目的 探讨乙型肝炎病毒(hepatitis B virus,HBV)慢性感染合并脂肪肝的关联因素,为HBV合并脂肪肝的防治提供依据.方法 选择2019年6月启东市HBV感染队列随访人群,收集相关病史信息,采用B超检测脂肪肝,用多因素Logistic回归分析模型分析合并脂肪肝的关联因素.结果 该队列人群年龄(63.22±7.84)岁,脂肪肝患病率为30.18％(909/3 012);患病率女性高于男性(33.94％＞27.25％,x2=15.767,P＜0.001).患病率在各年龄组差异有统计学意义(x2=11.614,P=0.003),以60～ 70岁年龄组最高.肝纤维化患者中脂肪肝的检出率为62.50％(205/328).多因素Logistic回归分析模型分析显示,高血压、糖尿病、高血脂病史、烟酒嗜好以及肥胖是脂肪肝的主要危险因素(均有P＜0.001).结论 启东地区中老年HBV感染人群脂肪肝的患病率较高,且女性高于男性,并随年龄增长而降低.体重、血压、血脂及肝纤维化等也是脂肪肝不可忽视的危险因素,应当加以重视.

目的 分析江苏省启东市2014 ～2015年来笔者医院体检的肝癌患者家族成员的乙型肝炎病毒感染现状以及部分肝功能指标.方法 收集2014年1月～ 2015年12月在启东市人民医院登记的肝癌患者家族成员的体检资料,分析其HBV感染情况及肝功能指标,比较不同性别家族成员的乙肝血清学标志物阳性率及肝功能指标差异,并对乙肝表面抗原阳性和阴性研究对象的部分肝功能指标异常率的差异进行了分析.结果 共纳入537例研究对象,平均年龄为45.55±14.61岁,乙肝血清学标志物HBsAg、抗-HBs、HBeAg、抗-HBe以及抗-HBc的阳性率分别为23.46％、37.24％、3.91％、14.15％和49.72％.乙肝血清学标志物阳性率的差异在男、女性性别间均无统计学意义(P＞0.05).男、女性肝功能指标中ALT、AST、DBIL、ALB、A/G、GGT和PA的比较,差异有统计学意义(P＜0.05),TBIL、IBIL、TP、GLO及ALP的差异无统计学意义(P＞0.05).ALT与TBIL异常率在HBsAg阳性组与阴性组间比较,差异有统计学意义(P＜0.05),而两组间TP、ALB、ALP及PA检测指标异常率比较,差异无统计学意义(P＞0.05).结论 启东市肝癌患者家族成员HBsAg携带率较高,HBsAg阳性者ALT异常率显著高于阴性者,应加强HBsAg阳性的肝癌患者家族成员的随访,定期健康体检,减少这部分人群肝癌的发生.

Objective To investigate the distribution of HBV genotypes in Qidong and the correlation with clinical manifestations.Methods Serum samples of 372 patients suffered from HBV related liver diseases were collected.HBsAg,HBeAg,anti-HBe,HBV DNA and HBV genotypes were detected to analysis the correlation between HBV genotypes and clinical manifestations.Results C genotype was found to be predominant as 95.70%,another was B genotype(4.30%).No other genotypes were found in this study.There were no significant differences of sex,age,HBeAg expression and HBV DNA level between the two genotypes(P>0.05).HBeAg serum conversion rate of C genotype was significantly lower than that of B genotype(P<0.001).The proportion of C genotype in ASC group exhibited significantly lower than that in CHB and HCC groups(P<0.005).There was no significant difference of genotype distribution between HCC and CHB groups(P>0.05).Conclusion There are B and C genotypes prevalent in Qidong,and C is significantly predominant.No significant differences of sex,age,HBeAg expression and HBV DNA level were showed between B and C.Genotype C may be related with more severe liver diseases.

Objective To study the status and characteristics of hepatitis B virus ( HBV) infection in family mem-bers of HBsAg-positive liver cancer patients in Qidong. Methods Eight hundred and twenty-five family members ( par-ents, compatriots, children) of 242 HBsAg-positive patients with liver cancer were investigated, and their venous blood was collected to detect HBV serological indexes. The status and characteristics of HBV infection in family members were statistically analyzed. Results The HBsAg-positive rate of family members was 39. 76%, higher than those of local co-hort (10. 92%) and general population (8. 00%), the difference was statistical significant (P<0. 001). The positive rates of HBsAg in males and females were 39. 17% and 40. 16%, respectively, and the difference was not statistically significant (P>0. 05). The positive rates of HBsAg in parents, compatriots, and children were 16. 33%, 35. 5% and 46. 37%, respectively, the difference among three groups was statistically significant (P<0. 01). There was no statisti-cally significant difference in the positive rate of HBsAg between fathers and mothers, brothers and sisters, sons and daughters ( P >0 . 05 ) . The difference of HBsAg-positive rate in parents and compatriots between female and male probands were not statistically significant ( P>0 . 05 ) , but the positive rate of HBsAg in children of female probands was 3 . 52 times than that of the children of the male probands ( P<0 . 001 ) . Conclusion HBsAg-positive in the hepatoma family has aggregation phenomenon, but gender may be unrelated with HBV infection. The effect of mother-to-child transmission is significantly greater than father-to-child transmission in the family.

目的 观察乙型肝炎病毒(HBV)感染与原发性肝癌(肝癌)发生的关系及临床意义.方法 在肝癌高发地区对携带乙型肝炎表面抗原(HBsAg)的220例患者和作为对照的非携带者228人进行前瞻性定群观察,历时26年.结果 HBsAg(+)组肝癌发生率为962.97/10万人年,HBsAg(-)组为72.42/10万人年,HBsAg(+)组发生肝癌的风险是HBsAg(-)组的13.30倍,差异有统计学意义(x2=42.05,P＜0.001).HBsAg(+)人群中的肝癌发病归因于HBsAg(+)的部分占全部发病的92.48％.肝癌患者中,发现感染HBV到诊断肝硬化的平均时间为20.26年,中位时间9年;生存时间最短31 d,最长12年2个月仍生存,平均2年6个月,中位生存期为9个月.结论 HBV感染是当地肝癌高发的主要病因,防治乙型肝炎、定期观察肝癌高危人群是切实可行的肝癌防治方案.

[Purpose] To analysis the blood glucose level in patients with liver cancer and in their first degree relatives. [Method] Four hundred and forty-eight cases with liver cancer,1282 cases of their first degree relatives,and 1236 healthy person as control were enrolled. The HBsAg and fasting blood glucose were detected. Chi-square test was used for statistic analysis. [Results]The hyperglycemia rate in liver cancer group was significant higher than that in relatives group and control group(χ2=16.64,64.80,respectively,P all0.01),and hyperglycemia rate in relatives group was higher than that in control group(χ2=24.33,P0.01). The positive rate of HBsAg in liver cancer group was significant higher than that in relatives group and control group(χ2=382.91 and 726.61, respectively,P all 0.01),and the positive rate in relatives group was higher than that in control group(χ2=91.04,P0.01). [Conclusion] High blood glucose level and HBsAg positivity may be independent or synergic risk factors for liver cancer. Perhaps the relatives of these patients are a group of people susceptible to liver cancer.Control and prevention should be enhanced.

Objective: To explore the smoking, drinking age correlation with primary liver cancer . Methods: 549 cases of primary liver cancer patients were systematicaly analyzed according to their smoking and drinking were divided into four groups, namely smoking and drinking group, the group of smokers without drinking , drinking and smoking group does neither smoking nor drinking group , respectively with a, B, C, D on behalf of the group, the average age of onset cases comparative analysis of the four groups of patients. Results: The mean age of onset for patients in group A (41.2 ± 8.4) years, the average age of onset group B patients was (47.6 ± 7.9) years, mean age of patients in group C was (48.3 ± 8.4) years old , D patients the average age was (57.4 ± 6.9) years of age , age of patients in group A was significantly lower than the other three groups , and there are differences (P <0.05), and D groups were more significant differences (P <0.01) , age of patients in group D at the latest . Conclusion: Drinking is a high risk factor in the pathogenesis of hepatocelular carcinoma dense , the incidence of primary liver cancer causes prolonged drinking of getting younger , the age of onset of smoking alone had no significant impact on primary liver cancer , but smoking and drinking At the same time the presence of the age of onset of primary liver cancer were significantly younger.

调查分析随访10年的乙肝表抗阳性和阴性队列的体检结果.结果:HBsAg(+)与HBsAg(-)组比较:DM、IFG、IGT、脂肪肝的发生率无统计学差异.而脂肪肝组的糖尿病发病率41.8％高于非脂肪肝组的糖尿病发病率20.5％.

Objective:To explore the correlation between hepatitis B virus e antigen(HBeAg) and hepatocellular carcinoma(HCC) in residents of Qidong — a high-risk area of HCC in Jiangsu Province,China.Methods:This study included 807 hepatitis B virus surface antigen(HBsAg) carriers and 761 age-and gender-matched HBsAg(-) controls enrolled in a prospective cohort in Qidong during 1992.The relationship between the occurrence of HCC and HBsAg was analyzed during the follow-up period from May 1992 to March 2010.Results:A total of 24 715 person-years(PY) was observed.Of 807 cases in HBsAg-positive group,156 cases had developed HCC,and the incidence rate of HCC was 1 288.83/100 000 PY;while in HBsAg-negative group,9 of 761 cases had developed HCC,and the incidence rate of HCC was 71.37/100 000 PY.The relative risks(RRs) of HCC were 13.25(95% confidence interval:6.67-26.33;P0.001) and 28.05(95% confidence interval:13.87-56.73;P0.001) in HBsAg(+) /HBeAg(-) group and HBsAg(+) /HBeAg(+) group,respectively.In the HBsAg(+) group,the RRs for HCC of the four subgroups(HBeAg titer24,1:24-1:27,1:28-1:212,and212) were 2.55(95% confidence interval:1.54-4.22;P0.001),5.02(95% confidence interval:2.89-8.73;P0.001),1.71(95% confidence interval:0.91-3.18;P0.05),and 1.19(95% confidence interval:0.64-2.23;P0.05) folds higher than that of HBeAg(-) subgroup,respectively.Conclusion:HBeAg is an essential predictive factor for the development of HCC.The patients with low titers of HBeAg are at a high-risk of HCC.

Objective:To study the relationship between hepatitis B surface antigen(HBsAg) and the primary liver cancer (PLC).Methods:A 20-year prospective follow-up study was performed continuously in Qidong on a cohort of 515 HBsAg positive male patients aged 20-60 years old.The markers of hepatitis B virus,HBsAg,HBsAb,HBeAg,HBeAb and HBcAb (HBVM 1,2,3,4,5) were detected at the first time of the follow-up.Results:The PLC incidence of the whole cohort was 1 340.90/100 000 person years(PY).The middle age of the PLC diagnosis was 43 with an average survival of 15 months.The PLC incidence was significantly higher in 41-50 age group than that of other age groups(P 0.05).The three major HBVM patterns were 15,135 and 145 in the cohort with percentages of 38.83%(200/515),15.92%(82/515)and 44.08%(227/515) respectively.The PLC incidences of these three patterns were 1 433.69/100 000 PY,2 284.71/100 000 PY,984.10/100 000 PY respectively,showing a significant difference between 135 and 145 (P 0.01).The percentages of 15,135 and 145 were 39.64%(44/111),23.42%(26/111) and 35.14%(39/111) in PLC patients respectively,showing a significant difference between 15 and 135 (P 0.01).The liver cirrhosis mortality of those three patterns were 195.50/100 000 PY,966.61/100 000 PY and 277.57/100 000 PY respectively,showing the significant differences between 135 and other two patterns (P 0.01).Conclusion:HBsAg carriers were high risk population of PLC.The regular following-up is helpful on early diagnosis and treatment of PLC in those people,and can prolong the survival time.It was found that 135 had higher PLC risk than other HBVM patterns,suggesting a relationship between HBV duplication and PLC.The anti-virus treatment may delay or remove the occurring of PLC.

Objective To study the relations between exposition quantity of ADM1 and occurrence of PHC.M ethods We carry on a twenty-year prospective study in 148 males who are 25-60 years old and positive inh epatitis B surface antigen(individuals at high risk for liver cancer).Using the monoclonal antibody system of anti-AFM1 with high affinity and immunity concentration,high-pressure liquid chromatography(HPLC),wed etermine the accumulation displacement of AFM1 in urine.We detect the five symbols of hepatitis B virus infection in serum with enzyme-linked immunosorbent assay(ELISA).We use the LAI to determine alanine aminotransferase(ALT).Using solid phase radioimmunoassay to detect AFP.Result(1)Of the total rate of PHC,rate of the group is 70.73%,who are positive in hepatitis B surface antigen with AFM1-positive.In this twenty years,the rate of PHC is 1835.45/100,000 per year in average.Either the rate of PHC or the positive rate ofA LT in this group is obviously higher than those with AFM1-negative(P<0.01).(2)Rate of 1,4,5 positive simultaneously in the AFM1-positive is obviously higher than that in the AFM1-negative(P<0.01).(3)Rate of AFP-positive in the AFM1-positive is obviously higher than that in the AFM1-negative(P<0.05).(4)Thosew ho drink wine massively(≥50g/d)all have PHC.Conclusion HBV infection is the basic cause of PHC.A FM1 is an important auxiliary cause of the disease.Exposition of AFM1 and HBV infection obviously have syncarcinogenesis.And long-term massively drinking will promote PHC.So we advocate healthy diet and study on preventing HBV infection,and these have important meanings in preventing and controlling liver cancer.

Objective To investigate the features and relationships of HBV markers and HBV DNA levels in primary liver cancer(PLC) patients of the Qidong high risk region.Methods Serum HBV markers and HBV DNA levels of 211 PLC patients and 229 HBV infected cases were detected by ELISA and FQ-PCR methods,respectively.Results 99.5% of the PLC patients were infected by HBV,and the HBV DNA positive rate of two groups was 70.0% and 66.4%,respectively(P0.05).PLC group showed a significantly lower HBsAg positive rate than the control group,85.2% vs 93.9%(P0.05),the HBV DNA positive rate of those patients was significantly higher than that of the control group,79.9% vs 69.3%(P0.05).The rate of HBV DNA level ≥106 copies/ml was significantly lower than that of the control group,28.0% vs 40.3%(P0.05).The distributions of the three most common HBVM patterns were significantly different between the two groups(P0.01).HBsAg/anti-HBe/anti-HBc+ was the most common HBVM pattern in the control group(41.5%),while HBsAg/anti-HBc+ in the PLC group(35.7%),and the HBsAg/anti-HBc+ PLC patients had significantly higher HBV DNA positive rate and higher average level than the control(P0.05).Conclusion PLC patients of Qidong region endure serious HBV infections.Most of them suffer from HBV DNA replications that are active but not too high,which may enhance the HBV DNA insertion and finally induce the carcinogenesis.HBsAg/anti-HBc+ is the most common HBVM pattern in Qidong PLC,the absence of the HBVe system may suggest the existence of some special mutations.

目的:探讨肝癌术后长期生存患者临床病理及P53、c-myc癌基因表达的特点和意义.方法:以启东肝癌高发区34例肝癌术后生存10年以上的病例(A组)作为研究对象,42例肝癌术后5年内死亡的病例(B组)为对照,进行临床病理特点观察,并用免疫组化方法检测肝癌及癌旁P53和c-myc表达. 结果:肝癌组织中P53、c-myc表达阳性率分别为56.58%(43/76)和60.53%(46/76),A组中分别为47.06%(16/34)和50.00%(17/34),B组中分别为64.29%(27/42)和69.05%(29/42),两组相比无显著差异.癌旁组织中P53、c-myc表达阳性率分别为42.11%(32/76)和57.89%(44/76),A组中分别为26.47%(9/34)和41.18%(14/34),与B组中54.76%(23/42)、71.43%(30/42)相比差异有统计学意义.A组85.29%(29/34)的病人有完整包膜,显著多于B组的21.43%(9/42);5.88%(2/34)有门脉栓塞,38.24%(13/34)伴有肝硬化,显著低于B组(69.05%,78.57%).结论:癌周组织中P53、c-myc表达与术后生存呈负相关;肝癌包膜完整、无门脉栓塞、无肝硬化的单结节病人,预后好,术后生存期明显延长.

目的：探讨启东地区肝癌高发人群的庚型肝炎病毒感染状况。方法：应用ELISA法检测了50例HBsAg慢性携带者、35例肝细胞癌(HCC)患者、50例临床肝炎患者和50例正常成人血清抗-HGV。结果：四组人群抗-HGV阳性率分别为4.00％、22.86％、10.00％和0，HCC组显著高于HBsAg(+)组(P＜0.01)和正常成人组(P＜0.005)。HBsAg阳性组与阴性组相比、ALT异常组与正常组相比，抗-HGV阳性率均有显著差异(分别为11.21％和2.89％，P＜0.05；12.62％和2.44％，P＜0.02)。结论：启东地区HGV流行性与其它地区基本一致。HGV对肝脏有一定的损伤作用，但致病性可能较弱。

目的:分析血清AFP阳性和阴性的PHC患者HBV感染状况及其临床意义.方法:以ELISA法检测HBV五项标志物,RIA法检测AFP.以卡方检验进行统计学处理.结果:AFP阳性组PHC患者抗-HBs检出率显著低于AFP阴性组(P＜0.025),而抗-HBc检出率显著高于AFP阴性组(P＜0.01).PHC患者HBVM模式共有19种,其中具有传染性的四种常见模式AFP阳性组占203/248(71.48%),AFP阴性组占20/32(62.50%).结论:PHC患者常伴有HBV复制活跃,其中AFP阳性者更甚.在治疗过程中,应加强保肝、抗病毒治疗.

目的:了解启东肝癌高发区抗-HBc阳性慢性乙肝患者血清中HBVDNA分布情况.方法:采用ELISA法筛选慢性乙肝患者中抗-HBc阳性者,再用聚合酶链反应(PCR)检测这些血清中的HBVDNA.结果:HBVDNA总检出率为75.24%(158/210).抗-HBc与HBsAg、HBeAg同在时HBVDNA阳性率最高,达97.26%(71/73),显著高于其它模式(P＜0.005).抗-HBc/HBsAg阳性血清中HBVDNA检出率为81.08%(150/185),单纯抗-HBc/HBsAg阳性血清中HBVDNA检出率为80.77%(42/52),单纯抗-HBc阳性血清中检出率为20%(1/5).结论:抗-HBc是乙肝病毒感染的一个直接标志.判断患者的传染性应通过免疫学和基因学两种方法来检测.启东慢性乙肝患者中HBVDNA整合现象可能要高于其它地区,这或许是启东肝癌高发的机制之一,值得进一步研究.基因学和免疫学方法检测乙肝病毒感染情况各有利弊,应互补共存.

应用两株抗人肝特异性F抗原的单克隆抗体建立测定血清F抗原的夹心ELISA法.结果显示本法标准曲线工作范围(5-200)μg/ml,平均回收率95.6%.正常对照、良性肝病、急性肝炎、肝硬化、肝癌患者F抗原含量(μg/ml1)分别为0.20±0.07、0.45±0.14、35.50±8.40、22.16±7.12、41.50±14.17,其中急性肝炎及肝癌血清F抗原水平显著升高.该法可为肝损伤,尤其是肝癌提供早期辅助诊断.