拉米夫定联合血浆置换治疗慢性乙型重型肝炎

目的:观察拉米夫定联合血浆置换治疗慢性乙型重型肝炎的疗效。方法:将48例慢性乙型重型肝炎患者随机分为对照组(22例),给予内科综合及血浆置换治疗;治疗组(26例),在此基础上加用拉米夫定,比较两组临床症状、TB(总胆红素)、PTA(凝血酶原活动度)、ALB及HBV-DNA含量。结果:治疗组在改善TB、PTA及提高治疗有效率、HBV-DNA阴转率方面较对照组差异有显著性(P<0.05)。结论:拉米夫定在血浆置换等的治疗基础上有可能进一步提高慢性乙型重型肝炎患者的治疗效果。

Identification and characterization of genotype A and D recombinant hepatitis B virus from Indian chronic HBV isolates

AIM： To confirm the presence of recombination, fulllength hepatitis B virus （HBV） from chronic patients was sequenced and analyzed. METHODS： Full-length HBV genomes from 12 patients were amplified and sequenced in an automated sequencer. Phylogenetic analysis was carried out on full-length, Core and preS2/Surface regions using MEGA software. SimPIot Boot Scanning and amino acid sequence analysis were performed for confirmation of recombination. RESULTS： Eight patients were infected with genotype D strain; one patient with genotype A and three patients had genotype A and D recombination; two of them had cirrhosis and one had hepatocellular carcinoma. Phylogenetic analysis of core and preS2/surface regions separately showed evidence of genotype A and D recombination. The breakpoints of recombination were found to be at the start of preS2 and at the endof surface coding regions. CONCLUSION： We identified and characterized recombinant A and D genotype HBV in hepatitis B surface antigen （HBsAg）-positive patients.

A pilot study on the combined therapy of granulocyte-macrophage colony-stimulating factor and hepatitis B vaccine on chronic hepatitis B virus carrier children

Objective To observe the efficacy of treating intrauterine infected chronic hepatitis B virus (HBV) carrier children with a combination of granulocyte macrophage colony stimulating factor (GM CSF) or hepatitis B immunoglobulin (HBIG) plus recombinant hepatitis B vaccine (rHBvac) Methods A total of 27 chronic HBV infected children, who were born to HBV carrier mothers and received hepatitis B immunoprophylaxis at birth, were randomized into 2 groups: one receiving a combined therapy of 50 μg of GM CSF plus 10 μg of rHBvac injected intramuscularly at the same location (GM CSF group, 14 children) or 200 IU HBIG and 10 μg rHBvac in different muscles (HBIG group, 13 children) on a monthly four dose schedule HBV DNA quantification and other HBV serological markers were tested before and after the four dose therapy Results Twelve children in each group completed the study Of them, 3 children in the GM CSF group and 4 in the HBIG group had elevated serum alanine transaminase (ALT) before the trial, and then 2 in each group became ALT normal after the treatment Before the therapy, hepatitis B e antigen (HBeAg) positivity was found in nine children in the GM CSF group and 10 in the HBIG group One from each group had an HBeAg/anti HBe seroconversion after the treatment The quantity of HBV DNA was significantly lower after the treatment ( P =0 023) in GM CSF group, but was not significantly reduced in HBIG group No subjects were found to be negative for hepatitis B surface antigen (HBsAg) after the treatment, and no serious adverse events occurred in either group Conclusion Combined GM CSF and rHBvac therapy inhibit HBV replication in carrier children who were not protected after treatment with immunoprophylaxis