乙型与丙型肝炎病毒感染对小肝癌患者预后的影响

Objective To compare the prognosis of small hepatocellular carcinoma patients with hepatitis B virus infection versus hepatitis C virus infection. Methods 413 patients receiving curative resections at Tianjin Cancer Hospital for small HCC (≤ 3 cm) from January 1997 to December 2003 were divided into four groups: HCV only (n = 75), HBV only (n = 251), HBV and HCV (n = 33), and neither HBV nor HCV (NBNC, n = 54). The preoperative status and postoperative recurrence were recorded. Survival analysis were used to assess the impact of HBV/HCV status on HCC recurrence. Results Patients with HCV were associated with older age, lower mean preoperative platelet counts and albumin levels, higher mean prothrombin time, alanine aminotransferase and total bilirubin levels. Tumors in patients with HCV are mul-tinodular and less differentiated, and were associated with a higher incidence of vascular invasion and cirrhosis. During the follow-up, the HCV group showed a higher incidence of intrahepatic recurrence and multiple recurrent lesions than the other patients. Conclusions HCC patients with HCV infection tended to be older, and were characterized by more severe cirrhosis and higher incidence of tumor multinodular. The statistically significant determinants of reoccurrence in patients with small HCC were HCV infection, presence of vascu- lar invasion and multiple tumors.     

乙型与丙型肝炎病毒感染对小肝癌患者预后的影响

Objective To compare the prognosis of small hepatocellular carcinoma patients with hepatitis B virus infection versus hepatitis C virus infection. Methods 413 patients receiving curative resections at Tianjin Cancer Hospital for small HCC (≤ 3 cm) from January 1997 to December 2003 were divided into four groups: HCV only (n = 75), HBV only (n = 251), HBV and HCV (n = 33), and neither HBV nor HCV (NBNC, n = 54). The preoperative status and postoperative recurrence were recorded. Survival analysis were used to assess the impact of HBV/HCV status on HCC recurrence. Results Patients with HCV were associated with older age, lower mean preoperative platelet counts and albumin levels, higher mean prothrombin time, alanine aminotransferase and total bilirubin levels. Tumors in patients with HCV are mul-tinodular and less differentiated, and were associated with a higher incidence of vascular invasion and cirrhosis. During the follow-up, the HCV group showed a higher incidence of intrahepatic recurrence and multiple recurrent lesions than the other patients. Conclusions HCC patients with HCV infection tended to be older, and were characterized by more severe cirrhosis and higher incidence of tumor multinodular. The statistically significant determinants of reoccurrence in patients with small HCC were HCV infection, presence of vascu- lar invasion and multiple tumors.     

乙型与丙型肝炎病毒感染对小肝癌患者预后的影响

Objective To compare the prognosis of small hepatocellular carcinoma patients with hepatitis B virus infection versus hepatitis C virus infection. Methods 413 patients receiving curative resections at Tianjin Cancer Hospital for small HCC (≤ 3 cm) from January 1997 to December 2003 were divided into four groups: HCV only (n = 75), HBV only (n = 251), HBV and HCV (n = 33), and neither HBV nor HCV (NBNC, n = 54). The preoperative status and postoperative recurrence were recorded. Survival analysis were used to assess the impact of HBV/HCV status on HCC recurrence. Results Patients with HCV were associated with older age, lower mean preoperative platelet counts and albumin levels, higher mean prothrombin time, alanine aminotransferase and total bilirubin levels. Tumors in patients with HCV are mul-tinodular and less differentiated, and were associated with a higher incidence of vascular invasion and cirrhosis. During the follow-up, the HCV group showed a higher incidence of intrahepatic recurrence and multiple recurrent lesions than the other patients. Conclusions HCC patients with HCV infection tended to be older, and were characterized by more severe cirrhosis and higher incidence of tumor multinodular. The statistically significant determinants of reoccurrence in patients with small HCC were HCV infection, presence of vascu- lar invasion and multiple tumors.     

乙型与丙型肝炎病毒感染对小肝癌患者预后的影响

Objective To compare the prognosis of small hepatocellular carcinoma patients with hepatitis B virus infection versus hepatitis C virus infection. Methods 413 patients receiving curative resections at Tianjin Cancer Hospital for small HCC (≤ 3 cm) from January 1997 to December 2003 were divided into four groups: HCV only (n = 75), HBV only (n = 251), HBV and HCV (n = 33), and neither HBV nor HCV (NBNC, n = 54). The preoperative status and postoperative recurrence were recorded. Survival analysis were used to assess the impact of HBV/HCV status on HCC recurrence. Results Patients with HCV were associated with older age, lower mean preoperative platelet counts and albumin levels, higher mean prothrombin time, alanine aminotransferase and total bilirubin levels. Tumors in patients with HCV are mul-tinodular and less differentiated, and were associated with a higher incidence of vascular invasion and cirrhosis. During the follow-up, the HCV group showed a higher incidence of intrahepatic recurrence and multiple recurrent lesions than the other patients. Conclusions HCC patients with HCV infection tended to be older, and were characterized by more severe cirrhosis and higher incidence of tumor multinodular. The statistically significant determinants of reoccurrence in patients with small HCC were HCV infection, presence of vascu- lar invasion and multiple tumors.     

乙型与丙型肝炎病毒感染对小肝癌患者预后的影响

Objective To compare the prognosis of small hepatocellular carcinoma patients with hepatitis B virus infection versus hepatitis C virus infection. Methods 413 patients receiving curative resections at Tianjin Cancer Hospital for small HCC (≤ 3 cm) from January 1997 to December 2003 were divided into four groups: HCV only (n = 75), HBV only (n = 251), HBV and HCV (n = 33), and neither HBV nor HCV (NBNC, n = 54). The preoperative status and postoperative recurrence were recorded. Survival analysis were used to assess the impact of HBV/HCV status on HCC recurrence. Results Patients with HCV were associated with older age, lower mean preoperative platelet counts and albumin levels, higher mean prothrombin time, alanine aminotransferase and total bilirubin levels. Tumors in patients with HCV are mul-tinodular and less differentiated, and were associated with a higher incidence of vascular invasion and cirrhosis. During the follow-up, the HCV group showed a higher incidence of intrahepatic recurrence and multiple recurrent lesions than the other patients. Conclusions HCC patients with HCV infection tended to be older, and were characterized by more severe cirrhosis and higher incidence of tumor multinodular. The statistically significant determinants of reoccurrence in patients with small HCC were HCV infection, presence of vascu- lar invasion and multiple tumors.     

乙型与丙型肝炎病毒感染对小肝癌患者预后的影响

Objective To compare the prognosis of small hepatocellular carcinoma patients with hepatitis B virus infection versus hepatitis C virus infection. Methods 413 patients receiving curative resections at Tianjin Cancer Hospital for small HCC (≤ 3 cm) from January 1997 to December 2003 were divided into four groups: HCV only (n = 75), HBV only (n = 251), HBV and HCV (n = 33), and neither HBV nor HCV (NBNC, n = 54). The preoperative status and postoperative recurrence were recorded. Survival analysis were used to assess the impact of HBV/HCV status on HCC recurrence. Results Patients with HCV were associated with older age, lower mean preoperative platelet counts and albumin levels, higher mean prothrombin time, alanine aminotransferase and total bilirubin levels. Tumors in patients with HCV are mul-tinodular and less differentiated, and were associated with a higher incidence of vascular invasion and cirrhosis. During the follow-up, the HCV group showed a higher incidence of intrahepatic recurrence and multiple recurrent lesions than the other patients. Conclusions HCC patients with HCV infection tended to be older, and were characterized by more severe cirrhosis and higher incidence of tumor multinodular. The statistically significant determinants of reoccurrence in patients with small HCC were HCV infection, presence of vascu- lar invasion and multiple tumors.     

乙型与丙型肝炎病毒感染对小肝癌患者预后的影响

Objective To compare the prognosis of small hepatocellular carcinoma patients with hepatitis B virus infection versus hepatitis C virus infection. Methods 413 patients receiving curative resections at Tianjin Cancer Hospital for small HCC (≤ 3 cm) from January 1997 to December 2003 were divided into four groups: HCV only (n = 75), HBV only (n = 251), HBV and HCV (n = 33), and neither HBV nor HCV (NBNC, n = 54). The preoperative status and postoperative recurrence were recorded. Survival analysis were used to assess the impact of HBV/HCV status on HCC recurrence. Results Patients with HCV were associated with older age, lower mean preoperative platelet counts and albumin levels, higher mean prothrombin time, alanine aminotransferase and total bilirubin levels. Tumors in patients with HCV are mul-tinodular and less differentiated, and were associated with a higher incidence of vascular invasion and cirrhosis. During the follow-up, the HCV group showed a higher incidence of intrahepatic recurrence and multiple recurrent lesions than the other patients. Conclusions HCC patients with HCV infection tended to be older, and were characterized by more severe cirrhosis and higher incidence of tumor multinodular. The statistically significant determinants of reoccurrence in patients with small HCC were HCV infection, presence of vascu- lar invasion and multiple tumors.     

乙型与丙型肝炎病毒感染对小肝癌患者预后的影响

Objective To compare the prognosis of small hepatocellular carcinoma patients with hepatitis B virus infection versus hepatitis C virus infection. Methods 413 patients receiving curative resections at Tianjin Cancer Hospital for small HCC (≤ 3 cm) from January 1997 to December 2003 were divided into four groups: HCV only (n = 75), HBV only (n = 251), HBV and HCV (n = 33), and neither HBV nor HCV (NBNC, n = 54). The preoperative status and postoperative recurrence were recorded. Survival analysis were used to assess the impact of HBV/HCV status on HCC recurrence. Results Patients with HCV were associated with older age, lower mean preoperative platelet counts and albumin levels, higher mean prothrombin time, alanine aminotransferase and total bilirubin levels. Tumors in patients with HCV are mul-tinodular and less differentiated, and were associated with a higher incidence of vascular invasion and cirrhosis. During the follow-up, the HCV group showed a higher incidence of intrahepatic recurrence and multiple recurrent lesions than the other patients. Conclusions HCC patients with HCV infection tended to be older, and were characterized by more severe cirrhosis and higher incidence of tumor multinodular. The statistically significant determinants of reoccurrence in patients with small HCC were HCV infection, presence of vascu- lar invasion and multiple tumors.     

乙型与丙型肝炎病毒感染对小肝癌患者预后的影响

Objective To compare the prognosis of small hepatocellular carcinoma patients with hepatitis B virus infection versus hepatitis C virus infection. Methods 413 patients receiving curative resections at Tianjin Cancer Hospital for small HCC (≤ 3 cm) from January 1997 to December 2003 were divided into four groups: HCV only (n = 75), HBV only (n = 251), HBV and HCV (n = 33), and neither HBV nor HCV (NBNC, n = 54). The preoperative status and postoperative recurrence were recorded. Survival analysis were used to assess the impact of HBV/HCV status on HCC recurrence. Results Patients with HCV were associated with older age, lower mean preoperative platelet counts and albumin levels, higher mean prothrombin time, alanine aminotransferase and total bilirubin levels. Tumors in patients with HCV are mul-tinodular and less differentiated, and were associated with a higher incidence of vascular invasion and cirrhosis. During the follow-up, the HCV group showed a higher incidence of intrahepatic recurrence and multiple recurrent lesions than the other patients. Conclusions HCC patients with HCV infection tended to be older, and were characterized by more severe cirrhosis and higher incidence of tumor multinodular. The statistically significant determinants of reoccurrence in patients with small HCC were HCV infection, presence of vascu- lar invasion and multiple tumors.     

Significance of hepatitis B virus surface antigen, hepatitis C virus expression in hepatocellular carcinoma and pericarcinomatous tissues

AIM： To investigate the correlation between hepatitis B virus surface antigen （HBsAg）, hepatitis C virus （HCV） expression in hepatocellular carcinoma （HCC）, the HAI score of the noncancerous region of the liver and the serum Alpha fetoprotein （AFP） level.
METHODS： The patterns of HBsAg and HCV in 100 cases of HCC and their surrounding liver tissues were studied on paraffin-embedded sections with immunohistochemistry, the histological status was determined by one pathologist and one surgeon simultaneously using the hepatitis activity index （HAIl score, and AFP was detected by radioimmunity. The study included 100 consecutive patients who underwent curative resection for HCC. Based on HBsAg and HCV expression, the patients were classified into 4 groups： patients positive for HBsAg （HBsAg group）, patients positive for HCV （HCV group）, patients negative for both HCV and HBsAg （NBNC group） and patients positive for both HBsAg and HCV （BC group）.
RESULTS： The BC group had significantly higher HAI scores than the other three groups. （BC 〉 HCV 〉 HBsAg 〉 NBNC）. HBV and HCV virus infection was positively correlated with HAI （rs = 0.39, P = 0.00011. The positive rate of AFP （85.7%） and the value of AFP （541.2 ng/mL） in the group with HBV and HCV co-infection were the highest among the four groups. The positive rate （53.3%） of AFP and the value of AFP （ 53.3 ng/mL） in the group with none-infection of HBV and HCV were the lowest. HBV and HCV virus infection was positively correlated with AFP（rs = 0.38, P = 0.0001）.
CONCLUSION： The AFP increase in patients with liver cancer was positively correlated with the infection of HBV and HCV. The-serum AFP elevation by the infection of HBV and HCV is one of mechanisms which lead to hepatocarcinogenesis, and the antivirus intervening treatment of hepatitis is significant for the prognosis of liver cancer. From our Spearman＇s rank correlation analysis, we can conclude that the severity of virally induced     

胎盘滋养层细胞的乙型肝炎病毒感染与宫内感染机制

目的：检测HBV对胎盘、胎肝和滋养层细胞的感染情况，探讨HBV的宫内感染机制。方法：研究对象包括20例孕妇胎盘组织、6例引产胎儿胎肝组织及体外培养的胎盘滋养层细胞。ELISA法检测孕妇外周血、胎儿脐血和6个月婴儿外周血HBV标志物；荧光定量PCR法检测血清和滋养层细胞中的HBV DNA；免疫组织化学法和免疫荧光法检测胎盘、胎肝组织及滋养层细胞中HBV标志物的表达；末端脱氧核糖核酸转移酶介导的缺口标记法（TUNEL）检测胎盘和滋养层细胞凋亡情况。结果：孕妇血清HBV DNA水平与胎儿脐血HBV DNA水平相关，脐血HBV DNA阳性者其母血HBV DNA〉1.0×10^7拷贝／mL；6例胎盘组织和3例引产胎儿胎肝组织中可见HBsAg免疫组织化学染色阳性细胞，其中1例胎肝组织中发现HBcAg阳性细胞；体外培养滋养层细胞与HBV DNA阳性血清共孵育后，可检测到HBsAg的表达，亦可检测到HBV DNA。体内和体外实验均检测到HBV感染后滋养层细胞凋亡呈增加趋势，且胎盘细胞的凋亡与脐血HBV DNA水平相关。体外实验结果显示，随感染时间的延长，滋养层细胞凋亡呈增加趋势。6个月后，12例新生儿有1例血清HBsAg、HBeAg和抗-HBc阳性，6例抗-HBs阳性。结论：HBV宫内感染的机制可能是通过HBV感染胎盘屏障而使胎儿发生HBV宫内感染。HBV在胎儿组织器官内的定位和复制可能是新生儿发生慢性HBV感染的重要因素。滋养层细胞凋亡可能是胎盘屏障阻断HBV宫内传播的一种保护性机制。     

Dual chronic hepatitis B virus and hepatitis C virus infection

Dual hepatitis B virus (HBV) and hepatitis C virus (HCV) infection are common in HBV or HCV endemic areas. However, several clinical and pathogenetic issues remain unresolved. First, clinical and in vitro studies suggest the interactions between two viruses. The dynamics of the interaction in untreated setting versus treated setting and its influence on the long-term outcomes await further studies. A key issue regarding viral interactions is whether modulation of infection occurs in the same dually infected individual hepatocyte of the liver. Clarifying this issue may help to understand the reciprocal interference between HCV and HBV and provide clues for future immunopathogenetic studies. Second, the prevalence and clinical significance of coexisting occult HBV infection in patients with chronic HCV infection need further investigations. Third, combination therapy of peginterferon alfa-2a and ribavirin appears to be just as effective and safe for the treatment of hepatitis B surface antigen (HBsAg)-positive patients chronically infected with active chronic hepatitis C as it is in patients with HCV monoinfection. Nevertheless, one-third of dually infected patients with nondetectable serum HBV DNA-level pretreatment developed HBV reactivation posttreatment. How to prevent and treat this reactivation should be clarified. Furthermore, about 10% of the dually infected patients lost HBsAg. Underlying mechanisms await further investigations. Finally, the optimal treatment strategies for dually infected patients with hepatitis B e antigen-positive chronic hepatitis B should be identified in future clinical trials.     

Occult hepatitis B virus infection

Occult hepatitis B virus(HBV)infection(OBI)refers to the presence of HBV DNA in the absence of detectable hepatitis B surface antigen.Since OBI was first described in the late 1970s,there has been increasing interest in this topic.The prevalence of OBI varies according to the different endemicity of HBV infection,cohort characteristics,and sensitivity and specificity of the methods used for detection.Although the exact mechanism of OBI has not been proved,intrahepatic persistence of viral covalently closed circular DNA under the host’s strong immune suppression of HBV replication and gene expression seems to be a cause.OBI has important clinical significance in several conditions.First,OBI can be transmitted through transfusion,organ transplantation including orthotopic liver transplantation,or hemodialysis.Donor screening before blood transfusion,prophylaxis for high-risk organ transplantation recipients,and dialysis-specific infection-control programs should be considered to reduce the risk of transmission.Second,OBI may reactivate and cause acute hepatitis in immunocompromised patients or those receiving chemotherapy.Close HBV DNA monitoring and timely antiviral treatment canprevent HBV reactivation and consequent clinical deterioration.Third,OBI may contribute to the progression of hepatic fibrosis in patients with chronic liver disease including hepatitis C.Finally,OBI seems to be a risk factor for hepatocellular carcinoma by its direct protooncogenic effect and by indirectly causing persistent hepatic inflammation and fibrosis.However,this needs further investigation.We review published reports in the literature to gain an overview of the status of OBI and emphasize the clinical importance of OBI.     

Occult hepatitis B virus infection

Many studies have shown that hepatitis B virus infection may also occur in hepatitis B surface antigen-negative patients. This occult infection has been identified both in patients with cryptogenic liver disease and in patients with hepatitis C virus-related chronic hepatitis, and much evidence suggests that it may be a risk factor of hepatocellular carcinoma development. However, several aspects of this occult infection remain unclear, such as its prevalence and the factor(s) involved in the lack of circulating hepatitis B surface antigen. Moreover, it is uncertain whether the occult hepatitis B virus infection may contribute to chronic liver damage, considering that it is usually associated with a suppressed viral replication. Evidence and hypotheses concerning this fascinating field of biomedical research are reviewed.     

Fibromyalgia-associated hepatitis C virus infection

The objective was to determine whether there might be an association between hepatitis C virus (HCV) chronic infection and fibromyalgia (FM). We determined the prevalence of HCV infection in 112 FM patients, in comparison with matched rheumatoid arthritis (RA) patients from the out-patient clinic of a teaching tertiary care general hospital. Furthermore, we looked for evidence of FM in 58 patients diagnosed with chronic hepatitis due to HCV, compared with matched surgery clinic patients, HCV antibodies were determined by enzyme-linked immunosorbent assay (ELISA) and recombinant immunoblot assay (RIBA). Serum RNA of HCV (HCV-RNA) was determined by polymerase chain reaction. In the group of FM patients, HCV antibodies were found by ELISA in 17 (15.2%) patients and in six (5.3%) of the RA controls (P < 0.05). RIBA was positive in 16 and indeterminate in one of the FM patients. Serum HCV-RNA was found in 13 of these FM patients. In eight (47%) FM patients, alanine aminotransferase (ALT) was normal, although HCV-RNA was detected in four (50%) of them. In the group of patients with chronic hepatitis due to HCV, all patients had HCV antibodies and the presence of HCV-RNA in serum. Within these patients, 31 (53%) had diffuse musculoskeletal pain, while six (10%) fulfilled FM diagnostic criteria. In the control group, 13/58 (22%) had diffuse musculoskeletal pain (P < 0.001), whereas only one female patient (1.7%) fulfilled FM criteria (P < 0.05). Serum ALT was 51.7 +/- 38.4 in FM patients, whereas it was 122 +/- 76.3 in patients with HCV chronic hepatitis but without FM (P < 0.001). There were no statistical differences in autoimmune markers between patients with and without FM. These data suggest that there exists an association between FM and active HCV infection in some of our patients. FM is not associated with liver damage or autoimmune markers in these patients. HCV infection should be considered in FM patients even though ALT elevations were absent.      

HIV and hepatitis virus infection

As the life expectancy of patients with HIV infection increases, greater attention will need to be focused on concurrent illnesses, such as viral hepatitis, that may increase mid- to long-range morbidity and mortality. The incidence of viral hepatitis is increased in patients with HIV disease, reflecting the epidemiologic risks that these two conditions share. Coinfection with HIV seems to adversely affect the natural history of hepatitis C but may actually reduce the hepatic damage associated with hepatitis B. Immunosuppression due to HIV does not seem to significantly affect hepatitis A, E, or G. Clinicians have been reluctant to treat viral hepatitis in the HIV-infected population, but this therapeutic nihilism is unwarranted. Most studies have concluded that the treatment of hepatitis C in HIVinfected patients results in an initial efficacy and a long-term response similar to those seen in the HIV-seronegative population. Although the efficacy of interferon is reduced against hepatitis B, some nucleoside analogues are effective.     

HIV and hepatitis virus infection

As the life expectancy of patients with HIV infection increases, greater attention will need to be focused on concurrent illnesses, such as viral hepatitis, that may increase mid- to long-range morbidity and mortality. The incidence of viral hepatitis is increased in patients with HIV disease, reflecting the epidemiologic risks that these two conditions share. Coinfection with HIV seems to adversely affect the natural history of hepatitis C but may actually reduce the hepatic damage associated with hepatitis B. Immunosuppression due to HIV does not seem to significantly affect hepatitis A, E, or G. Clinicians have been reluctant to treat viral hepatitis in the HIV-infected population, but this therapeutic nihilism is unwarranted. Most studies have concluded that the treatment of hepatitis C in HIV-infected patients results in an initial efficacy and a long-term response similar to those seen in the HIV-seronegative population. Although the efficacy of interferon is reduced against hepatitis B, some nucleoside analogues are effective.     

HIV and hepatitis virus infection

As the life expectancy of patients with HIV infection increases, greater attention will need to be focused on concurrent illnesses, such as viral hepatitis, that may increase mid- to long-range morbidity and mortality. The incidence of viral hepatitis is increased in patients with HIV disease, reflecting the epidemiologic risks that these two conditions share. Coinfection with HIV seems to adversely affect the natural history of hepatitis C but may actually reduce the hepatic damage associated with hepatitis B. Immunosuppression due to HIV does not seem to significantly affect hepatitis A, E, or G. Clinicians have been reluctant to treat viral hepatitis in the HIV-infected population, but this therapeutic nihilism is unwarranted. Most studies have concluded that the treatment of hepatitis C in HIV-infected patients results in an initial efficacy and a long-term response similar to those seen in the HIVseronegative population. Although the efficacy of interferon is reduced against hepatitis B, some nucleoside analogues are effective.