Predictive Value of Serum pgRNA on HBeAg Clearance in Patients with Chronic Hepatitis B with Low HBeAg Levels Treated with Pegylated Interferon

Objective:To study the predictive value of serum pregenomic RNA(pgRNA)on HBeAg clearance in patients with chronic hepatitis B with low HBeAg levels during pegylated interferon therapy.Methods:Twenty chronic hepatitis B patients with HBeAg positive and quantitative<50S/CO were selected for this study.The subjects underwent pegylated interferon therapy for 48-96 weeks and were followed up in the outpatient clinic after treatment.The patients were then divided into groups based on whether their HbeAg turned negative.The predictive ability of each indicator for HBeAg negative conversion was evaluated in the HBeAg negative group and the HBeAg positive group.Results:The results of logistic regression analysis suggested that pgRNA and HBcrAg were better indicators for predicting the clearance of HBeAg after treatment.Conclusion:For patients with chronic hepatitis B with low HBeAg levels,pgRNA is a good indicator in predicting HBeAg clearance during pegylated interferon therapy.

Review on article of effects of tenofovir alafenamide and entecavir in chronic hepatitis B virus patients

This letter comments on the article which reported that tenofovir alafenamide may increase blood lipid levels compared with entecavir in patients with chronic hepatitis B published on World J Hepatol 2023 August 27.We review the related research content,topic selection,methodology,conclusions,strengths and weaknesses of this article.And evaluate it in relation to other published relevant articles.

Individualized management of pregnant women with high hepatitis B virus DNA levels

Hepatitis B is a major health concern in the Asia-Pacific region, and is endemic in China, Southeast Asia, and Africa. Chronic hepatitis B virus (HBV) infection may cause hepatic cirrhosis and liver cancer. It is estimated that there are more than 350 million chronic HBV carriers worldwide, of whom approximately one quarter will die of chronic hepatitis B-related liver diseases. HBV is transmitted horizontally through blood and blood products or by sexual transmission, and vertically from mother to infant. Perinatal infection is the predominant mode of transmission in countries with a high prevalence of hepatitis B surface antigen (HBsAg) carriage, and perinatal transmission leads to high rates of chronic infection. Therefore, it is important to prevent the mother-to-child transmission (MTCT) of HBV. Research has shown that pregnant women with high HBV DNA levels have an increased risk of MTCT. However, most of the obstetrics guidelines do not make a distinction between pregnant women with high HBV DNA levels and those who are HBsAg positive only. This review addresses the management of pregnant women with high levels of HBV viremia, in terms of antiviral therapy, use of hepatitis B immunoglobulin (HBIG), the combined application of hepatitis B vaccine and HBIG, choice of delivery mode and feeding practices. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.

Rapid quantification of hepatitis B virus DNA by real-time PCR using efficient TaqMan probe and extraction of virus DNA

AIM： To rapidly quantify hepatitis B virus （HBV） DNA by real-time PCR using efficient TaqMan probe and extraction methods of virus DNA. METHODS： Three standards were prepared by cloning PCR products which targeted S, C and X region of HBV genome into pGEM-T vector respectively. A pair of primers and matched TaqMan probe were selected by comparing the copy number and the Ct values of HBV serum samples derived from the three different standard curves using certain serum DNA. Then the efficiency of six HBV DNA extraction methods including guanidinium isothiocyanate, proteinase K, NaI, NaOH lysis, alkaline lysis and simple boiling was analyzed in sample A, B and C by real-time PCR. Meanwhile, 8 clinical HBV serum samples were quantified. RESULTS： The copy number of the same HBV serum sample originated from the standard curve of S, C and X regions was 5.7 × 10^4/mL, 6.3 × 10^2/mL and 1.6 × 10^3/ mL respectively. The relative Ct value was 26.6, 31.8 and 29.5 respectively. Therefore, primers and matched probe from S region were chosen for further optimization of six extraction methods. The copy number of HBV serum samples A, B and C was 3.49 × 10^9/mL, 2.08 × 10^6/mL and 4.40 × 10^7/mL respectively, the relative Ct value was 19.9, 30 and 26.2 in the method of NaOH lysis, which was the efficientest among six methods. Simple boiling showed a slightly lower efficiency than NaOH lysis. Guanidinium isothiocyanate, proteinase K and NaI displayed that the copy number of HBV serum sample A, B and C was around 10^S/mL, meanwhile the Ct value was about 30. Alkaline failed to quantify the copy number of three HBV serum samples. Standard deviation （SD） and coefficient variation （CV） were very low in all 8 clinical HBV serum samples, showing that quantification of HBV DNA in triplicate was reliable and accurate. CONCLUSION： Real-time PCR based on optimized primers and TaqMan probe from S region in combination with NaOH lysis is a simple, rapid and accurate method for quantification of HBV serum DNA.

220例血清HBV DNA≤2000 IU/mL的代偿期肝硬化患者肝功能评价指标、并发症分析

目的了解血清乙型肝炎病毒(HBV)DNA≤2000 IU/mL的乙型肝炎病毒(HBV)相关代偿期肝硬化患者的肝功能及并发症发生情况,为后续临床诊疗提供依据。方法220例血清HBV DNA≤2000IU/mL的HBV相关代偿期肝硬化患者,收集其肝功能评价指标资料和并发症资料。结果220例患者肝功能生化指标血清甲胎蛋白为4.80(2.12,8.35)ng/mL、总胆红素为18.90(14.10,28.76)μmol/L,白蛋白为39.35(34.60,43.90)g/L、肌酐为64(56,73.52)μmol/L、丙氨酸转氨酶为31.73(21.12,52.17)U/L、天冬氨酸转氨酶为30.35(23.85,48.85)U/L、γ-谷氨酰转肽酶42.70(24,66.08)U/L、碱性磷酸酶为82.05(63.38,113)U/L、血小板为105(57.25,158)×109/L、凝血酶原活动度为81.03%(66%,93.97%)、国际标准化比值为1.09(1.02,1.21);肝功能CTP分级以A级为主,终末期肝病模型评分(8.91±3.78)分、天冬氨酸转移酶及血小板比率指数(1.63±2.83)分、基于4因子的肝纤维化指数评分(4.84±5.28)分。220例患者中HBV DNA阳性(血清HBV DNA 100~2000 IU/mL)49例、乙肝表面抗原阳性183例、乙肝e抗原阳性151例。220例患者并发症发生情况为脾大103例、脾功能亢进110例、食管胃底静脉曲张74例、门静脉血栓6例、HCC 6例。与其他年龄比较,年龄<40岁的HBV相关代偿期肝硬化患者脾大发生率高(χ^(2)=6.864,P<0.05)。结论虽然血清HBV DNA≤2000 IU/mL的代偿期HBV相关肝硬化患者的肝功能基本正常,但部分指标处于正常范围的低值。血清HBV DNA≤2000 IU/mL的代偿期HBV相关肝硬化患者脾大、脾功能亢进等并发症发生率较高。

采用高敏检测技术检测血清HBV DNA载量筛选低病毒血症的无偿献血人群隐匿性乙型肝炎病毒感染研究

目的 探讨采用高敏检测技术检测血清乙型肝炎病毒(HBV)DNA筛选低病毒血症(LLV)的无偿献血人群隐匿性乙型肝炎病毒感染(OBI)的价值。方法 2017年2月~2021年12月我市收集的11352份血清HBsAg阴性的无偿献血人群血液标本,采用电化学发光法定性检测血清(HBeAg、HBeAb和HBcAb),定量检测血清HBsAb,使用AU5800型全自动生化分析仪检测血生化指标,使用ABI ViiA7型荧光定量PCR扩增仪,采用高敏PCR法检测血清HBV DNA载量,对所有经高敏PCR法检测为HBV DNA阳性的血清再使用Cobas AmpliPrep/Cobas TaqMan全自动核酸定量检测系统复核。结果 以全自动核酸定量检测系统检测结果为金标准,发现高敏PCR检测为HCV DNA阳性的67例(0.59%)为LLV人群,结果显示,该方法诊断OBI人群LLV的灵敏度和特异度均为100.0%和100.0%;金标准方法与高敏PCR检测血清HCV DNA载量差异无统计学意义【(110.7±20.2)IU/ml对(108.2±19.6)IU/ml,P>0.05】;经高敏PCR法检验发现,LLV人群血清HBV DNA载量为100~200 IU/ml者41例(61.2%),20~100 IU/ml者15例(22.4%),和<20 IU/ml者11例(16.4%);5例血清HBsAb/HBeAb/HBcAb阳性人群血清HBV DNA载量为(162.4±18.3) IU/ml,显著高于9例血清HBcAb阳性人群【(82.3±14.1)IU/ml,P<0.05】或16例HBeAb/HBcAb阳性人群【(136.9±15.7)IU/ml,P<0.05】或32例HBsAb/HBcAb阳性人群【(99.3±15.5)IU/ml,P<0.05】或3例HBsAb阳性人群【(71.5±12.9)IU/ml,P<0.05】或2例血清HBV标志物全阴性人【分别为55.0 IU/ml和56.1 IU/ml】。结论 采用高敏PCR法检测血清HBV DNA载量能够在献血员人群中筛选LLV的OBI感染者,为临床用血安全又加了一道保险。

昆明地区低病毒载量慢性乙肝患者血清高敏HBV DNA检测分析

目的 探讨昆明地区持续低水平病毒血症的慢乙肝患者,高敏HBV-DNA载量、HBV的基因型分布特点、HBV P区耐药位点的突变特征,和HBeAg、HBsAg、ALT之间的关系及临床应用价值。方法 采集2021年1月至2021年12月期间于昆明市第三人民医院就医的707例慢性乙肝患者的血清,分析高敏HBVDNA、HBV的基因型以及HBV P区的耐药位点突变情况,并分析不同HBV-DNA载量与HBeAg、 HBsAg、ALT之间的关系。结果 研究707例持续低载量慢性乙肝患者中,高敏HBV DNA(<500 IU/mL)446例,占(63.50%),高敏HBV DNA小于2 000 IU/mL的慢乙肝患者共有576例,占(81.90%);HBeAg阳性262例(37.05%);基因分型以C基因型占比最高60.53%(428/707)。在196例HBeAg阳性且HBV DNA <2 000 IU/mL患者组中,男性为主,占69.89%;ALT> 40 U/L占28.57%,有73.47%患者的HBV DNA> 20 IU/mL。在265例HBV DNA <20 IU/mL的患者中,80.38%(213例)患者HBeAg阴性,19.62%(52例)HBeAg呈阳性。临床指标比较,HBeAg阳性率、ALT异常率、耐药位点和其它位点突变率在HBV DNA载量水平不相同组之间差异有统计学意义(P <0.05)。结论 对持续低水平病毒血症的慢性乙型肝炎患者,选择高敏的PCR技术定期监测乙肝病毒HBV DNA,结合HBeAg、HBsAg、ALT等临床指标的定量监测,可为后续患者的临床治疗提供客观的参考依据。

Modified model for end-stage liver disease improves shortterm prognosis of hepatitis B virus-related acute-on-chronic liver failure

AIM To investigate whether the short-term prognosis of hepatitis B virus(HBV)-related acute-on-chronic liver failure(ACLF) could be improved by using a modified model for end-stage liver disease(MELD) including serum lactate.METHODS This clinical study was conducted at the First Affiliated Hospital, Fujian Medicine University, China. From 2009 to 2015, 236 patients diagnosed with HBV-related ACLF at our center were recruited for this 3-month followup study. Demographic data and serum lactate levels were collected from the patients. The MELD scores with or without serum lactate levels from survival and nonsurvival groups were recorded and compared.RESULTS Two hundred and thirty-six patients with HBV-ACLF were divided into two groups: survival group(S) andnon-survival group(NS). Compared with the NS group, the patients in survival the S group had a significantly lower level of serum lactate(3.11 ± 1.98 vs 4.67 ± 2.43, t = 5.43, P < 0.001) and MELD score(23.33 ± 5.42 vs 30.37 ± 6.58, t = 9.01, P = 0.023). Furthermore, serum lactate level was positively correlated with MELD score(r = 0.315, P < 0.001). Therefore, a modified MELD including serum lactate was developed by logistic regression analysis(0.314 × lactate + 0.172 × MELD-5.923). In predicting 3-month mortality using the MELD-LAC model, the patients from the S group had significantly lower baseline scores(-0.930 ± 1.34) when compared with those from the NS group(0.771 ± 1.32, t = 9.735, P < 0.001). The area under the receiver operating characteristic curve(AUROC) was 0.859 calculated by using the MELD-LAC model, which was significantly higher than that calculated by using the lactate level(0.790) or MELD alone(0.818). When the cutoff value was set at-0.4741, the sensitivity, specificity, positive predictive value and negative predictive value for predicting short-term mortality were 91.5%, 80.10%, 94.34% and 74.62%, respectively. When the MELD-LAC scores at baseline level were set at-0.5561 and 0.6879, the corresponding mortality rates within three months were 75% and 90%, respectively.CONCLUSION The short-term prognosis of HBV-related ACLF was improved by using a modified MELD including serum lactate from the present 6-year clinical study.

Prognostic value of M30/M65 for outcome of hepatitis B virus-related acute-on-chronic liver failure

AIM: To determine the prognostic value of circulating indicators of cell death in acute-on-chronic liver failure (ACLF) patients with chronic hepatitis B virus (HBV) infection as the single etiology. METHODS: Full length and caspase cleaved cytokeratin 18 (detected as M65 and M30 antigens) represent circulating indicators of necrosis and apoptosis. M65 and M30 were identified by enzyme-linked immunosorbent assay in 169 subjects including healthy controls (n = 33), patients with chronic hepatitis B (CHB, n = 55) and patients with ACLF (n = 81). According to the 3-mo survival period, ACLF patients were defined as having spontaneous recovery (n = 33) and non-spontaneous recovery which included deceased patients and those who required liver transplantation (n = 48). RESULTS: Both biomarker levels significantly increased gradually as liver disease progressed (for M65: P < 0.001 for all; for M30: control vs CHB, P = 0.072; others: P < 0.001 for all). In contrast, the M30/M65 ratio was significantly higher in controls compared with CHB patients (P = 0.010) or ACLF patients (P < 0.001). In addition, the area under receiver operating characteristic curve (AUC) analysis demonstrated that both biomarkers had diagnostic value (AUC >= 0.80) in identifying ACLF from CHB patients. Interestingly, it is worth noting that the M30/M65 ratio was significantly different between spontaneous and non-spontaneous recovery in ACLF patients (P = 0.032). The prognostic value of the M30/M65 ratio was compared with the Model for End-Stage Liver Disease (MELD) and Child-Pugh scores at the 3-mo survival period, the AUC of the M30/M65 ratio was 0.66 with a sensitivity of 52.9% and the highest specificity of 92.6% (MELD:AUC = 0.71; sensitivity, 79.4%; specificity, 63.0%; Child-Pugh: AUC = 0.77; sensitivity, 61.8%; specificity, 88.9%). CONCLUSION: M65 and M30 are strongly associated with liver disease severity. The M30/M65 ratio may be a potential prognostic marker for spontaneous recovery in patients with HBV-related ACLF. (C) 2014 Baishideng Publishing Group Co., Limited. All rights reserved.

Mutations in hepatitis B virus core regions correlate with hepatocellular injury in Chinese patients with chronic hepatitis B

AIM: To elucidate the relationship between the frequency of core mutations and the clinical activity of hepatitis B virus (HBV)-related liver disease and to characterize the amino acid changes in the core region of HBV.METHODS: We studied 17 Chinese patients with chronic hepatitis B according to their clinical courses and patterns of the entire core region of HBV.RESULTS: Amino acid changes often appeared in the HBV core region of the HBV gene in patients with high values of alanine aminotransferase (ALT) or with the seroconversion from HbeAg to anti-HBe. The HBV core region with amino acid changes had high frequency sites that corresponded to HLA Ⅰ/Ⅱ restricted recognition epitopes reported by some investigators.CONCLUSION: The core amino acid changes of this study occur due to influence of host immune system. The presence of mutations in the HBV core region seems to be important for predicting the clinical activity of hepatitis B in Chinese patients.

乙型肝炎病毒前S1抗原与HBV DNA和HBV-M及肝功能的相关性探讨

目的探讨兰州地区乙型肝炎病毒(HBV)感染者血清中前S1抗原(Pre-S1Ag)与HBV DNA、HBV-M及肝功能之间的相关性。方法对905例HBV感染者(HBV感染组)及100例健康体检者(健康对照组)进行Pre-S1Ag、HBV-M、HBV DNA和肝功能检测。结果 905例标本中,Pre-S1Ag和HBV DNA阳性率分别为68.51%(620/905)和67.96%(615/905),差异均无统计学意义(χ2=30.064,P>0.05);570例HBeAg阳性组中,HBV Pre-S1阳性率为85.08%(485/570),显著高于HBeAg阴性组的Pre-SAg1阳性率40.30%(135/335),差异有统计学意义(χ2=108.881,P<0.01)。Pre-S1Ag阳性组与阴性组ALT、AST异常率分别为53.22%、25.96%和51.29%、32.98%,差异有统计学意义(χ2ALT=53.148,P<0.001,χ2AST=66.635,P<0.001)。结论 Pre-S1Ag是乙肝病毒感染与复制的可靠指标,与HBV-DNA阳性相关度高,是对HBeAg的重要补充和加强,可为指导临床治疗提供更及时可靠的实验依据。

乙肝病毒血清标志物与HBV DNA载量及肝功能指标的关联性

目的探讨外周血中乙肝病毒血清标志物(hepatitis B virus serum markers,HBV-M)、HBV DNA载量和反映肝损伤的肝功能指标之间的关联性。方法回顾分析2014年3月~2016年3月同济医院483例慢性乙型肝炎患者资料,HBV-M采用微粒子化学发光技术定量检测;HBV DNA采用实时荧光定量PCR检测;谷丙转氨酶(ALT)和谷草转氨酶(AST)采用紫外连续监测法检测。结果 HBsAg的含量与HBV DNA载量、ALT异常比例(>41U/L)和AST异常比例(>35U/L)之间均无关联性(均P>0.05);HBeAg的含量与HBV DNA载量和ALT异常比例之间均无关联性(均P>0.05),但与AST异常比例有关联,关联程度不密切(r=0.21,P<0.01);抗-HBe的含量与HBV DNA载量和AST异常比例之间有关联性,但关联程度不密切(r=0.16,P<0.05;r=0.19,P<0.01),与ALT异常比例之间无关联性(P>0.05);抗-HBc的含量与HBV DNA载量、ALT异常比例和AST异常比例之间均有关联性,但关联程度不密切(r=0.25,P<0.01;r=0.29,P<0.01;r=0.29,P<0.01);HBV DNA载量的对数值与ALT和AST呈正相关,但线性相关程度较弱(r=0.24;r=0.29)。结论乙肝病毒血清标志物定量检测和HBV DNA定量检测,二者相互补充但不能取代,同时联合肝功能各项指标的检测,更有助于了解肝组织的受损程度。

HBV前S1抗原与HBV DNA联合检测的临床意义

目的探讨乙型肝炎病毒前S1抗原(HBV pre-Sl)、HBV DNA与HBV表面标志物(HBV-M)的关系。方法从临床乙型肝炎标本中筛出HBsAg阳性病例329例,采用ELISA法检测乙肝血清标志物和前S1抗原,荧光定量PCR法检测标本HBV DNA。结果血清HBeAg抗原阳性组,HBV DNA和pre-Sl的阳性率分别为97.2%和90.0%,而HBeAg抗原阴性组的HBV DNA与pre-Sl阳性率分别为42.9%和37.0%,HBeAg阳性患者血清的HBV DNA与pre-Sl的阳性检出率明显高于HBeAg阴性患者。结论 HBV pre-Sl和HBV DNA在各组中阳性检出率有较高的一致性,pre-Sl在一定程度上可替代HBV DNA。pre-Sl与乙肝血清标志物联合检测能为乙肝患者病毒复制、肝功能损伤提供有价值的实验室依据,同时有助于慢性乙肝患者疗效考核和预后判断。

血清乙肝病毒大蛋白在HBeAg阴性和低水平HBV-DNA乙肝患者中的检测意义

为了探讨血清乙肝病毒大蛋白在HBeAg阴性与低水平HBV-DNA乙肝患者中的检测意义。对162例HBV感染者及47名健康对照血清采用酶联免疫吸附试验检测乙肝病毒大蛋白、乙肝病毒前S1抗原、病毒前S2抗原及乙肝病毒标志物;FQ-PCR定量检测HBV-DNA。结果显示:162例HBV感染者血清中,HBV-LP浓度与HBV-DNA拷贝数间具有良好的正相关性(rs=0.64,P<0.001),不同HBV-DNA拷贝数组别间HBV-LP浓度存在差异显著性(P<0.01);HBV-LP与HBV-DNA、HBeAg、HBVpreS2、HBVpreS1间均关联显著(P<0.01)。HBV-LP与HBV-DNA、HBeAg、HBVpreS2、HBVpreS1间阳性率均存在差异显著性(P<0.05),HBV-LP阳性率为84.57%,较HBV-DNA、HBeAg、HBVpreS2、HB-VpreS1均敏感。其中HBeAg阴性组中HBV-LP与HBVpreS1、HBVpreS2、HBV-DNA间阳性率均存在差异显著性(P<0.05),HBV-LP阳性率为76.77%(76/99),较HBV-DNA,HBVpreS2,HBVpreS1均高(P<0.01);DNA阴性组中HBV-LP与HBVpreS2、HBVpreS1、HBeAg间阳性率均存在差异显著性(P<0.05),HBV-LP阳性率为73.33%,较HB-VpreS2、HBVpreS1、HBeAg均高。血清HBV-LP浓度是反映血清HBeAg阴性和低水平DNA的HBV感染者体内病毒复制、疾病进程、疗效与预后判断的新的敏感监测指标。

HBV-DNA低复制慢性乙肝患者血清HA、LN、PcⅢ、CⅣ水平与肝纤维化病理分期相关性分析

目的研究HBV-DNA低复制、肝功能基本正常或轻微异常的慢性乙肝患者(chronic hepatitis B,CHB)肝纤维化血清指标与肝组织纤维化程度之间的关系。方法选择84例HBV-DNA低复制、肝功基本正常或轻微异常的CHB患者,采用双抗体夹心酶联免疫法检测血清透明质酸(HA)、层粘连蛋白(LN)、Ⅲ型胶原(PcⅢ)、Ⅳ型胶原(CⅣ)水平,并与其肝组织病理分期进行对比研究。结果不同年龄段的HBV-DNA低复制、肝功基本正常或轻微异常的CHB患者其HA、LN、PcⅢ、CⅣ水平均具有显著性差异(P<0.01),血清HA、PcⅢ和CⅣ水平随着肝内纤维化程度的加重而递增,并与肝纤维化程度呈正相关,而LN水平在肝纤维化各期无明显差异,与肝纤维化程度无明显相关性(P>0.05)。结论对于不同年龄段的HBV-DNA低复制、肝功基本正常或轻微异常的CHB患者,血清肝纤维化指标可作为反映此类患者肝纤维化程度的参考指标,并对该类患者治疗时期的选择具有一定的指导意义。

联合检测血清标志物、ALT和HBV-DNA对乙型肝炎患者诊疗的临床意义

目的通过联合检测乙型肝炎血清标志物、ALT和HBV-DNA,分析三者之间的相关性。方法分别采用ELISA、实时荧光定量聚合酶链反应(FQ-PCR)和IFCC双试剂酶法对682例乙型肝炎患者HBV血清标志物(HBsAg、HB-sAb、HBeAg、HBeAb、HBcAb)、HBV-DNA载量和ALT水平进行测定。结果 682例乙型肝炎患者中,有373例检测出HBV-DNA阳性,阳性率为54.69%;以模式Ⅰ组(HBsAg+HBeAg+HBcAb阳性)和模式Ⅱ组(HBsAg+HBeAg阳性)HBV-DNA阳性率和平均载量为最高,且明显高于模式Ⅲ(HBsAg+HBcAb阳性)、模式Ⅳ组(HBsAg+HBeAb+HBcAb阳性)和模式Ⅴ组(HBcAb阳性)(P<0.05);模式Ⅰ组ALT阳性率、平均含量明显高于其它组(P<0.01)。在HBV-DNA阳性患者中,HBV-DNA载量与ALT水平呈正相关。结论 HBV-DNA载量与血清标志物以及ALT水平之间存在着一定的关系,但三者反映的是疾病的不同方面。在HBV感染的诊疗过程中,联合检测血清标志物、HBV-DNA载量和ALT水平,在判断病情转归、抗病毒疗效观察等方面具有重要意义。

HBV感染血清标志物、HBV DNA水平与性别的关系

探讨HBV感染者血清标志物、HBVDNA水平和性别之间的关系。选择 4 95例HBsAg阳性的血清标本和5 0 2例HBVDNA高于 1× 10 8copy/ml以上的血清标本 ,分别通过ELISA法以及实时荧光定量法进行HBV感染血清标志物HBVDNA的检测。三种组合〔组合 1为HBsAg(+)HBeAg(+)抗 -HBc(+) ,组合 2为HBsAg(+)抗 -HBe(+)抗 -HBc(+) ,组合 3为HBsAg(+)抗 -HBc(+)〕的HBVDNA阳性率 (分别为 95 %、18%和 5 3% )存在极显著差异 (P <0 0 1) ;女性在HBeAg阴性模式中的比例与在HBeAg阳性模式中的比例差异显著 (P <0 0 5 )。HBV感染血清标志物、HBVDNA水平和性别之间存在着重要的关系 ;对于组合 3的患者要给予足够重视 ;女性在高HBVDNA水平而且HBeAg阴性组合中的比例非常小 ,这也许与女性在肝癌患者中所占比例较低存在着一定的关系。

慢性乙型肝炎病毒感染者外周血T细胞亚群变化与其血清HBV DNA的水平分析

目的观察慢性乙肝病毒(HBV)感染者细胞免疫功能的变化,探讨病毒复制程度与细胞免疫功能的关系。方法应用流式细胞仪直接免疫荧光法检测230例乙肝病毒感染者5、0例正常对照外周血T细胞亚群百分率,用荧光定量PCR法检测乙肝感染者血清HBV DNA。结果HBV感染者外周血CD4+T细胞百分率及CD4+/CD8+比值较正常对照组明显减低(36.8±10.6%vs 39.4±9.8%,P<0.05;1.5±0.8 vs 1.9±0.9,P<0.01),CD8+T细胞百分率明显升高(27.9±8.3%vs 24.1±7.0%,P<0.01),而CD3+T细胞百分率无明显差异(70.2±10.3%vs 69.9±5.2%,P>0.05)。根据HBV感染者血清中HVB DVA载量的高低,将它们分为低拷贝组(103-104copies/ml),高拷贝组(105-108copies/ml)以及DNA阴性组(<102copies/ml)。低拷贝组和高拷贝组的CD4+T细胞百分率及CD4+/CD8+比值比对照组明显减低(36.4±10.9%vs 39.4±9.8%,P<0.05;36.4±10.9%vs 39.4±9.8P<0.05;1.5±0.9 vs 1.9±0.9,P<0.01;1.1±0.7 vs 1.9±0.9,P<0.01),高拷贝组的CD4+/CD8+比值比低拷贝组和DNA阴性组明显减低(1.1±0.7 vs 1.5±0.9,P<0.01;1.1±0.7 vs 1.6±0.8,P<0.01),CD8+细胞百分率明显高于对照组和DNA阴性组(29.4±8.4%vs 24.1±7.0%,P<0.01;29.4±8.4%vs 25.7±7.3%vs 24.1±7.0%P<0.05)。而CD3+T细胞百分率在各组之间没有明显差异存在(P>0.05),CD4+在低、高拷贝组及DNA阴性组之间虽无明显差异存在(P>0.05),但随着DNA复制的增加,CD4+呈逐渐减少趋势。结论HBV感染可导致感染者细胞免疫功能的改变,HBA DNA复制增加进一步加重乙肝病毒感染者T细胞亚群的率乱,CD4+/CD8+比值的动态变化可及时提示临床HBV感染者细胞免疫功能的变化并加强临床的临测。

乙肝病毒外膜大蛋白、前S1抗原、HBV-DNA与血清标志物之间相关性分析

目的通过对乙型肝炎患者HBV-LP、Pre-S1抗原、HBV-DNA载量和乙型肝炎血清标志物的检测,探讨反映不同血清学类型患者体内病毒复制及抗病毒疗效监测的最佳指标以及分析各指标之间的关系。方法对864例HBV感染者及100例健康体检者血清采用ELISA法定性检测HBV-M;ELISA双抗体夹心法检测HBV-LP、Pre-S1;荧光定量PCR法检测HBV-DNA。结果 HBsAg、HBeAg、HBcAb阳性模式组(大三阳)HBV-LP、Pre-S1及HBVDNA阳性率显著高于其它HBV-M模式组(P<0.05);HBV-LP与HBV-DNA的阳性率无显著差异(P>0.05),PreS1的阳性率明显低于HBV-LP与HBV-DNA的阳性率(P<0.05);HBV-DNA拷贝数与HBV-LP、Pre-S1平均A值具有明显的相关性(相关系数r=0.926),而与HBsAg定量值无明显相关性。结论 HBV-LP比Pre-S1试剂效果大大提高,且大蛋白的检出率与血液中病毒DNA的检出高度符合,对于判断病毒复制具有重要意义,可作为HBeAg及HBV-DNA的补充检测指标。

乙肝病毒携带产妇血清标志物模式与血清及乳汁HBV-DNA相关性研究

目的通过检测分析乙肝病毒携带产妇血清学标志物与血清、乳汁HBV-DNA阳性率的关系,以及产妇血清与乳汁中HBV-DNA含量之间的相关性,旨在指导母乳喂养。方法选取96例乙肝病毒携带产妇,将其分为大三阳组(54例)、小三阳组(25例)、HbsAg和HbeAg均阳性组(8例)及HbsAg和HbcAb均阳性组(9例)。另选取12例乙肝两对半全阴的产妇作为对照组。ELISA法检测乙肝病毒携带产妇乙肝免疫血清学标志物,实时荧光定量PCR法分别检测产妇血清与乳汁中HBV-DNA含量,并对所有检测指标进行相关性分析。结果大三阳组产妇血清和乳汁HBV-DNA阳性率明显高于其他三组(P<0.05)。乳汁HBV-DNA在各组中检出的阳性率均小于血清HBV-DNA,但两者差异无统计学意义(P>0.05)。根据乙型肝炎血清学标志物HBeAg是否阳性将96例产妇分为HBeAg阳性组(62例)和HBeAg阴性组(34例),血清HBeAg阳性产妇的血清和乳汁中HBV-DNA阳性率均明显高于HBeAg阴性产妇,差异具有统计学意义(P<0.01)。但一部分血清HBeAg阴性产妇血清和乳汁中HBV-DNA亦为阳性。产妇血清与乳汁中HBV-DNA含量呈正相关(r=0.891,P<0.05)。结论乙肝病毒携带产妇乳汁HBV-DNA检出的阳性率低于血清HBV-DNA,且乳汁HBV-DNA含量随血清HBV-DNA含量的升高而增大,因此定量双重检测产妇血清、乳汁中HBV-DNA来确定母婴乙肝病毒传播的风险性更为可靠,这将有利于阻断乙肝传播,确定哺乳方式,指导母乳喂养,从而降低乙肝新生儿感染率。