The Predictive Value of Baseline HBs Ag Level and Early Response for HBs Ag Loss in Patients with HBe Ag-positive Chronic Hepatitis B during Pegylated Interferon Alpha-2a Treatment

Objective To explore the predictive value of baseline HBs Ag level and early response for HBs Ag loss in patients with HBe Ag-positive chronic hepatitis B during pegylated interferon alpha-2a treatment. Methods A total of 121 patients with HBe Ag-positive chronic hepatitis B who achieved HBs Ag loss were enrolled; all patients were treated with PEG-IFNα-2a 180 μg/week. Serum HBV DNA and serological indicators （HBs Ag, anti-HBs, HBe Ag, and anti-HBe） were determined before and every 3 months during treatment. Results The median treatment time for HBs Ag loss was 84 weeks （7-273 weeks）, and 74.38% （90 cases） of the patients needed extended treatment （〉 48 weeks）. The correlation between baseline HBs Ag levels and the treatment time of HBs Ag loss was significant （B = 14.465, t = 2.342, P = 0.021）. Baseline HBs Ag levels together with the decline range of HBs Ag at 24 weeks significantly correlated with the treatment time of HBs Ag loss （B = 29.862, t = 4.890, P = 0.000 and B = 27.993, t = 27.993, P = 0.005）. Conclusion Baseline HBs Ag levels and extended therapy are critical steps toward HBs Ag loss. Baseline HBs Ag levels together with early response determined the treatment time of HBs Ag loss in patients with HBe Ag-positive chronic hepatitis B during pegylated interferon alpha-2a treatment.

A male-ABCD algorithm for hepatocellular carcinoma risk prediction in HBs Ag carriers

Objective: Hepatocellular carcinoma(HCC) development among hepatitis B surface antigen(HBs Ag) carriers shows gender disparity, influenced by underlying liver diseases that display variations in laboratory tests. We aimed to construct a risk-stratified HCC prediction model for HBs Ag-positive male adults.Methods: HBs Ag-positive males of 35-69 years old(N=6,153) were included from a multi-center populationbased liver cancer screening study. Randomly, three centers were set as training, the other three centers as validation. Within 2 years since initiation, we administrated at least two rounds of HCC screening using Bultrasonography and α-fetoprotein(AFP). We used logistic regression models to determine potential risk factors,built and examined the operating characteristics of a point-based algorithm for HCC risk prediction.Results: With 2 years of follow-up, 302 HCC cases were diagnosed. A male-ABCD algorithm was constructed including participant's age, blood levels of GGT(γ-glutamyl-transpeptidase), counts of platelets, white cells,concentration of DCP(des-γ-carboxy-prothrombin) and AFP, with scores ranging from 0 to 18.3. The area under receiver operating characteristic was 0.91(0.90-0.93), larger than existing models. At 1.5 points of risk score,26.10% of the participants in training cohort and 14.94% in validation cohort were recognized at low risk, with sensitivity of identifying HCC remained 100%. At 2.5 points, 46.51% of the participants in training cohort and 33.68% in validation cohort were recognized at low risk with 99.06% and 97.78% of sensitivity, respectively. At 4.5 points, only 20.86% of participants in training cohort and 23.73% in validation cohort were recognized at high risk,with positive prediction value of 22.85% and 12.35%, respectively.Conclusions: Male-ABCD algorithm identified individual's risk for HCC occurrence within short term for their HCC precision surveillance.

测定乙肝表面抗原(HBs-Ag)酶联免疫法与胶体金免疫层析法的临床比较分析

目的:探讨酶联免疫法与胶体金免疫层析法检测乙肝表面抗原的临床价值;方法:选取2009年3月至2011年3月于我院体检中心行自愿体检的患者1024例,所有患者均采用酶联免疫法(ELISA)和胶体金免疫层析法(G ICA)两种方法进行乙肝表面抗原检测;结果:ELISA检测,共检出49例阳性,检测阳性率为4.79%,经G ICA检测共检出45例阳性,检测阳性率为4.39%,两种方法阳性检测率差异明显,在统计学上无意义(P>0.05);以ELISA检测结果为标准,可见G ICA的特异度为100%,灵敏度为91.84%;两种检测方法的诊断符合率为99.61%;结论:ELISA与G ICA两种方法检测乙肝表面抗原结果均比较可靠,但G ICA灵敏度相对较低,在临床应用中需进一步提高其灵敏度。

ELISA法与金标法检测HBs—Ag结果误差原因分析

目的：为了探讨目前检测HBsAg常用的酶联免疫吸附法与胶体金免疫法的两种方法对同一患者标本检测的结果误差原因。方法：笔者采用了对高值HbsAg定值血清倍比稀释及高中低浓度HbsAg质控品检测的方法，以检测两种方法的灵敏度及其性能。结果：两种方法的灵敏度具有较大差异（P〉0．05），且不同厂家同种方法的同种试剂灵敏度相差也较大（P〉0．05），对高浓度样品检测也有较大差异。结论：金标法测定HBsAg试条对HBsAg的最小检出量为4—5ng／ml，与ELISA法比较，特异较高，不易出现假阳性，未发现后带反应；检测所需时间5～30分钟，但试剂成本为ELISA法的4～5倍。只能作为过筛实验，必要时应用ELISA法加以确认，以免带来不必要的医疗纠纷。

HBsAg阳性患者中产钳助产对乙型肝炎病毒母婴传播的影响

目的评估阴道产钳助产是否增加乙肝病毒母婴传播的风险。方法本研究回顾性研究2015年1月1日至2020年6月1日首都医科大学附属北京佑安医院分娩的足月单胎妊娠患者,试验组为产钳助产分娩且HBsAg阳性的产妇,对照组选取同时段阴道顺产HBsAg阳性的产妇,两组患者新生儿均完成乙肝免疫球蛋白及乙肝疫苗的联合免疫,随访12个月。比较两组患者出生时新生儿及7月龄婴儿乙肝表面抗原阳性率,同时对比两组产妇的产后出血量,会阴裂伤,新生儿黄疸及新生儿产伤的比率。结果共纳入183例,产钳助产组61例,阴道顺产组122例。其中0月龄新生儿HBsAg阳性率,产钳组(16/61)高于顺产组(27/122),P>0.05,差异无统计学意义;两组患者7月龄婴儿HBsAg阳性率皆为0;产钳组产后出血量[(191.29±115.36) mL]高于阴道顺产组[(121.73±73.45) mL],P<0.0001;会阴侧切或Ⅱ度裂伤比率(61/61)高于顺产组(56/122),P<0.05,但两组患者均无会阴Ⅲ/Ⅳ度裂伤;两组患者新生儿黄疸率无差别(产钳组:15/61,顺产组:32/122,P>0.05);产钳组新生儿皮肤轻度擦伤比率较高,无严重产伤发生。结论HBsAg阳性产妇行产钳助娩不增加HBV母婴感染的风险,产妇产后出血量及会阴Ⅱ度裂伤、新生儿皮肤擦伤比率高于阴道顺产组,但会阴重度裂伤、新生儿黄疸、新生儿严重产伤的发生与顺产组无明显统计学差异。

丹东口岸朝鲜籍入境人员传染病监测结果分析

目的对朝鲜入境人员传染病监测并对结果进行分析，为有效防止传染病的传播和蔓延提供科学依据。方法对1816名入境的朝鲜人员进行乙肝、丙肝和梅毒的监测。结果检出HBs—Ag阳性104例，检出率为5．73％；HCV阳性8例，检出率为0．44％；TPPA阳性6例，检出率为0．33％。30-49岁与〈30岁〉50岁这两个年龄组的HBs-Ag阳性检出率进行比较，差异有统计学意义（p〈0．05）。结论HBV是影响朝鲜入境人员健康的主要问题，应加强对朝鲜入境人员的传染病的宣传和监管，尤其应加大HBV的传染病监管，防止传染病通过国门传播和蔓延。