不同亚型乙型病毒性肝炎患者T细胞亚群调查研究

目的研究不同亚型乙型肝炎患者外周血T淋巴细胞亚群变化及其临床意义。方法选择40例慢性活动性乙型肝炎、30例乙型肝炎病毒携带者、30例乙型肝炎肝硬化、20例急性乙型肝炎患者和30例健康对照者,采用流式细胞仪检测各组外周血T淋巴细胞亚群的表型和频率。结果与正常对照组比较,慢性活动性肝炎、肝炎肝硬变患者外周血CD4 、CD4 /CD8 比值均有显著性下降(P<0.01),以肝炎肝硬变下降最显著,慢性病毒携带者肝炎、急性乙型肝炎外周血T细胞亚群数量和比值变化不明显(P>0.05)。HBV DNA病毒载量与患者外周血CD4 T细胞数量无相关性(P>0.05)。结论慢性活动性乙型肝炎和肝硬化患者的细胞免疫功能降低,其下降程度与病毒复制水平无相关性。     

病毒性肝炎患者血清白细胞介素12的检测及临床意义

目的：探讨病毒性肝炎患者血清中IL-12的改变及其临床意义。方法：双抗体夹心酶联免疫吸附法（ELISA）检测64例病毒性肝炎患者及20例正常对照血清IL-12水平。结果：病毒性肝炎患者血清IL-12水平明显高于正常对照，与临床病型关系密切，在慢性肝炎、急性肝炎及重型肝炎依次升高，差异有显著性意义（P〈0．01）。恢复期血清IL-12水平迅速复常（P〉0．05）；血清IL-12水平与血清总胆红素及谷丙转氨酶水平呈正相关。结论：IL-12参与了病毒性肝炎的免疫病理过程。早期检测血清IL-12水平，可判断病情的预后，并指导临床的诊断及治疗。     

视黄醇结合蛋白、前白蛋白、白蛋白联合检测对病毒性肝炎患者诊断的临床意义

目的：探讨视黄醇结合蛋白（RBP）、前白蛋白（PA）、白蛋白（ALB）对各型病毒性肝炎患者血清中的水平及意义。方法：用免疫比浊法和溴甲酚绿法检测100例不同临床类型的病毒性肝炎患者及正常对照组的血清RBP、PA、ALB水平。结果：急性肝炎患者血清RBP、PA均显著低于对照组（P〈0．05）。重型肝炎患者血清RBP、PA、ALB同时下降，与正常对照组比较有显著型差异（P〈O．01）。结论：血清RBP可作为判断急性肝损害的灵敏指标。能更准确地反映肝储备功能。     

两种方法检测血清HBsAg的对比分析

我国是乙型肝炎的高发地区,乙肝病毒（HBV）人群携带率大约为10％。乙型病毒性肝炎是目前已确认的病毒性肝炎中对人类健康危害最为严重的一种肝炎。目前检测的乙型肝炎病毒（HBV）特异血清标志物主要有乙肝表面抗原、乙肝表面抗体、乙肝病毒e抗原及其e抗体和核心抗体（HBsAg、HB—sAb、HBeAg、HBeAb、HBcAb）五项（俗称两对半）。急性和慢性乙型肝炎病人及血液HBsAg阳性无症状的携带者是HBV的主要传染源。     

地高辛标记HBVDNA探针在乙型肝炎诊断中的应用

检测血清 HBVDNA 是诊断 HBV 复制的直接方法,地高辛标记 HBVDNA 斑点杂交法是一种较敏感的方法。我院自1991年8月～1992年2月对158例各型 HBV 感染者血清 HBVDNA 进行了检测,探讨了其临床意义,结果如下。材料和方法1 病例选择 158例为1991年我院诊治的各型HBV 感染者,诊断按照1990年全国病毒性肝炎学术会议修订的标准,其中急性肝炎(AH)38例;慢性迁延型肝炎(CPH)51例;慢性活动型肝炎(CAH)32例;肝炎后肝硬化(LC)16例;无症状HBsAg 携带者(ASC)21例。另外有不明原因肝损害者12例。     

49例乙型和丙型肝炎病毒重叠感染的病例分析

目的在病毒性肝炎患者中，乙型肝炎部分患者血清中可检测到丙型肝炎抗体（抗-HCV）。为了解乙型肝炎患者重叠感染丙型肝炎病毒（HCV）的状况，我们对乙型和丙型肝炎病毒重叠感染患者的血清进行分析。方法应用ELISA法对49例乙肝和丙肝重叠感染患者的血清进行肝炎标志物检测。结果49例乙型肝炎患者血清抗-HCV阳性率46．9，不同类型乙型肝炎患者血清抗HCV阳性率之间比较有显著差异。（P〉0．05）结论两型肝炎与乙型肝炎有着共同的传播途径，反复接受血液或血渡制品，静脉内吸毒或性传播是造成HCV与HBV合并感染的直接原因。     

DcR3在慢性乙型肝炎患者中表达升高及其意义

目的探讨诱骗受体3(DcR3)在慢性乙型肝炎(CHB)患者中的表达及意义。方法收集确诊为CHB患者血清90例,对照组为同期体检的健康者50例。采用PCR检测乙型肝炎病毒(HBV)DNA拷贝数,ELISA检测血清中DcR3水平,全自动生化分析仪检测丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、谷氨酰转移酶(γ-GGT)。根据HBV DNA拷贝数分为4组:健康对照组(Control组)、低HBV DNA拷贝数组(Low组)、中HBV DNA拷贝数组(Middle组)、高HBV DNA拷贝数组(High组)。根据ALT和HBV DNA水平将患者分为活动性肝炎组和乙型肝炎携带者组。采用SPSS统计学软件分析不同组血清指标的表达差异,评估DcR3与其余血清指标的相关性。结果在Low、Middle、High 3组中DcR3表达依次升高,且高于Control组,差异有统计学意义(P0.05),活动性肝炎组DcR3表达明显高于乙型肝炎携带者组(P0.05)。CHB患者血清中DcR3水平与HBV DNA、ALT、AST、γ-GGT具有显著相关性:DcR3HBV DNA(r=0.27,P0.05)、DcR3ALT(r=0.53,P0.05)、DcR3AST(r=0.54,P0.05)、DcR3γ-GGT(r=0.48,P0.05)。结论 DcR3在慢性乙型肝炎患者中明显升高,并与HBV DNA、ALT、AST、γ-GGT相关。     

不同时期慢性HBV感染者血清IFN-λs水平的变化

目的：了解不同时期慢性HBV感染者血清IFN-λs水平,探讨其变化与慢性HBV感染进程的关系。方法选择120例慢性HBV感染者,其中HBV携带者、慢性乙型病毒性肝炎（慢乙肝）患者、乙肝肝硬化患者、HBV相关肝癌患者各30例,以20名健康人为对照。采用双抗体夹心ELISA法,检测各组研究对象血清IFN-λs （IL-29、IL-28A和IL-28B）水平。结果慢乙肝、乙肝肝硬化、HBV相关肝癌患者的血清IFN-λ1（IL-29）水平均明显低于健康对照组（P均＜0．01）,慢乙肝、乙肝肝硬化、HBV 相关肝癌患者血清 IFN-λ1（IL-29）水平明显低于 HBV 携带者（P 均＜0．01）;HBV携带者血清IL-29水平与健康对照组相近（P＞0．05）。各组慢性HBV感染患者的血清IFN-λ2（IL-28A）水平与健康对照组比较均无统计学意义（P＞0．05）。HBV相关肝癌患者血清IFN-λ3（IL-28B）水平高于健康人、HBV携带者、慢乙肝患者、乙肝肝硬化患者（P均＜0．01）;HBV携带者、慢乙肝、乙肝肝硬化和健康对照组间血清IL-28B水平比较差异无统计学意义（P＞0．05）。结论慢性HBV感染者血清IFN-λ1（IL-29）水平明显下降,而且HBV相关肝癌患者血清IFN-λ3（IL-28B）的水平明显升高,可能与肝癌的发生有关。     

慢性乙型肝炎患者血清补体C3b水平的研究

目的探讨慢性乙型肝炎患者血清补体C3b水平及其临床意义。方法选择乙型肝炎病毒（HBV）感染的慢性乙型肝炎患者140例,据患者血清中HBV e抗原（HBeAg）和丙氨酸氨基转氨酶（ALT）水平,将其分为6组：A组（HBeAg阳性,ALT正常）、B组（HBeAg阴性,ALT正常）、C组（HBeAg阳性,ALT轻、中度升高）、D组（HBeAg阳性,ALT高度升高）、E组（HBeAg阴性,ALT轻、中度升高）、F组（HBeAg阴性,ALT高度或重度升高）。另将20例健康者作为对照组。HBeAg采用酶联免疫吸附测定（ELISA）法,HBV-DNA采用荧光定量聚合酶链反应（PCR）法,ALT采用速率法,补体C3b采用ELISA-生物素亲和素抗体夹心法测定。结果 D组与F组患者血清C3b、ALT、天冬氨酸氨基转氨酶（AST）水平显著高于A、B、C、E组（P〈0.05）;而D组与F组比较,患者血清C3b、AST水平均无统计学差异（P〉0.05）。对照组受检者血清C3b水平显著低于A、B、C、D、E、F组（P〈0.05）。C3b水平与ALT、AST、HBsAg存在正相关（P〈0.05）,而与HBeAg和HBV-DNA无显著相关（P〉0.05）。结论补体C3b水平与HBV的感染及肝细胞损伤程度有关,而与病毒复制的活跃程度无关,可作为感染和预后的辅助检测指标。     

HBeAg阳性或阴性的慢性乙型肝炎和肝硬化患者血清HBV DNA、ALT、AST的结果分析

目的了解HBeAg阳性或阴性的慢性乙型肝炎（CHB）和肝硬化（LC）患者血清乙型肝炎病毒DNA（HBV DNA）、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）水平及其相关性。方法分析152例CHB患者和53例LC患者的临床资料、检测结果以及它们的相互关系。结果 CHB患者和LC患者在年龄方面存在差异（P〈0.05）;HBeAg阳性的LC患者的HBV DNA阳性率、ALT升高例数、AST升高例数均高于HBeAg阴性的LC患者,差异有统计学意义（P〈0.01）;HBeAg阳性CHB患者的HBV DNA阳性率高于HBeAg阴性的CHB患者,差异有统计学意义（P〈0.01）。结论 CHB患者和LC患者血清HBV DNA水平变化与HBeAg变化呈正相关性（γ=0.913）。     

Lamivudine treatment in HBeAg-negative chronic hepatitis B patients with low level viraemia

BACKGROUND: Our aim was to determine the short-term natural course of viraemia and the response to lamivudine treatment in HBeAg-negative chronic hepatitis B patients with a persistently low hepatitis B virus (HBV)-DNA level. METHODS: A total of 55 patients were included. Group 1 consisted of 37 patients with low-level viraemia and high serum alanine aminotransferase (ALT) levels and further randomized to two groups: group 1a (n=19) patients received 1 year of lamivudine therapy and group 1b (n=18) patients were untreated controls. Group 2 consisted of 18 inactive carriers who were followed as controls of untreated low viraemic chronic hepatitis B patients. HBV DNA was longitudinally determined by real-time polymerase chain reaction assay. RESULTS: A female predominance in group 2 was observed while males were predominant in group 1. Mean age and baseline HBV-DNA levels did not differ between group 1 and 2 patients while group 1 patients had a higher histological score (P<0.01). Of group 1a patients, 44% had complete ALT normalization at end of treatment, whereas 21% untreated group 1b patients had normal ALT at the end of the follow-up. No change in histological activity was observed in group 1a patients at the end of treatment. HBV-DNA levels did not significantly change from baseline to end-of-treatment/observation period in patient groups. The viraemia course was not different across the groups. CONCLUSIONS: Low viraemic HBeAg-negative patients with high ALT present with minimal/mild histological activity. Inactive carriers cannot be differentiated from low viraemic patients with high ALT based on HBV DNA determination. Although lamivudine treatment can be effective in some cases, observation rather than a prompt treatment attempt seems to be more logical because of mild histological changes and low response rate to treatment in these patients.     

Markers of disease activity in chronic hepatitis B virus infection

BACKGROUND: Assessment of disease activity is important in the management of chronic hepatitis B virus (HBV) infection. Our objective was to study the correlation between serum HBV DNA levels and HBV e antigen (HBeAg) status, alanine aminotransferase (ALT) levels, histologic activity, age and sex in patients who had chronic HBV, with emphasis on those who were HBeAg negative with high replication but had normal or below-normal liver enzyme levels and mild liver disease. METHOD: At our university-affiliated tertiary care medical centre in Turkey, we studied prospectively 179 consecutive patients who were long-term hepatitis B surface antigen carriers. These patients were first separated into 2 groups according to HBeAg positivity and then subdivided into 4 groups according to the presence of HBV DNA, HBeAg status and ALT levels. The clinical, virologic and histologic differences in these patients were evaluated with respect to the HBeAg status. RESULTS: Of the 179 patients, 120 (67%) were HBeAg positive and 59 (33%) were HBeAg negative. The mean (and standard deviation) age in the former group was 24.8 (7.60) and in the latter group was 32.2 (11.2) years (p < 0.001). HBeAg-negative patients had significantly more severe liver disease, more male predominance and lower serum HBV DNA levels than HBeAg-positive patients (p < 0.05). HBeAg status had a close correlation with age. There was a significant correlation between age and serum HBV DNA levels but not between HBV DNA levels and disease activity in study groups. We found that some of anti-HBe-positive patients had below-normal ALT levels with minimal or absent histologic changes despite high viral replication. CONCLUSIONS: Monitoring of ALT is of value in assessing hepatocellular damage in patients with chronic hepatitis B virus infection. HBeAg-negative patients with elevated ALT levels and some with normal ALT levels should be considered highly infectious in the course of chronic HBV infection.     

可溶性上皮钙黏素检测在HBV感染相关疾病中的应用研究

目的探讨血清可溶性上皮钙黏素(sE-cadherin)检测在乙型肝炎病毒(HBV)感染相关疾病中的应用价值。方法采用酶联免疫吸附测定(ELISA)试剂盒分别检测了113例慢性乙型肝炎(CHB)、101例乙肝后硬化(Cirrhosis),75例肝细胞癌(HCC)患者和125例对照组血清中的sE-cadherin和干扰素-γ(IFN-γ)水平。结果 HBV相关疾病患者血清sE-cadherin水平均高于对照组,差异有统计学意义(P0.05)。CHB和Cirrhosis患者血清sE-cadherin水平与INF-γ、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)水平呈正相关(P0.05)。HCC患者血清sE-cadherin水平与ALT、AST水平呈正相关(P0.05)。结论 sE-cadherin可能是评估HBV相关疾病进程的一个重要血清标志物。     

慢性乙肝患者血清cccDNA临床相亲性研究

目的探讨慢性乙型肝炎患者血清HBV cccDNA与血清AST、ALT及血清HBV—DNA之间关系。方法应用实时荧光定量聚合酶链反应（FQ-PCR）技术检测慢性乙型肝炎患者血清HBV cccDNA及HBV—DNA水平。结果91例乙肝患者中血清ALT、AST异常的分别有79例、59例,检出HBV cccDNA阳性的分别有53例、41例,检出率分别为67．09％、69．49％,检出率与正常组相比有统计学意义（P=0．001〈0．05,P=0．015〈0．05）;血清HBV cccDNA在HBV-DNA复制水平〈10^4 copies／mL时检出率为11.11％,HBV-DNA复制水平10^4-6 copies／mL时检出率为53．33％,HBV—DNA复制水平〉10^6 copies／mL时检出率为86．05％,以上不同的HBV—DNA复制水平血清HBV cccDNA检出率相比差异有统计学意义（P=0．000〈0．05）。结论血清HBV cccDNA检出率与血清HBV—DNA水平及血清ALT、AST水平有明显正相关性,血清HBV cccDNA的动态检测可以作为临床治疗及监测的一个重要参考指标。     

Soluble CD30 serum levels before and after treatment with alpha-interferon in patients with chronic hepatitis C.

It has been suggested that soluble CD30 (sCD30) serum levels in chronic hepatitis C are correlated with the activity of the disease and with the outcome of interferon (IFN) treatment. In this study, sCD30 serum levels in 25 patients with chronic hepatitis C, before and after treatment with IFN-2alpha, were measured. A total of 20 healthy subjects were used as controls. High sCD30 levels in serum were found in 36% of patients and in 5% of controls. In patients with sCD30 levels above or within the normal range, no significant differences in age, gender, serum transaminases and histology activity index were found. In relation to IFN treatment, only responder patients had serum sCD30 higher than controls, although the difference between responders and non-responders was not significant. No changes from baseline values were observed after treatment. Although high, sCD30 serum levels in chronic hepatitis C are not correlated with the disease activity, are not affected by IFN treatment and are not predictors of response to IFN treatment.     

HBV感染者IL-4水平变化及与临床的相关性

目的探讨乙型肝炎病毒(HBV)感染者外周血白细胞介素4(IL-4)水平变化及与临床的相关性。方法收集60例HBV携带者(ASC组)、60例慢性乙型肝炎患者(CHB组)、60例乙型肝炎肝硬化患者(LC组)、60例原发性肝癌患者(HCC组)和50例健康对照者(健康对照组)空腹血清,采用酶联免疫吸附试验(ELISA法)检测血清IL-4水平;采用荧光定量聚合酶链反应(PCR法)检测血清HBV DNA载量;应用全自动生化分析仪检测血清肝功能水平。结果与健康对照组[(1.64±0.17)ng/mL]比较,HBV感染者CHB组、LC组和HCC组外周血IL-4水平均显著升高[(4.18±0.48)、(4.71±0.42)、(3.62±0.31)ng/mL,P0.05],其中LC组最高,ASC组最低;与ASC组相比,CHB组、LC组和HCC组外周血IL-4水平均显著升高(P0.05);与HCC组相比,LC组外周血IL-4水平均显著升高(P0.05);LC组患者IL-4水平与总胆红素(TBIL)水平呈正相关(r=0.529,P0.01);HCC组患者IL-4水平与丙氨酸氨基转移酶(ALT)和TBIL水平均呈正相关(r=0.263、0.323,P0.05)。结论 IL-4在HBV发生、发展过程中可能起重要作用,检测其外周血水平可作为评估慢性乙型肝炎病情严重程度的重要指标。     

The role of beta2 microglobulin levels in monitoring chronic hepatitis B

Beta2 microglobulin is one of the domains of the histocompatibility class I human leukocyte antigen (HLA) antigen. In hepatitis infection the presentation of the viral antigen on the hepatocyte in the presence of class I HLA antigens plays a significant role in the elimination of the virus. The aim of the study was to estimate the serum beta2 microglobulin levels in cases of chronic hepatitis B infection. Serum beta2 microglobulin levels were assessed in 65 cases with chronic hepatitis B infection including 29 pediatric and 36 adult patients as the study group and in 30 cases as seronegative control group. Beta2 microglobulin level was found significantly higher in chronic active Hepatitis B virus (HBV) patients compared to the asymptomatic HBV carriers and also in the chronic active HBV patients compared to control group. We are of the opinion that beta2 microglobulin concentration is an indicator for monitoring chronic active HBV infections at the asymptomatic hepatitis B virus carrier patients, thus would lead to early initiation of Interferon (IFN) treatment and to monitor the effectiveness of the therapy.     

HBV DNA不同载量的CHB患者的HBeAg和ALT水平比较

目的 探讨乙型肝炎病毒(HBV)DNA不同载量的慢性乙型肝炎(CHB)患者乙肝病毒e抗原(HBeAg)与丙氨酸氨基转移酶(ALT)的关系,为临床治疗提供依据.方法 分别比较214例ALT正常的CHB患者中HBeAg(+)、HBeAg( -)患者与200名HBsAg( -)、ALT正常的健康对照者ALT水平的差异.将AL...     

TRAIL mRNA实时荧光定量方法的建立及对慢性乙肝患者外周血单个核细胞检测的意义

目的:建立肿瘤坏死因子相关凋亡诱导配体(TRAIL)mRNA的实时荧光定量PCR检测方法,探讨慢性乙型肝炎(CHB)患者外周血单个核细胞(PBMCs)中TRAIL mRNA与HBV载量的关系及TRAIL在HBV感染后肝损伤中的作用。方法:自行建立检测TRAIL mRNA的TaqMan实时荧光定量RT-PCR法,对58例慢乙肝患者PBMCs中TRAILmRNA进行测定,采用夹心酶联免疫吸附法(ELISA)分析其血清可溶性TRAIL(sTRAIL)水平,实时荧光定量法检测PBMCs中HBV DNA含量,与肝功能相关指标进行相关性分析。结果:各型慢性乙型肝炎患者外周血单个核细胞TRAILmRNA表达水平高于健康者(t=28.311,P<0.001),但各组间差异显著性,与PBMCs中HBV载量无相关性。CHB轻度、CHB中度、重度~慢性重型肝炎、LC患者血清sTRAIL水平比健康者sTRAIL水平降低(t=0.801,P=0.430;t=2.315,P=0.027;t=2.672,P=0.013;t=5.085,P=0.000),各型慢性乙型肝炎之间差异无统计学意义,与白蛋白(Alb)呈正相关(r=0.426,P=0.002),与TBil、ALT及PBMCs中HBV载量无相关性。结论:慢性乙肝患者PBMCs中TRAILmRNA表达水平增加,血清sTRAIL水平降低,血清sTRAIL与Alb呈正相关,提示外周血单个核细胞膜结合型TRAIL增加,经TRAIL参与的肝细胞损害增加。