A nested case-control study of maternal-neonatal transmission of hepatitis B virus in a Chinese population

AIM:To examine the determinants of maternal-neonatal transmission of hepatitis B virus(HBV) METHODS:A nested case-control study was conducted in Changsha,Hunan,People's Republic of China from January 1,2005 to September 31,2006 To avoid potential maternal blood contamination,we collected vein blood of newborns immediately after birth and before initial hepatitis B vaccination to determine the HBV infection status of the newborn For each HBsAg-positive infant,one HBsAg-negative infant born to an HBsAg-positive mother was matched by hospital at birth(same),gender(same),and date of birth(within 1 mo) A faceto-face interview was conducted to collect clinical and epidemiological data Conditional logistic regression analysis was used to estimate the independent effects of various determinants on maternal-neonatal transmission of HBV RESULTS:A total of 141 HBsAg-positive infants and 141 individually matched HBsAg-negative infants were included in the final analysis Maternal first-degree family history of HBV infection,intrahepatic cholestasis,and premature rupture of membranes were risk factors for perinatal transmission of HBV,whereas systematic treatment and HBV immunoglobulin injections for mothers with HBV infection were protective factors for maternal-neonatal transmission of HBV,after adjustment for potential confounding factors CONCLUSION:For HBsAg-positive mothers,systematic treatment,HBV immunoglobulin administration,and controlling intrahepatic cholestasis and pregnancy complications may reduce the incidence of perinatal transmission of HBV.

Association between diabetes mellitus,hypertension,hyperlipidemia,chronic viral hepatitis,and the risk of multiple myeloma:a case-control study

Objective This case-control study aimed to investigate whether diabetes mellitus(DM),hypertension,hyperlipidemia,and chronic viral hepatitis are risk factors for multiple myeloma(MM).Moreover,the clinical characteristics of MM patients with or without the abovementioned exposure factors were analyzed.Methods In total,340 MM patients and 680 patients with benign diseases who were hospitalized from January 2012 to December 2017 were classified under the case group and control group,respectively.Data about medical history of DM,hypertension,hyperlipidemia and chronic viral hepatitis were collected by reviewing medical records.Univariate and multivariate analyses were conducted to compare the history of DM,hypertension,hyperlipidemia,and viral hepatitis between the two groups.Considering DM,hypertension,hyperlipidemia,and chronic viral hepatitis as exposure factors,clinical characteristics,such as renal function and presence of fungal and other types of infections,between the exposed and nonexposed groups were analyzed.Results No significant difference was observed in the prevalence of DM,hypertension,and hyperlipidemia between the case and control groups.MM patients had a higher prevalence of chronic viral hepatitis than those with benign diseases.No significant difference was observed in the prevalence of renal dysfunction,fungal infection,and non-fungal infections in MM patients with or without DM,hypertension,and hyperlipidemia.MM patients with chronic viral hepatitis had a significantly higher prevalence of nonfungal infections during hospitalization than those without.Conclusion No significant association was noted between MM and DM,hypertension,and hyperlipidemia.Chronic viral hepatitis is correlated to a significantly higher risk of MM,and MM patients with chronic viral hepatitis were more susceptible to non-fungal infections during hospitalization.Although a non-significant trend was observed in this study,we believe that DM and hypertension might be associated with a higher risk of MM.Thus,large-scale studies must be conducted to validate the results of the current study.

Risk factors for liver-related mortality in chronic hepatitis C patients:A deceased case-living control study

AIM:To investigate the risk factors for liver-related mortality in chronic hepatitis C(CHC)patients.METHODS:All deceased CHC inpatient data were collected from the Beijing 302 Hospital clinical database,which includes more than 8250 CHC inpatients during the period from 2002 to 2012.The controls were matched to cases by age(±2 years),sex and date of hospital admission(within the same year).Potential risk factors were included for the evaluation,and odds ratios(OR)and 95%CI were estimated using univariate(unadjusted)and multivariate(adjusted OR,AOR)conditional logistic regression.All statistical tests were two-sided.P values<0.05 were considered statistically significant.RESULTS:Based on examinations of 144 CHC-related deceased cases and 576 controls,we found that antiviral therapy with interferon-αwas associated with a 47%decrease in the risk of hepatic mortality(AOR=0.53,95%CI:0.28-0.99,P=0.048).Additionally,the initial diagnostic stage of the disease(AOR=2.89,95%CI:1.83-4.56 and P<0.001 for liver cirrhosis/AOR=8.82,95%CI:3.99-19.53 and P<0.001for HCC compared with CHC),diabetes(AOR=2.35,95%CI:1.40-3.95,P=0.001),hypertension(AOR=1.76,95%CI:1.09-2.82,P=0.020),alcohol consumption(AOR=1.73,95%CI:1.03-2.81,P=0.037)and HBsAg positivity(AOR=22.28,95%CI:5.58-89.07,P<0.001)were associated with a significant increase in the risk of liver-related mortality in CHC patients.CONCLUSION:This study indicates that interferon-αtreatment,the stage at the initial diagnosis of the disease and comorbidities are all independent risk factors for liver-related mortality in CHC patients.

Natural history of chronic hepatitis C in patients on hemodialysis: Case control study with 4-23 years of follow-up

AIM: Hepatitis C virus (HCV) infection is very common among end-stage kidney disease patients on hemodialysis, but its natural history is not known.METHODS: In this study, 189 dialysis patients (case) positive for HCV antibodies who were followed up for more than 4 years were compared with twice as many sex/age matched controls with chronic hepatitis C who were diagnosed in the same month as the case and followed up for comparableperiods. The longest follow-up was 23 years in dialysis cases.The disease activities were graded into 'asymptomatic' if ALT was less than 40 (35 in cases) IU/L, 'low activities' if ALT was 40 (35)-79 IU/L, and 'high activities' if ALT was above 80 IU/L during the last or latest 4 year period.RESULTS: All 25 dialysis cases who were followed up for more than 15 years were asymptomatic and 15 of them were negative for HCV RNA. Of the 50 controls followed up for more than 15 years, 34 had high acvities, and none deared HCV RNA. There were 60 controls who were asymptomatic,but they were all positive for HCV RNA, while 22.3% of asymptomatic dialysis cases were RNA negative. No dialysispatients with chronic hepatitis C progressed to cirrhosis,whereas the disease progressed to cirrhosis in more thanone quarter of the controls. These differences were highlysignificant (P<0.0001).CONCLUSION: Chronic hepatitic C among hemodialysispatients is mild in disease activity, and is not progressive,perhaps due to immunological abnormalities in these patients.Hepatic C virus is frequently cleared in asymptomatic dialysispatients during a long course. A possible mechanism forviral clearance is viral particle destruction on the surface ofthe dialyzer membrane.

High level of serum cholesteryl ester transfer protein inactive hepatitis C virus infection

AIM: To determine the significance of cholesteryl ester transfer protein(CETP) in lipoprotein abnormalities in chronic hepatitis C virus(HCV) infection.METHODS: We evaluated the significance of the serum concentration of CETP in 110 Japanese patients with chronic HCV infection. Fifty-five patients had active HCV infection, and HCV eradication had been achieved in 55. The role of CETP in serum lipoprotein abnormalities, specifically, in triglyceride(TG) concentrations in the four major classes of lipoproteins, was investigated using Pearson correlations in conjunction with multiple regression analysis and compared them between those with active HCV infection and those in whom eradication had been achieved. RESULTS: The serum CETP levels of patients with active HCV infection were significantly higher than those of patients in whom HCV eradication was achieved(mean ± SD, 2.84 ± 0.69 μg/m L vs 2.40 ± 1.00 μg/m L, P = 0.008). In multiple regression analysis, HCV infection status(active or eradicated) was an independent factor significantly associated with the serum CETP level. TG concentrations in low-density lipoprotein(mean ± SD, 36.25 ± 15.28 μg/m L vs 28.14 ± 9.94 μg/m L, P = 0.001) and high-density lipoprotein(HDL)(mean ± SD, 25.9 ± 7.34 μg/m L vs 17.17 ± 4.82 μg/m L, P < 0.001) were significantly higher in patientswith active HCV infection than in those in whom HCV eradication was achieved. The CETP level was strongly correlated with HDL-TG in patients with active HCV infection(R = 0.557, P < 0.001), whereas CETP was not correlated with HDL-TG in patients in whom HCV eradication was achieved(R =-0.079, P = 0.56). CONCLUSION: Our results indicate that CETP plays a role in abnormalities of lipoprotein metabolism in patients with chronic HCV infection.

原发性肝癌发病影响因素的病例对照研究

目的:探讨原发性肝癌的主要危险因素,为肝癌的病因预防和人群预防提供依据。方法:以2009年4月至2011年11月在河南省肿瘤医院住院的原发性肝癌患者323例和同时期住院的其他非肝癌患者443例为对象进行病例对照研究,经过单因素和多因素非条件logistic回归分析筛选出原发性肝癌发病的影响因素。结果:多因素非条件logistic回归分析结果表明:男性中,HBV感染、吸烟、剩饭菜、腌制食品、饮酒、饮茶、蔬菜的OR值及95%CI分别为33.532(13.943～80.644,P<0.001)、4.180(1.808～9.667,P=0.001)、4.173(2.205～7.901,P<0.001)、2.915(1.178～7.218,P=0.021)、1.378(1.011～1.878,P=0.042)、0.199(0.075～0.525,P=0.001)、0.053(0.026～0.106,P<0.001);女性中,HBV感染、饮酒、油多的饭菜、剩饭菜、文化程度、蔬菜、饮茶的OR值及95%CI分别为41.949(8.548～205.857,P<0.001)、37.012(1.266～108.246,P=0.036)、5.375(1.297～22.271,P=0.020)、4.254(1.727～10.480,P=0.002)、0.098(0.029～0.334,P<0.001)、0.011(0.002～0.055,P<0.001)、0.010(0.001～0.194,P=0.002)。结论:HBV感染、吸烟、饮酒、吃剩饭菜、吃腌制食品及油多的饭菜可能是肝癌发生的危险因素;高文化程度、常吃蔬菜、饮茶是肝癌发生的保护因素。

乙型肝炎病毒宫内感染的机制

目的 探索乙型肝炎病毒 (HBV)宫内传播的机制和时间 .方法 孕妇和新生儿血清 HBs Ag和 HBV DNA检测采用 EL ISA和 PCR法 .引产胎儿肝组织和胎盘的 HBs Ag,HBx Ag,HBc Ag和 HBV DNA检测采用 ABC免疫组化染色和原位杂交 .结果 母亲外周血 HBV 高浓度 (≥ 0 .0 2μg· L- 1 )、先兆早产和胎盘绒毛毛细血管内皮细胞 HBV感染导致宫内感染发生的危险性比值比 (OR)分别为 7.0 6 ,13.0 8和 16 .15 .胎盘 HBV感染从孕早期、孕中期至足月分娩愈来愈严重且广泛 .在足月分娩胎盘中 ,从母面蜕膜细胞至胎儿面绒毛毛细血管内皮细胞 HBV感染率呈逐渐下降趋势 ,但胎儿宫内感染的 OR值却越来越大 .1例孕 19wk引产胎儿肝组织中检出 HBV DNA和抗原 .结论 胎儿宫内感染的发生可经 2条途径 ,即血源性和细胞性 .宫内感染可发生在孕19 wk前 ,但主要时期是在孕晚期 .

广州地区肝细胞癌与HCV、HBV感染关系的病例对照研究

在肝细胞癌（ＨＣＣ）中度流行区广州地区，对６４例ＨＣＣ患者抗－ＨＣＶ和ＨＢｓＡｇ状况按性别、年龄配对和１：２数量比设对照组进行了病例对照研究。结果表明：ＨＣＣ组抗－ＨＣＶ和ＨＢｓＡｇ阳性率分别为１８．７５％（１２／６４）和８４．３８％（５４／６４），分别显著高于对照组的２．３４％（３／１２８，Ｐ＜０．００１）和１４．０６％（１８／１２８，Ｐ＜０．００１）。与抗－ＨＣＶ、ＨＢｓＡｇ双阴性组比较，仅抗－ＨＣＶ阳性，仅ＨＢｓＡｇ阳性时发生ＨＣＣ的相对危险度分别为４６．７１和４３．７９，二者双阳性时上升至７０．０７。显示ＨＣＶ、ＨＢＶ均与ＨＣＣ显著相关，两者重叠感染具有协同致癌作用。作者提出预防和控制ＨＢＶ、ＨＣＶ感染对降低ＨＣＣ发病率意义重大。

贵州省原发性肝癌危险因素的病例对照研究

目的：探讨贵州省人群原发性肝癌（PHC）常见的危险因素。方法采用成组病例对照研究，通过非条件Logistic回归分析及分层分析，对贵州省人群PHC常见的危险因素，以及饮酒合并乙型肝炎病毒感染与PHC发生的关系进行分析。结果饮酒（OR＝2．948，95％CI2．096～4．146，P＝0．000）、5年前经济状况（OR＝0．386，95％CI0．279～0．534，P＝0．000）、肝癌家族史（OR＝2．402，95％CI1．372～4．206，P＝0．002）、吸烟（OR＝3．468，95％CI2．265～5．311，P＝0．000）、慢性肝病史（OR＝1．502，95％CI1．054～2．141，P＝0．024）、乙型肝炎病毒感染（OR＝31．999，95％CI19．318～53．002，P＝0．000）、糖尿病史（OR＝4．750，95％CI2．761～8．171，P＝0．000）在病例组和对照组间的差异有统计学意义；饮酒合并乙型肝炎病毒感染者OR值达96．903（95％CI35．265～266．275，P＝0．000）。结论乙型肝炎病毒感染仍为贵州省人群PHC常见的危险因素，而饮酒可增加乙型肝炎病毒感染者患PHC的风险。

六味五灵片治疗慢性乙型肝炎多中心随机对照研究

目的:观察六味五灵片治疗慢性乙型肝炎(CHB)的临床疗效和安全性。方法:采用多中心、随机、对照方法。治疗组324例,口服六味五灵片;对照组108例,口服联苯双酯滴丸。研究分临床治疗阶段和随访阶段。临床治疗阶段6个月,分为常规量治疗期3个月和减量治疗期3个月两个分阶段。在完成6个月的治疗后,ALT恢复正常或下降75%的病例进入随访阶段。随访阶段为3个月。结果:两组患者治疗3个月及6个月后肝功能及中医证候均有明显改善;在降低AST水平方面,六味五灵片治疗组明显高于联苯双酯滴丸对照组(P<0.01、P<0.05),且AST复常的总有效率亦明显高于对照组(P<0.05)。两组病例治疗结束后随访3个月,治疗组ALT反跳率(11.11%)低于对照组(32.41%)(P<0.05);治疗组AST反跳率(14.20%)亦低于对照组(20.37%)(P<0.05)。结论:六味五灵片治疗CHB,ALT、AST反跳率低、稳定性好,有很好的安全性。

肝炎病毒感染、饮酒与肝细胞癌病例对照研究

目的 研究乙型肝炎病毒、丙型肝炎病毒及饮酒与肝细胞癌的关系。方法 应用成组病例对照研究设计 ,选择 1999年 10月～ 2 0 0 2年 8月间住院初诊为肝细胞癌患者 16 4例作为病例组 ;选择性别、年龄、入院时间等与病例组均衡可比的眼科、皮肤科、泌尿科、心脏内科、呼吸内科患者 2 6 8例 ,作为对照组 ;通过非条件Logistic回归分析 ,探讨肝炎病毒感染、饮酒与肝细胞癌的相关性及病毒感染与酒精之间的协同作用。结果 肝细胞癌病例组HBsAg阳性率为 6 5 .2 % ,HCVRNA阳性率为 4 .9% ;对照组HBsAg阳性率为 10 .1% ,HCVRNA阳性率为 0 .7% ;病例组中有重度饮酒史 (每天酒精摄入量 >80 g ,至少 5年 )者占 5 8.5 % ,对照组中占 36 .9%。HBsAg阳性、HCVRNA阳性及重度饮酒的优势危险比 (OR)值分别为 16 .76 (95 %CI :10 .0 5～ 2 7.93) ,6 .92 (95 %CI :1.4 5～ 33.0 1)和 2 .4 1(95 %CI:1.6 2～3.5 9) ;HBsAg和HCVRNA均阳性与重度饮酒之间有协同增效作用。HBV感染是肝癌的最主要的相关原因 ,人群归因危险度 (AR)为 94 ,0 3% ,其次是HCV感染 ,AR为 6 8% ,以及重度饮酒 ,AR为 5 8.5 %。结论 肝炎病毒感染及饮酒与肝细胞癌的发生有关 ,对肝癌发生的危险度有叠加作用。

慢性乙型肝炎反复发作影响因素的病例对照研究

[目的]探讨影响慢性乙型肝炎反复发作的因素,指导预防慢性乙型肝炎患者的发作和临床治疗。[方法]采用病例对照研究,严格按照病例和对照的纳入和排除标准,随机抽取2006年6月到2007年5月在唐山市传染病院收住院的两次以上的慢性乙型肝炎患者194例组成病例组;选择发病1次的慢性乙型肝炎患者为对照。采用面对面问卷方式填写调查表。以聚合酶链反应定量分析HBVDNA;进行肝组织病理及免疫组化检查。[结果]单因素非条件Logistic回归分析显示:影响慢性乙型肝炎反复发作有显著性统计学意义的14个变量如下:12个危险因素:从事体力劳动(OR=4.091,95%CI:2.397～6.982);慢性乙型肝炎病史(OR=2.801,95%CI:1.271～6.173);重叠HEV病毒感染(OR=4.153,95%CI:2.297～7.510);父亲患有乙型肝炎史(OR=9.152,95%CI:2.611～31.474);母亲患有乙型肝炎史(OR=3.924,95%CI:2.154～7.150);既往有手术史(OR=5.429,95%CI:1.959～15.045);饮酒史(OR=2.198,95%CI:1.605～3.011);甜食摄入(OR=1.725,95%CI:1.196～2.488);血型(OR=2.283,95%CI:1.328～3.925);PCR-HB-VDNA定量(OR=2.313,95%CI:1.523～3.514);肝组织炎症程度G(OR=1.438,95%CI:1.156～1.788);肝组织免疫组化HBcAg阳性(OR=2.264,95%CI:1.410～3.637);2个保护因素:使用抗病毒药物(OR=0.238,95%CI:0.136～0.416);文化程度(OR=0.545,95%CI:0.423～0.704)。[结论]从事体力劳动、慢性乙型肝炎病史、父、母患有乙型肝炎、手术史、饮酒史、甜食摄入、重叠HEV病毒感染、高PCR-HBVDNA定量和肝组织炎症程度(G)高是影响慢性乙型肝炎反复发作的重要危险因素;使用抗病毒药物是保护性因素。

重叠甲型肝炎病毒感染对慢性乙型肝炎影响的对比研究

应用ELISA法对 12 6例CHB患者检测血清抗 HAV IgM ,同时应用肝穿刺活检、荧光定量PCR及免疫组化技术对重叠与未重叠HAV感染者进行了临床与病理学对比。具有可比性的重叠与未重叠感染者 8例、16例 1年后做第 2次肝穿活检 ;HBeAg阴性重叠感染者 9例做HAV感染急性期、恢复期血清HBeAg定性、HBV DNA含量对比。结果发现重叠HAV感染者 2 2例。重叠感染者较未重叠感染者ALT、TBIL增高、PTA降低 ,但A/G、γ EP无显著差别 ;血清HBeAg、肝组织HBcAg阳性率及血清、肝组织HBV DNA含量低 ;肝组织炎症活动度重 ,但纤维化程度无明显差别。重叠与未重叠感染者 1年前肝脏病变无显著差别、1年后仍无显著差别。HAV感染恢复期血清HBeAg阳性率、HBV DNA含量高于急性期。提示重叠HAV感染加重CHB肝脏炎症活动度 ,但并不加重纤维化程度及加速进展 ;抑制HBV复制 ,但并不持久。

病毒性肝炎患者继发肝硬化的危险因素分析

目的探讨病毒性肝炎患者发展至肝硬化的危险因素。方法选择2012-06-01~2016-12-31期间我院感染科接收的病毒性肝炎合并肝硬化患者(病例组)和病毒性肝炎患者(对照组)各189例为研究对象,进行1∶1配对病例对照研究。回顾性分析两组患者入院检查时的基本情况,并通过问卷调查了解其社会人口学特征、病毒性肝炎病史和行为习惯等,分析影响病毒性肝炎发展为肝硬化的危险因素。结果多因素Logistic回归分析结果显示:(1)长期大量饮酒(OR=2.23,95%CI 1.44-5.69]、长期大量吸烟(OR=1.99,95%CI 1.39-4.03)以及长期晚睡(OR=1.78,95%CI 1.03-2.33)是病毒性肝炎合并肝硬化发生的危险因素(P<0.05);(2)保肝治疗(OR=0.88,95%CI 0.71-1.16)、抗病毒治疗(OR=0.29,95%CI0.22-0.74)和身体锻炼(OR=0.41,95%CI 0.18-0.79)是病毒性肝炎合并肝硬化的保护性因素(P<0.05);(3)劳动、肝病家族史、职业在本次研究中对病毒性肝炎肝硬化的影响无统计学意义(P>0.05)。结论病毒性肝炎肝硬化的主要危险因素是不能坚持抗病毒治疗、不配合保肝治疗、大量饮酒、吸烟、长期晚睡和缺乏锻炼等不良行为习惯。医院应加强对病毒性肝炎患者的健康教育,改变其不良行为习惯,坚持抗病毒治疗与保肝治疗,预防肝硬化的发生。

乙型肝炎及其与戊型肝炎重叠感染临床对照

目的 了解乙型肝炎患者重叠戊型肝炎感染状况及重叠感染对病情的影响。方法 对单纯HBV感染者与HBV重叠HEV感染者进行临床对照研究。结果 72 6例乙型肝炎患者血清抗 HEV阳性率为 12 2 5 %(89/72 6 )。其中重型肝炎、肝硬化患者中抗 HEV阳性率分别为 2 2 4 1%和18 83%;急性肝炎和慢性肝炎分别为 8 6 9%和 7 2 4%。重型肝炎、肝硬化患者抗HEV阳性率高于急性肝炎和慢性肝炎 (P <0 0 1)。各型肝炎重叠感染戊型肝炎后其肝功能恢复正常时间延长 (P <0 0 5 ) ,且在乙型肝炎基础上重型肝炎和肝硬化重叠感染戊型肝炎血清胆红素明显升高 (P <0 0 1)。重叠感染者并发症及病死率较单纯感染者高。结论 乙型肝炎重叠感染戊型肝炎是病情加重及重症化的因素之一。

前S_1抗原-乙型肝炎病毒的传染性标志

通过临床和流行病学研究探讨前Ｓ１抗原作为乙型肝炎病毒（ＨＢＶ）一个传染性指标的意义。采取整群抽样和随机抽样方法收集血清１４４９份。ＨＢＶ—ＤＮＡ检测采用核酸斑点杂交法和ＰＣＲ法，其余指标测定采用ＥＬＩＳＡ法。结果显示，前Ｓ１抗原与ＨＢｅＡｇ同时在乙型肝炎患者血清中消失，它只能在ＨＢＶ—ＤＮＡ阳性血清中检出；前Ｓ１抗原阳性传播ＨＢＶ的危险性高于前Ｓ１抗原阴性的乙型肝炎患者和无症状ＨＢｓＡｇ携带者，其家庭成员感染ＨＢＶ的危险性也比较高。提示，前Ｓ１抗原为一个反映ＨＢＶ复制和传染性的指标。

基于双生子样本的婴儿乙肝疫苗低/无免疫应答的围生期相关因素分析

目的探讨围生期环境因素如喂养方式、生命早期营养状况等对婴儿乙肝疫苗低/无免疫应答的影响,为研究乙肝疫苗免疫失败机制提供依据。方法采用病例对照研究设计,纳入来自5家协作医院儿童保健科参加常规体检的1周岁的双生子和无关个体组成两个独立样本,排除无关个体样本中低出生体重儿及两样本中乙肝表面抗原(HBsAg)阳性及母亲有乙肝病史的研究对象。通过病案调查及现场访谈,收集研究对象的父母健康状况、母亲孕产史、婴儿出生状况及1岁以内体检信息等可能的暴露因素资料。在分析乙肝疫苗低/无免疫应答的相关影响因素时,双生子样本采用XTGEE广义估计模型,无关个体样本采用Logistic回归模型和Tobit回归模型进行分析。结果纳入分析的双生子样本为370人,无关个体样本为300人。19.2%(71例)双生子和11.7%(35例)无关个体在接种乙肝疫苗后发生低/无免疫应答。在双生子样本中,父亲吸烟(OR=4.50,95%CI:2.52～8.03)和低出生体重(OR=2.55,95%CI:1.33～4.87)可能增加乙肝疫苗低/无免疫应答风险,Apgar评分高和0～1周岁体重增长量大可能降低乙肝疫苗低/无免疫应答的风险。但在出生体重正常的无关个体样本中未发现上述因素与乙肝疫苗低/无免疫应答的相关性。结论按照0-1-6方案接种乙肝疫苗后,低出生体重、父亲吸烟、Apgar评分和0～1周岁体重增长量与婴儿发生乙肝疫苗低/无免疫应答相关。

应用巢式病例对照探讨HBV围生期传播的影响因素

目的:探讨HBV围生期传播的影响因素,为防制HBV围生期传播提供科学依据。方法:应用1∶1匹配巢式病例对照研究,选择141对HBsAg阳性孕妇及所生的新生儿作为研究对象,进行问卷调查,并检测血液相关指标,资料采用单因素及多因素条件logistic回归分析对HBV围生期传播的影响因素进行分析。结果:单因素配对四格表χ2检验有统计学意义的因素为文化程度、一级家族史、肝功能异常、血清谷丙转氨酶、系统治疗、妊娠肝内胆汁淤积症(ICP)、胎儿宫内窘迫及接种乙肝免疫球蛋白等。进入条件logistic回归方程的影响因素为一级家族史、接种乙肝免疫球蛋白、系统治疗及妊娠肝内胆汁淤积症。结论:对肝功能异常的HBsAg阳性妇女孕前进行积极正规治疗,规范接种乙肝免疫球蛋白,防治妊娠肝内胆汁淤积症,可以降低HBV的围生期传播。

孕产妇HBV感染相关因素的病例对照研究

收集１９９７年２月至１１月间ＨＢｓＡｇ阳性孕产妇１００例，同期收集健康孕产妇１０９例进行孕产妇ＨＢＶ感染影响因素的病例对照研究。多因素分析表明ＨＢＶ感染者接触史、频繁在外用餐、街头摊点用餐及出生于南方为孕产妇ＨＢＶ感染的危险因素，乙肝疫苗接种为保护因素。分级分析表明暴露于父母ＨＢＶ感染家庭的孕产妇ＨＢＶ感染的估计相对危险性（１６．０９）分别大于暴露于同胞（６．１３）、丈夫（５．１１）及其他（１．８４）ＨＢＶ感染者。结果提示：父母ＨＢＶ感染史、ＨＢＶ感染家族史、频繁在外用餐、街摊用餐及出生地对孕产妇ＨＢＶ感染影响较大，而经血传播并非孕产妇ＨＢＶ感染的主要途径。

芪参益气滴丸治疗慢性乙型肝炎的疗效观察

目的:观察芪参益气滴丸治疗肝功能异常的慢性乙型肝炎的疗效和安全性。方法:选取80例肝功能异常的慢性乙肝患者,随机分成研究组和对照组各40例,研究组口服芪参益气滴丸每次0.5g,tid,共12周,对照组口服护肝宁片每次4片,tid,疗程12周。对两组进行比较,评价治疗前后患者临床症状和肝功能与肝纤维化指标的恢复情况,同时记录不良反应。结果:治疗后,研究组和对照组的患者症状均有不同程度改善,其中研究组有腹胀和肝区不适患者的症状改善率明显高于对照组(P<0.05)。两组患者治疗后的肝功能及血清纤维化指标与治疗前比较均得到显著改善,但两组间比较差异无显著性意义(P>0.05)。研究组总有效率达77.5%,对照组为70%,两组比较差异无显著性意义(P>0.05)。且都无明显的不良反应。结论:芪参益气滴丸治疗肝功能异常的慢性乙型肝炎患者安全、有效。