAg、HBeAg和抗-HBc三者均表达为阳性组"与"HBsAg、HBeAg和抗-HBc三者均表达为阳性组"比较无显著性差异(P＞0.05),而肝癌组与非肝癌组比较,肝癌组肝损害显著高于非肝癌组(P＜0.01).表明慢性乙型肝炎病毒感染在原发性肝癌病因学中起着十分重要的作用,"HBsAg、抗-HBe和抗-HBc三者均表达为阳性者"是原发性肝癌的高危人群.     

乙型肝炎病毒DNA在患者血清及肝组织中存在状态的研究

对29例肝炎,1例尸检肝组织和血清中乙型肝炎病毒的DNA(HBV DNA)进行了研究,发现HBsAg( )/HBeAg( )患者中,有9/17(52.94％)血清HBV DNA阳性;HBsAg( )/抗-HBe( )患者中,2/6(33.33％)也为阳性。从30例肝组织中提取DNA经琼脂糖电泳,Southern吸印转移及分子杂交试验结果表明,27例HBV DNA阳性,全部有游离型HBV DNA。27例中有5例经用标记pBR322探针杂交排除非特异杂交带后,在高分子量区有HBV DNA特异的杂交带,提示有HBV DNA整合。     

小剂量干扰素对慢性乙型肝炎抗病毒治疗的追踪观察

本文对40例曾经小剂量干扰素治疗、疗程达6个月的慢性乙肝患者进行治后6～20个月的追踪观察。从HBV标志物阴转率来看,抗病毒远期疗效结果为HBeAg治前19例阳性中,12例阴转(63.1％),其中6例并出现抗-HBe转阳。DNA-P治前3例阳性中,2例阴转(66.6％)。HBcAg治前2例阳性者也阴转。HBV-DNA治前3例阳性者仅一例阴转。HBsAg 39例阳性中,7例阴转(17.9％)。其中HBeAg及DNA-p阴转率较突出,分别为63.1％及66.6％。再从抗病毒综合反应来看,远期总有效率达57.5％(23/40),其中3例在治后14、15及20个月观察时:HBsAg、HBeAg、HBcAg、DNA-P及HBV-DNA均阴性。对照组20例HBsAg、HBeAg及DNA-P阴转率分别为0％、22.2％及0％。可见并非自然阴转,而是药物作用所致。由此认为小剂量干扰素对抗慢性乙肝病毒远期疗效是可取的,值得深入研究。     

乙型肝炎病毒前S1抗原与HBV血清标志物同时检测及临床意义

目的：了解前S1抗原与HBV血清标志物的关系。方法：采用ELSIA方法同时检测2101例乙型肝炎病毒感染者的前S1抗原和HBV血清标志物。结果：29例HBsAg( )、HBeAg( )标本中,有28例前S1抗原阳性,阳性率96．55％;784例HBsAg( )、HBeAg( )、抗HBc( )标本中,有679例前S1抗原阳性,阳性率86．6l％;276例HBsAg( )、抗HBc( )标本中,有197例前S1抗原阳性,阳性率71．38％;1012例HBsAg( )、抗Hbe( )、抗HBc( )标本中,有468例前S1抗原阳性,阳性率46．25％。结论：前S1抗原作为病毒复制的指标与HBeAg具有很好的一致性,又具有其独立的检测价值,可弥补HBV血清标志物检测的不足。     

乙型肝炎病毒表面抗原在骨髓细胞中的存在及其与乙型肝炎病毒血清复制指标的关联

选择16例血清HBsAg阳性患者为实验组,19例血清HBsAg阴性患者为对照组,每一患者同时采取血清和骨髓涂片,用免疫细胞化学方法(PAP)检测骨髓涂片细胞中的HBsAg。结果,实验组3例骨髓细胞HBsAg阳性者,其血清中HBsAg滴度都很高,而且HBeAg均呈阳性。而在抗HBe阳性或HBeAg/HBeAb阴性者中均无骨髓细胞HBsAg阳性者。在5例血清HBV-DNA多聚酶阳性者中,骨髓细胞中HBsAg阳性者2例;6例多聚酶阴性者中,骨髓细胞中HBsAg阳性者仅1例。 本研究结果证明,HBV可在肝外组织细胞中测出,骨髓细胞HBsAg阳性的出现有集中于HBV高水平复制感染者中的倾向,同时更常见于HBV感染的较早时期。     

229例低复制慢性乙型肝炎患者血清相关指标的分析

目的探讨血清HBV—DNA低复制的CHB患者相关指标的变化及意义。方法收集HBV—DNA低复制的CHB患者血液标本229例,ALT、乙肝标志物、mIL-2R、IL-10、miRNA-122等指标均采用全自动分析仪测定,对结果进行比较和线性相关分析。结果低复制CHB患者中e抗原阳性患者占38．00％,e抗原阴性患者占51．53％;229例患者ALT升高者占总数的66．81％,患者血浆miRNA-122的表达量的变化与ALT浓度呈正相关（r=0．841）。e抗原阳性与e抗原阴性组IL-10、mIL-2R浓度与对照组比较差异均有统计学意义（P〈0．05）。结论HBV—DNA低复制CHB患者ALT、mlL-2R、IL-10、miRNA-122等指标的变化证明此类患者部分病例存在肝细胞实质性的损害,临床应高度重视,尤其要与非活动性乙型肝炎病原携带状态相鉴别,不可一概而论。     

大肠杆菌合成的HBcAg转化为HBeAg的研究及其应用

37℃用1％β-巯基乙醇处理大肠杆菌HBcAg2小时,可使其全部转化成HBeAg。以常规ELISA方法不能检出HBcAg活性。该制品能被抗-HBe阳性血清特异中和。4℃以液体形式存放稳定,-20℃经过冻融活性下降。HBcAg转化成HBeAg后聚丙烯酰胺凝胶电泳行为有所改变。分别用转化的大肠杆菌HBeAg和血浆HBeAg作为酶联反应的诊断试剂,检测35份HBsAg阳性乙肝病人血清标本的抗-HBe,符合率为91.4％。同用Abbott-HBe(RIA)试剂盒测定的17份HBsAg阳性血清标本的试验结果比较,符合率为100％。说明转化的大肠杆菌HBeAg可代替血浆HBeAg作为检测抗-HBe的诊断试剂应用。     

Doxorubicin Activates Hepatitis B Virus Replication by Elevation of p21 (Waf1/Cip1) and C/EBPα Expression

Hepatitis B virus reactivation is an important medical issue in cancer patients who undergo systemic chemotherapy. Up to half of CHB carriers receiving chemotherapy develop hepatitis and among these cases a notable proportion are associated with HBV reactivation. However, the molecular mechanism(s) through which various chemotherapeutic agents induce HBV reactivation is not yet fully understood. In this study, we investigated the role of the cell cycle regulator p21 (Waf1/Cip1) in the modulation of HBV replication when a common chemotherapeutic agent, doxorubicin, is present. We showed that p21 expression was increased by doxorubicin treatment. This elevation in p21 expression enhanced the expression of CCAAT/enhancer-binding protein α (C/EBPα); such an increase is likely to promote the binding of C/EBPα to the HBV promoter, which will contribute to the activation of HBV replication. Our current study thus reveals the mechanism underlying doxorubicin modulation of HBV replication and provides an increased understanding of HBV reactivation in CHB patients who are receiving systemic chemotherapy.     

Modulation of hepatitis B infection by intravenous application of an immunoglobulin preparation that contains antibodies to hepatitis B e and core antigens but not to hepatitis B surface antigen.

Repeated administration of an intravenous immunoglobulin containing antibody to hepatitis B e antigen (anti-HBe) and antibody to hepatitis B core antigen (anti-HBc) but free of antibody to hepatitis B surface antigen (anti-HBs) before and after the inoculation of 10(4.9) 50% chimpanzee infective doses of hepatitis B virus (HBV) markedly prolonged the incubation period of HBV in experimentally infected chimpanzees. Similar administration of an immunoglobulin preparation containing anti-HBc but free of anti-HBe and anti-HBs or intramuscular administration of a single dose of immunoglobulin containing anti-HBe and anti-HBc 3 days before or after inoculation with HBV did not appear to modulate HBV infection. These observations suggested that anti-HBe, or an unidentified antibody associated with it, may have biological activity in the modulation of HBV replication.     

High Risk of Hepatitis B Reactivation among Patients with Acute Myeloid Leukemia

BackgroundHepatitis B virus (HBV) infections are common and associated with significant morbidity and mortality in cancer patients. However, the incidence and risk factors of HBV reactivation in patients with acute myeloid leukemia (AML) are rarely investigated.MethodsAML patients followed-up at the National Taiwan University Hospital between 2006 and 2012 were analyzed. The clinical characteristics and laboratory data were retrospectively reviewed.ResultsFour hundred and ninety patients comprising 265 men and 225 women were studied. The median age was 52 years (range, 18 - 94). Chronic HBV carriage was documented at the time of leukemia diagnosis in 57 (11.6%) patients. Forty-six (80.7%) of the 57 HBV carriers received prophylaxis with anti-HBV agents. Sixteen HBV carriers (28.1%) developed hepatitis B reactivation during or after chemotherapy, including 7 patients who had discontinued antiviral therapy. The incidence of hepatitis B reactivation among AML patients with HBV carriage was 9.5 per 100 person-years. Prophylaxis with anti-HBV agents significantly decreased the risk of hepatitis B reactivation among HBV carriers (13% vs. 61%, p<0.001). Four (2.8%) of 142 patients with initial positive anti-HBsAb and anti-HBcAb experienced hepatitis B reactivation and lost their protective anti-HBsAb. Multivariate analysis revealed that diabetes mellitus (p=0.008, odds ratio (OR) = 2.841, 95% confident interval (CI): 0.985-8.193) and carriage of HBsAg (p<0.001, OR=36.878, 95% CI: 11.770-115.547) were independent risk factors for hepatitis B reactivation in AML patients.ConclusionsHepatitis B reactivation is not uncommon in the HBsAg positive AML patients. Prophylaxis with anti-HBV agent significantly decreased the risk of hepatitis B reactivation.     

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。     

Prognosis for the patients with chronic hepatitis B

The purpose of the research was to determine the influence of the hepatitis B virus on the progression of the chronic liver disease. In the present paper, 127 patients who were followed up for five years and who had histologically verified chronic liver disease, are described. Fifty two of them were carriers of HBsAg, 75 patients were HBsAg negative, but had other markers typical for a previous infection of HBV in the sera. All the patients were nonalcoholics and no drug addicts. In the sera of these 127 patients markers of HBV were prospectively followed up: HBsAg, HBeAg, anti-HBs, anti-HBc, anti-HBe, HBVDNA, antiHCV for C virus and anti-D for D virus. It was proved by these investigations that HBV provokes very severe chronic hepatitis: CAH (chronic active hepatitis) and CH (cirrhosis hepatis). It was also proved that HBV replicated in 44.20% patients, namely, HBVDNA was positive in the sera of those patients. In 26.08% of such patients the mutant form of HBV was present. In spite of progressive liver disease and without any antiviral therapy all the patients with chronic HBV cirrhosis hepatis were, after five year-follow-up, in Child-Pugh A grade. It was found that the patients who were HBsAg negative, but had one or more markers of HBV positive in the sera, had also a severe chronic hepatitis. That group of patients remains our object of further research. The five-years follow-up of all these patients demonstrates that it is necessary to find out an efficient medicament against HBV chronic hepatitis. Obligatory vaccination of the risk population against virus B remains the only prevention against this severe disease.     

重访乙型肝炎病毒感染肾脏的意义

乙型肝炎病毒(hepatitis B virus,HBV)嗜肝性主要由病毒与受体作用的特异性、支持共价闭合环状DNA(covalently closed circular DNA,cccDNA)形成的宿主因子和促进病毒RNA转录的核因子3种因素决定。人的肾脏很可能也提供这些要素,且许多研究发现HBV感染标记存在于慢性乙型肝炎患者的肾脏细胞中。本文探讨了HBV感染肾脏的可能性。由于目前血清乙型肝炎表面抗原(hepatitis B surface antigen,HBsAg)消失是功能性治愈慢性乙型肝炎的关键指标,如果肾脏也是HBV感染、表达和复制的另一靶器官,则肾脏在功能性治愈慢性乙型肝炎中的作用不可忽视。     

Levels of hepatitis B virus replicative intermediate in serum samples of chronic hepatitis B patients

Hepatitis B virus (HBV) cccDNA levels is an absolute marker of HBV replication in the liver of HBV infected patients. This study aimed to quantify the HBV cccDNA levels in sera and liver tissue samples of treatment naïve patients with chronic hepatitis B. Eighty one chronic hepatitis B (CHB) treatment naïve patients were enrolled from January 2009 to June 2011. Total HBV DNA and HBV cccDNA levels were quantified using sensitive real time PCR assay. The mean age of recruited patients was 34 ± 11.5 years. Fifty four (66.7 %) patients were HBeAg negative. Liver tissue samples were available from 2 HBeAg positive and 21 HBeAg negative CHB patients. The amount of total intrahepatic HBV DNA ranged from 0.09 to 1508.92 copies/cell. The median intrahepatic HBV cccDNA was 0.31 and 0.20 copies/cell in HBeAg positive and HBeAg negative cases, respectively. Serum HBV cccDNA was detectable in 85.2 % HBeAg positive and 48.1 % HBeAg negative CHB patients. Median serum HBV cccDNA was 46,000 and 26,350 copies/mL in HBeAg positive and HBeAg negative subjects, respectively. There was a significant positive correlation between the levels of intrahepatic total HBV DNA and intrahepatic HBV cccDNA (r = 0.533, p = 0.009). A positive correlation was also seen between serum HBV cccDNA levels and serum HBV DNA levels (r = 0.871, p < 0.001). It was concluded that serum HBV cccDNA could be detectable in higher proportion of HBeAg positive patients compared to HBeAg negative patients. Moreover, the median level of serum HBV cccDNA was significantly higher in HBeAg positive patients in contrast to HBeAg negative subjects.