60例婴儿肝炎综合征的病毒病因学研究

60例婴儿肝炎综合征患儿作了多病毒病原学检查,结果表明:CMV、HBV、HAV、EBV 风疹病毒是婴儿肝炎综合征的病毒病因。

缺血性肝炎24例临床分析

目的:探讨缺血性肝炎的临床特点。方法:对24例缺血性肝炎患者的临床资料进行回顾性分析。结果:缺血性肝炎患者的肝酶升高显著,尤其以ALT、AST升高为著,同时LDH显著升高。一旦诱因解除,酶学指标迅速恢复。结论:缺血性肝炎作为严重心衰、休克、低氧血症的并发症之一,其具有可逆性的极度增高的肝脏酶学改变是其特征之一,其治疗和预后与原发疾病的治疗密切相关。

血液透析乙丙型肝炎病毒感染的调查

目的:分析血液透析肝炎病毒感染相关的原因,并对病毒交叉感染的防治提出建议。方法:1997/2002年透析的患者为对照组,实施改革后2002/2007年透析的患者为实验组。酶联免疫吸附法检测HCV,微粒子酶联免疫分析法检测乙肝两对半。分析两组患者乙肝丙肝的感染率、阳转率、输血例数与量的差别。结果:实验组乙肝、丙肝的阳转率和丙肝的感染率明显低于对照组(P<0.05)。同时两组间的输血例数和量也有明显差异。结论:隔离和减少输血等对预防院内感染有重要意义。

病毒性肝炎新动向推测

目的推测细胞凋亡在病毒性肝炎发病中的新认识．方法细胞凋亡是细胞生命的基本特征之一，并且有着广泛的生理学和病理学意义，这对理解生命个体的正常发育、疾病过程及其影响等具重要意义．就细胞凋亡在病毒性肝炎发病机制中的作用，学者们早已观察到并且早有认识，研究发现，肝病患者普遍都发生细胞凋亡，凋亡细胞主要散布在肝小叶中，在小叶内坏死灶及小叶周边碎屑坏死处，可见凋亡细胞呈灶状甚至成群分布，重症肝炎肝细胞死亡也以凋亡为主，肝细胞凋亡与肝组织的炎症也有关系，组织炎症活动度较高者细胞凋亡也较多，第八次全国病毒性肝炎学术会议上，有人报告用检测不同型的慢性乙肝患者的肝组织发现Fas表达，细胞凋亡和细胞DNA损伤程度与慢性肝炎严重性呈正相关，有人也专门就慢性肝病患者末梢血单个核细胞（PBMC）的Fasl表达状况作过调查，结果提示，不论乙型或丙型肝炎，不论慢性肝炎或肝硬变，都可见到末梢血单个核细胞中Fasl表达的增多，这可能是机体清除病毒的作用之一．结果病毒性肝炎是人类易感的传染性疾病，他对机体的健康状况影响极大，很大程度的降低本人的日常劳动强度，部分患者也过早衰亡．因此我们有必要重新对病毒性肝炎经典的发病机制作出更新、更具体、更完整的理论认识，其最终?

抗结核药物致药物性肝炎84例分析

目的探讨抗结核药物致药物性肝炎出现的时间、程度与治疗转归。方法对该院2005—2011年收治的肺结核患者抗结核治疗后出现的药物性肝炎84例患者资料进行回顾性分析。结果抗结核药物所致药物性肝炎多见于具有危险因素的患者,多发生于用药后第2～6周。表现为丙氨酸氨基转移酶(ALT)、天门冬酸氨基转移酶(AST)伴或不伴碱性磷酸酶(ALP)、总胆红素(TB)升高,经保肝、降酶及对症治疗3周内肝酶均恢复正常。结论抗结核药致药物性肝炎只要早发现、早治疗,肝功能均可恢复正常,不会影响结核病治疗效果。

慢性乙肝合并复发性口腔溃疡证治心得

目的:总结中医药辨治慢性乙肝合并复发性口腔溃疡的临床体会。方法:通过门诊随师侍诊,对该病的中医药辨治方法进行总结。结果:临床上以虚证多见。治疗上主要分为脾虚湿蕴、肝肾阴虚、脾肾阳虚证型辨治。结论:对于慢性乙肝合并复发性口腔溃疡,在积极抑制病毒复制和护肝治疗的基础上,运用中医药对其进行辨证论治,延长间歇期,缩短发作期,减少溃疡个数,具有西医不可比拟的优势。

济南市无偿献血者抗-HCV流行情况调查研究

目的：了解济南市无偿献血者抗-HCV流行情况．确定低危献血群体，为安全输血提供保障。方法：选择2002～2004年济南市无偿献血者163854人，应用ELISA法检测其抗-HCV。统计学方法采用χ^2检验。结果：济南市无偿献血者抗-HCV阳性率0．52％（847／163854），2002～2004年阳性率分别为0．75％、0．43％、0．36％．（χ^2=94．08，P〈0．001）；男性阳性率为0．37％、女性阳性率为0．35％，差异无显著性（χ^2=0．17，P〉0.05）；初次献血者阳性率为0．53％，多次献血者阳性率为0．27％，差异有显著性（χ^2=23．45，P〈0．001）；18～30岁、31～40岁、41～55岁不同年龄段阳性率分别为0．37％、0．39％、0．23％，差异无显著性（χ^2=2．93，P〉0．05）；不同职业间（学生、现役军人和其他职业）阳性率分别为0．33％、0．41％，差异有显著性（χ^2=3．85，P〈0．05）。结论：多次献血者或学生、现役军人是安全输血的低危人群．应作为主要选择对象。

Hepatitis B and alcohol affect survival of hepatocellular carcinoma patients

AIM: In the USA, Hawaii has the highest incidence of hepatocellular carcinoma (HCC) and a diverse population.It is an ideal place to characterize HCC in the context of ethnicity/risk factors.METHODS: A total of 262 cases of HCC (1992-2003) were retrospectively reviewed for demographics, ethnicity, birthplace, viral hepatitis, alcohol use, diabetes, smoking and risk factors for viral hepatitis such as intravenous drug abuse (IVDA), transfusions, tattoos and vertical transmission. Tumor stage, Child's class, Cancer of the Liver Italian Program (CLIP) score, α-fetoprotein level, treatment and survival were recorded.RESULTS: Gender, age, viral hepatitis, alcohol, IVDA, and diabetes differed significantly in Asians, non-Asians and Pacific Islanders. There were also specific differences within Asian subgroups. Alpha-fetoprotein, smoking, transfusions, stage and resectability did not differ between groups. Asians were more likely to have hepatitis B, while non-Asians were more likely to have hepatitis C. Factors that decreased survival included hepatitis B, alcohol, elevated alpha-fetoprotein, CLIP ＞2 and increased Child's class. When Asians were combined with Pacific Islanders, median survival (1.52 years vs 3.54 years), 1- and 3-year survival was significantly worse than those for non-Asians. After Cox regression analysis for hepatitis B and alcohol, there was no difference in survival by ethnicity.CONCLUSION: Various ethnicities have different risk factors for HCC. Hepatitis B, alcohol, and α-fetoprotein are more important factors for survival than ethnicity.

Preliminary report of hepatitis B virus genotype prevalence in Iran

AIM： To determine the prevalence of hepatitis B virus （HBV） genotypes in Iranian hepatitis B surface antigen （HBsAg） carriers, chronic hepatitis B and cirrhotic patients. METHODS： A total of 109 HBsAg-positive patients were included in this study. HBV genotypes were determined by using INNO-LiPA methodology which is based on the reverse hybridization principle. RESULTS： The distribution of patients with different stages of liver disease was as follows： 95 （86.4%） chronic hepatitis, 11 （10%） liver cirrhosis, and 3 （2.7%） inactive carrier. Of the chronic hepatitis and liver cirrhosis patients, 26.4% were HBeAg-positive while 70% were HBeAg-negative. Genotype D was the only detected type found in all patients. CONCLUSION： Classifying HBV into genotypes has to be cost-effective and clinically relevant. Our study indicates that HBV genotype D prevails in the Mediterranean area, Near and Middle East, and South Asia. Continued efforts for understanding HBV genotype through international co-operation will reveal further virological differences of the genotypes and their clinical relevance.

YMDD variants of HBV DNA polymerase gene: Rapid detection and clinicopathoiogical analysis with long-term Iamivudine therapy after liver transplantation

AIM: To look for a rapid low-cost technique for the detection of HBV variants.METHODS: Two patients who underwent orthotopic liver transplantation (OLT) for HBV infection were treated with lamivudine (100 mg daily) and HBV infection recurred in the grafted livers. The patients were monitored intensively for liver enzymes, hepatitis B surface antigen (HBsAg) and HBV DNA in serum. Liver biopsy was performed regularly. HBV DNA in a conserved polymerase domain (the YMDD locus) was amplified from serum of each patient by PCR and sequenced. HBV genotypes were analyzed by restriction fragment length polymorphism (RFLP) of the PCR products generated from a fragment of the polymerase gene.RESULTS: YMDD wild-type HBV was detected in one patient by PCR-RFLP and DNA sequencing 19 mo after OLT, and YIDD mutant-type HBV in the other patient, 16 mo after OLT.CONCLUSION: PCR-RFLP assay is an accurate and simple method for genotyping lamivudine-resistant HBV variants.

Sustained virological response in a predominantly hepatitis C virus genotype 4 infected population

AIM:To assess sustained virological response(SVR) rates in a predominantly hepatitis C virus(HCV) genotype 4 infected population. METHODS:Between 2003-2007,240 patients who were treated for chronic hepatitis C infection at our center were included.Epidemiological data,viral genotypes,and treatment outcomes were evaluated in all treated patients.Patients with chronic renal failure, previous non-responders,and those who relapsed after previous treatment were excluded from the study.Among all patients,57%were treated with PEG-interferon(IFN)α-2a and 43%patients were treated with PEG-IFNα-2b;both groups received a standard dose of ribavirin. RESULTS:89.6%of patients completed the treatment with an overall SVR rate of 58%.The SVR rate was 54%in genotype 1,44%in genotype 2,73%in genotype 3,and 59%in genotype 4 patients.There was no statistical difference in the SVR rate between patients treated with PEG-IFNα-2a and PEG-IFNα-2b (61.5%vs 53%).Patients younger than 40 years had higher SVR rates than older patients(75%vs 51%,P =0.001).SVR was also statistically significantly higher when the HCV RNA load(pretreatment)was below 800.000(64%vs 50%,P=0.023),in patients with a body mass index(BMI)less than 28(65%vs 49%,P =0.01),and in patients who completed the treatment duration(64%vs 8%,P≤0.00001).CONCLUSION:The SVR rate in our study is higher than in previous studies.Compliance with the standard duration of treatment,higher ribavirin dose,younger age,lower BMI,and low pretreatment RNA levels were associated with a higher virological response.

血液透析患者乙型和丙型肝炎病毒感染调查

目的:了解维持性血液透析患者乙型和丙型肝炎病毒感染发生情况及防控措施。方法:选择2004-01/2009-10在北京大学首钢医院血液净化中心长期维持性血液透析患者226例的乙型和丙型肝炎病毒感染情况进行分析。结果:严格管理是减少维持性血液透析患者肝炎病毒感染发生的关键。结论:加强对透析患者、透析环境等的全面管理是杜绝和减少乙型和丙型肝炎病毒传播的关键,只有高度重视、严格执行感染控制措施,就能够预防并大大减少乙型和丙型肝炎病毒感染的发生。

维持性血液透析患者丙型肝炎病毒感染分析

目的探讨血液透析(HD)患者感染丙型肝炎与血液透析、输血的关系及临床指导意义。方法用ELISA和PCR法检测128例血液透析患者血清中抗HCV和HCV-RNA。结果血液透析患者丙型肝炎病毒感染明显高于对照组(P<0.01),血液透析患者输血组明显高于非输血组(P<0.01),而血液透析患者输血组与非输血组,乙型肝炎病毒感染差异无统计学意义(P>0.05)。结论血液透析易感染丙型肝炎病毒,输血是引起血液透析患者丙型肝炎病毒感染的最主要原因。接受异体输血的次数和输血量越多,感染的概率越大,阳性检出率则越高。

医务人员锐器伤后乙型肝炎病毒感染调查

目的了解医务人员职业暴露认识情况及医疗锐器伤后感染HBV情况,探讨防控对策。方法自设知识问卷对焦作市821例医务人员进行调查,对其中154例锐器伤者进行监测。结果锐器伤发生率18.76%。锐器伤发生后,按意外刺伤流程处理者82.47%;接种乙肝疫苗者24.03%;注射乙肝免疫球蛋白者46.10%;HBV感染者12.34%。结论医务人员锐器伤后感染HBV的危险性较高,应加强职业防护教育及培训,严格执行正确处理流程。

阿托伐他汀钙所致肝损害

阿托伐他汀钙为他汀类降脂药物,临床多用于治疗高胆固醇血症和混合型高脂血症等疾病。近年来因为有文献报道,本品可致肝功能损害,现摘要如下。1病历摘要刘秀金报道：男,56岁。

HCV感染致肝硬化的影响因素分析

目的:探讨感染丙型肝炎病毒(HCV)的时间、感染的途径、性别、肝功、病毒载量及基因型等因素对疾病的发展至肝硬化的影响。方法:351例慢性丙型肝炎患者分为肝硬化组和非肝硬化两组,对感染HCV致发展为肝硬化的几种因素进行统计学分析。结果:肝硬化组AST水平高于非肝硬化组,ALT水平、HCVRNA水平、性别构成均无差异;基因型1b患者、感染HCV的时间较长的患者、输血感染HCV的患者,更容易发展为肝硬化。结论:感染HCV致发展为肝硬化的受感染时间、感染的途径、AST水平、病毒基因型等因素影响较大,与ALT水平、病毒载量、性别关系不显著。