目的 研究外周血壳多糖酶3样蛋白1(CHI3L1)蛋白水平在肝纤维化中的诊断意义.方法 收集38例肝纤维化患者,检测血清中CHI3L1、肝胆酸(CG)、透明质酸(HA)、层粘连蛋白(LN)、Ⅲ型前胶原N端肽(PⅢP N-P)和Ⅳ型胶原(Ⅳ-Col),同时收集健康人作对照(n=90).比较两组CHI3L1蛋白水平差异,用ROC曲线分析评价肝纤维化组血清中CHI3L1、CG、HA、LN、PⅢP N-P和Ⅳ-Col的诊断优劣.结果 肝纤维化组血清CHI3L1蛋白水平高于正常对照组(P<0.001);ROC曲线分析血清CHI3L1蛋白对肝纤维化的诊断效能,曲线下面积(AUC)为0.994,在cutoff值为79.0g/L时,敏感度为100％,特异度为95.6％显著高于其他指标.结论 血清CHI3L1蛋白水平对肝纤维化具有良好的诊断效力,优于其他的肝纤维化标志物,可提高肝纤维化的早期诊断.

Objective To investigate the value of fluorescence real-time PCR (RT-PCR) in diagnosing pneumocystis pneumonia (PCP) in AIDS patients.Methods One hundred and nine AIDS patients with a clinical suspicion of PCP in Xixi Hospital from 2013 to 2016 were enrolled.Detection results of sputum and Bronchoalveolar lavage fluid(BALF) samples were compared by RT-PCR and PCR-sequence analysis.Results The total positive rates of RT-PCR and PCR-sequence analysis were 57.8％ and 60.6％,respectively in 93 sputum samples and 16 BALF samples.The result of RT-PCR was in good correlation with PCR-sequence analysis with the sensitivity of 87.9％ (58/66),the specificity of 88.4％ (38/43),the positive predictive value of 92.1％ and the negative predictive value of 82.6％.Sensitivity and specificity of RT-PCR in BALF specimens were both 100.0％,which were better than those in sputum samples.Conclusions RT-PCR has good sensitivity and specificity for the diagnosis of AIDS patients with PCP,and the detection effect in BALF is better than in sputum specimens.This method is helpful for rapid,sensitive and specific detection of PCP.

目的 了解艾滋病合并血流感染患者的病原体种类及耐药性.方法 收集2012—2015年在杭州市西溪医院住院治疗的94例艾滋病合并血流感染患者的临床资料,对其血培养分离的病原体种类和耐药情况进行描述性分析.结果 94例患者共分离出菌株109株,其中分枝杆菌4株,占3.67％;革兰阳性菌45株,占41.29％,以表皮葡萄球菌最多(10.09％);革兰阴性菌34株,占31.19％,以大肠埃希菌最多(7.34％);真菌26株,占23.85％,包括马尔尼菲蓝状菌(13.76％)和新型隐球菌(10.09％).革兰阳性菌对喹奴普汀/达福普汀、 利奈唑胺、 万古霉素、 替加环素和呋喃妥因的耐药率均为0.00％,对莫西沙星耐药率为2.44％;革兰阴性菌对哌拉西林/他唑巴坦、 厄他培南和亚胺培南3种药物的耐药率均为8.70％.结论 艾滋病合并血流感染患者病原体包括一定的机会感染病原体,对常用的三线抗菌药物敏感性较高.

OBJECTIVE To explore the clinical value of domestic plasma 1-3-β-D glucan test reagent in diagnosis of AIDS complicated with Pneumocystis pneumonia (PCP) and evaluation of curative effect.METHODS A total of 65 AIDS patients complicated with pulmonary infections who did not have other fungal infections and were treated in the hospital from Jan 2015 to Jun 2016 were enrolled in the study.According to the criteria for diagnosis of PCP in the Third Edition of the Guidelines for Diagnosis and Treatment of HIV/AIDS(2015),27 AIDS patients complicated with PCP were screened out and assigned as the case group,and 38 AIDS patients complicated with other pulmonary infections were set as the control group.The concentration of plasma 1-3-β-D glucan was detected by using domestic test reagents at the admission to the hospital and after the treatment for 3 weeks,and the statistical analysis was performed.RESULTS The median concentration of plasma 1-3-β-D glucan of the case group was 40.15 pg/ml,higher than 5.92 pg/ml of the control group(P＜0.001).The analysis of receiver-operating-characteristic (ROC) curve indicated that the optimal threshold of the plasma 1-3-β-D glucan was 16.51 pg/ml in the diagnosis of PCP,the area under curve (AUC) was 0.925 (95％CI 0.864～0.985,P＜0.001),and the sensitivity and specificity were 85.20％ and 86.80％,respectively.The plasma 1-3-β-D glucan level of the case group was 4.28 pg/ml after the treatment for 3 weeks,lower than 40.31 pg/ml before the treatment (P =0.005).CONCLUSION The domestic plasma 1-3-β-D glucan test reagent has significant clinical value in diagnosis of AIDS complicated with PCP and evaluation of curative effect.

肺孢子菌肺炎(Pneumocystis pneumonia,PCP)主要发生于艾滋病(AIDS)和自身免疫病、器官移植等免疫功能低下者,是导致AIDS病人死亡的主要原因之一.艾滋病病毒(HIV)主要攻击人的CD4+T淋巴细胞(简称CD4细胞),使CD4细胞减少、功能减退,同时也会造成CD8+T淋巴细胞(简称CD8细胞)等不同程度的损害,致使人体细胞免疫功能缺陷,导致严重机会性感染的发生率增加,甚至造成AIDS病人的死亡[1].为了寻找AIDS合并PCP患者淋巴细胞亚群变化的规律,探讨淋巴细胞亚群数量变化对AIDS病人感染PCP的预警作用,对杭州市西溪医院收治的147例AIDS病人进行淋巴细胞亚群检测分析,结果报告如下.

Objective To study the clinical features and distribution characteristics and drug sensitivity of plural pathogenic septicemia in AIDS patients.Methods Data of 12 AIDS with plural pathogenic septicemia concerning complications,inflammatory markers,prognosis,distribution of pathogens and drug sensitivity were analyzed retrospectively.Results There were 10 kinds of comorbidity in 12 AIDS patients,including nosocomial infection in 7 cases,3 patients died.The plasma levels of procalcitonin were (4.75 ± 9.43) μg/L and elevated only in 5 cases;24 strains were detected of which 8 strains were Gram-negative bacteria (33.3％),and 6 strains of Escherichia coli and Klebsiella pneumoniae were multidrug-resistance strains and producing 5 strains of ESBLs.Staphylococcus hominis and Staphylococcus aureus were the main pathogens of 13 Grampositive bacteria (54.2％).Conclusions AIDS with plural pathogenic septicemia had multiple complications,high mortality and resistance in G-bacill.It is nuessary to prevent and treat actively.

Objective To discuss the treatment strategies of intracranial hypertension among AIDS patients with cryptococcal meningitis,to reduce the mortality.Methods Thirty-four AIDS patients with cryptococcal meningitis with intracranial hypertension were treated by using repeated lumbar puncture,waist large pool catheter drainage,ommaya cystic drainage or ventricular peritoneal shunt,according to the level of initial intracranial pressure.The outcomes of different strategies of cerebrospinal fluid draining were compared.Results Six patients with intracranial pressure of 200-249 mmH2O were all cured.Out of the nine patients with intracranial pressure of 250-350mmH2O,eight recovered and one died.Among the nineteen patients with intracranial pressure higher than 350 mmH2O,thirteen recovered and six died.Twenty-seven patients were treated with repeated lumbar puncture,with twenty-two recovered and five dead.Four patients were treated with external drainage,with two recovered and two dead.Three patients were treated with external and internal drainage were all recovered.Conclusion Different strategies of lowering intracranial hypertension can be adopted to treat AIDS patients merged with new cryptococcal meningitis with intracranial hypertension,according to their initial level of intracranial pressure.Based on sufficient antifungal therapy,waist large pool catheter drainage,ommaya cystic drainage and ventricle peritoneal shunt were suggested to carry out as early as possible to control intracranial hypertension,improve clinical efficacy and reduce the mortality.

Objective To better understand the clinical characteristics of Penicilliosis marneffei(PSM)complicated in patients with acquired immunodeficiency syndrome(AIDS). Methods Clinical data of 37 patients of AIDS with PSM were studied retrospectively. Results The average age of 37 patients with AIDS combined with PSM was 37.22 years(19 -63 years old),male / female:31/6;54.05% of patients before the onset of long-term residents in ZheJiang province.The main clinical manifestations were fever(97.30%),cough(72.97%),sputum(51.35%),weight loss(48.65%),rash(27.03%). Consolidated disease from more to less in order:oral candidiasis,tuberculosis,lymph node tuberculosis, syphilis,pneumoniae pneumonia,cytomegalovirus infection,chronic hepatitis C,chronic hepatitis B,renal tuberculosis. Laboratory check:white blood cells<4.0×109/L(62.16%),lactate dehydrogenase increased(83.78%),albumin<30g/L(72.97%),aspartate aminotransferase increased (70.27%),D-dimer significantly increased(100%),CD4+cells below 20/μl(67.57%),Comms test positive(78.38%). Blood culture positive rate of 100%,blood culture reported sun time 3 days to 19 days range. Imaging examination:splenomegaly(64.86%),retroperitoneal lymph nodes(86.49%),mediastinal lymph nodes(43.24%),lung CT imaging without specific changes. Itraconazole,voriconazole, amphotericin B treatment were effective. Conclusions AIDS at the same time the existence of the above clinical features and tissue culture time extends to 14 days or longer,achieves early diagnosis of Penicillium marneffei disease. Standardized antifungal therapy can improve the prognosis.

OBJECTIVE To observe the correlation between the opportunistic infections in acquired immune deficiency syndrome (AIDS) patients complicated with pneumocystis pneumonia (PCP) and the CD4+ T cell counts.METHODS A total of 147 AIDS patients who were hospitalized in Hangzhou Xixi Hospital from 2012 to 2016 were enrolled in the study,including 60 AIDS patients complicated with PCP and 87 AIDS patients without PCP.The CD4 + T cell counts,CD8 + T cell counts,and ratio of CD4 + T cell to CD8 + T cell were observed and compared between the opportunistic infection group and the non-opportunistic infection group;the prevalence of opportunistic infections in the patients with different levels of CD4 + T cell was further analyzed.RESULTS Of the 60 patients,47 had the opportunistic infections,with the infection rate 78.33 ％;the oral candidiasis,cytomegalovirus infection,bacterial pneumonia,syphilis,and hepatitis B were dominant among the opportunistic infections,accounting for 41.67％,31.67％,31.67％,30.00％,and 11.67％,respectively.The CD4+ T cell counts of the AIDS patients complicated with PCP were less than 200 × 106/L,most of whom were no more than 50 × 106/L.The CD4 + T cell counts and ratio of CD4 + T cell to CD8 + T cell were remarkably lower in the opportunistic infection group than in the non-opportunistic infection group (P＜0.01,P＜0.05).The incidence of opportunistic infection of the patients with the CD4 + T cell counts no more than 50× 106/L was 90.91％,significantly higher than 57.14％ of the patients with the CD4 + T cell counts ranged between 51 and 100 × 106/L and 33.33 ％ of the patients with the CD4 + T cell counts ranged between 101 and 200 × 106/L(P＜0.017).CONCLUSION The incidence of opportunistic infections is high in the AIDS patients complicated with PCP,there are a great diversity of pathogens causing the infections in the AIDS patients complicated with PCP,and the CD4 + T cell count is closely associated with the opportunistic infection in the AIDS patients complicated with PCP.The risk of complication with multiple opportunistic infections may be further increased with the decline of the CD4 + T cell level and immunity.

目的：分析艾滋病合并沙门菌败血症的临床特点，为该病的诊治提供依据。方法回顾性分析杭州市西溪医院收治的6例艾滋病合并沙门菌败血症患者临床症状、血象、炎症指标、细菌分型、治疗用药及疗效。结果6例患者中社区获得性败血症5例，医院感染1例。发热等全身症状较重，消化道症状不明显。仅1例白细胞增高，为11.38×109／L；嗜酸性粒细胞均减少，其中3例计数为0。C反应蛋白为10～149 mg／L，轻至中度升高；降钙素原基本正常。CD4＋T淋巴细胞计数均＜200个／μL，其中4例＜50个／μL。5例4个血培养瓶均为阳性，分别为都柏林沙门菌2例，丙型副伤寒沙门菌2例，乙型副伤寒沙门菌1例，仅1例1个需氧菌瓶培养出甲型副伤寒沙门菌。6株沙门菌对氟喹诺酮类，三、四代头孢类，碳青霉烯类均敏感。通过抗菌治疗10～14 d，病情均好转。结论艾滋病合并沙门菌败血症患者全身感染症状明显，消化道反应较轻，炎症指标上升不明显，但菌血症明显，对三、四代头孢菌素及氟喹诺酮类、碳青霉烯类抗生素均敏感。

Objective To analyze the relationship of the expression of peripheral blood T lymphocyte subsets (CD3+, CD4+and CD8+lymphocytes) and regulatory T cells (CD4+CD25+Treg) with the level of HCV RNA in the patients with chronic hepatitis C (CHC). Methods According to the level of HCV RNA, 128 CHC cases were divide into HCV RNA negative group (n=48), low virus group (n=40, HCV RNA<105 IU/mL) and high virus group (n=40, HCV RNA ≥105 IU/mL), and other 30 healthy persons were selected as control. The peripheral blood T lymphocyte subsets and regulatory T lymphocytes of 4 groups were detected. The differences were analyzed among the 4 groups. Results The expression of CD4+CD25+Treg in high virus group, low virus group, negative group and control group were (13.57±1.87)%, (9.38±1.74)%, (5.95±1.28)% and (5.89±1.15)%, respectively. There were statistical differences among the 4 groups (F=35.28, P<0.01). The level of CD4+CD25+Treg increased with the increasing of HCV RNA. The level of CD4+CD25+Treg showed positive correlation with HCV RNA (r=0.625, P<0.05). The differences of CD3+, CD4+and CD4+/CD8+among the 4 groups had statistical significances (F=21.51, 28.52 and 15.51, P all <0.01). Among them, CD4+ lymphocyte and CD4+/CD8+ in high virus groupwere lower than other 3 groups, and those in low virus group were lower than negative group and control group (P all<0.05). Conclusions The percentage of CD4+CD25+Treg in patients with CHC has positive correlation with the level of HCV RNA. It suggests that CD4+CD25+Treg may play a role in chronic progress of HCV infection. The percentage of CD4+lymphocyte and CD4+/CD8+decrease significantly with the increasing of HCV RNA level, which demonstrates that the higher the level of HCV RNA is, the more obvious the depression of immunity will be.

目的 了解艾滋病(AIDS)合并神经梅毒(NS)的临床特征,为该病的诊治提供帮助.方法 回顾分析近1年多来22例AIDS合并NS患者的病史、临床表现、实验室检查、头颅CT及MRI检查情况.结果 22例患者均为男性,近半数有男-男性行为史.18例为无症状型NS,4例为有症状型,其中脑实质型2例、脑血管型2例.血清快速血浆反应素环状卡片试验(RPR)滴度≥1:32者19例(86.6％),有症状型患者头颅影像学检查均有异常.所有患者均进入AIDS期,需进行驱梅及抗人类免疫缺陷病毒(HIV)治疗.结论 本组AIDS合并NS的患者以无症状型多见,需积极驱梅、抗HIV治疗,对于血清RPR滴度≥1:32的患者,随访中应加强脑脊液复查.对于出现神经系统症状的年轻男性患者,需警惕AIDS合并NS的发生.

非酒精性脂肪性肝炎(nonalcoholic steatohepatitis,NASH)是由单纯性脂肪肝发展至肝纤维化、肝硬化和肝癌的重要阶段.由于生活方式的改变,在我国NASH发病率呈明显增加趋势,许多学者都在着眼于研究NASH病因学的预防和治疗,而建立理想NASH动物模型是非常重要的研究工具.本文综述了国内外常用的NASH动物模型,包括营养失调性、复合因素诱导及特殊品系的脂肪性肝炎模型,详述了各种模型的造模方法及优缺点,为今后建立更稳定的动物模型提供支持.

Objective To evaluate antimicrobial activity of fosfomycin combined with tigecycline against Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae and study the mechanism of drug resistance to fosfomycin. Methods Broth microdilution method was used to independently determine the minimum inhibitory concentrations (MIC)of fosfomycin and tigecycline against 42 Klebsiella pneumoniae isolates (including 20 KPC-producing and 22 KPC non-producing isolates).Checkerboard design method was applied to evaluate combined effect of different concentrations on antimicrobial susceptibility and calculate the fractional inhibitory concentration index (FICI).FICI=MICfosfomycin joint/MICfosfomycin monotherapy +MICtigecycline joint/MICtigecycline monotherapy .Related interpretation criteria were as following:FICI≤0.5 means synergy;0.5 <FICI≤1 .0 means additive;1 <FICI≤2 means indifference;FICI> 2 means antagonism.The fosfomycin resistant genes in KPC-producing Klebsiella pneumoniae isolates were screened.The data were analyzed by t test.Results Antimicrobial susceptibility testing&nbsp;results indicated the fosfomycin and tigecycline susceptibility rates in KPC-producing isolates were 35 .0%(7/20)and 70.0% (14/20 ),respectively.The susceptibility rates of drug combination increased to 50.0% (10/20 )and 95 .0% (19/20 ),respectively,with both MIC decreased.MIC of tigecycline decreased significantly after combination therapy and showed a statistical significance compared with the MIC of monotherapy (t = - 2.596,P = 0.013 ),whereas there was no significant difference between single and combined therapy of fosfomycin (t=-1 .274,P =0.211).FICI indicated that a total of 60.0%isolates showed synergy and additive effects between two antimicrobial agents,followed by indifference (40.0%),but there was no antagonism effect.Among 22 KPC non-producing isolates,there were 54.5 %showing indifference effects,followed by additive (31 .8%)and synergy (13.6%)effects.No antagonism effect was found.The study also identified two isolates with fosA resistant gene which located on the same plasmid as well as the bla KPC gene.The plasmid sizes in the two isolates were 138.9 kb and 104.5 kb, respectively.Conclusions KPC-producing Klebsiella pneumoniae are more susceptible to tigecycline. Combined use of two antimicrobial agents mainly exerts synergy and additive effect rather than antagonism,which may suggest the combination therapy strategy could inhibit the activity of KPC-producing Klebsiella pneumoniae .

Objective To evaluate the influence to detect ascites bacteria with 16S rRNA PCR-microarray in patients with spontaneous bacterial peritonitis( SBP) after treated with antibiotics.Methods Compared to ascites bacterial culture,ascites bacterial 16S rRNA genes were detected by PCR-microarray in 76 cases of suspected SBP with chronic liver diseases,and the difference of ascites bacteria positive rates between two groups with and without antibiotics were analyzed.Results Of the 76 ascites samples in SBP patients,there were 17(22.37％ ) ascites bacteria positive detected by PCR-microarray,and 6(7.89％ ) ascites bacteria positive detected by bacterial culture.The positive rates of former were much higher(x2 =18.05,P ＜0.01).In groups with and without antibiotics,the positive rates of bacterial detection with PCR-microarray were 19.35％ and 24.44％ respectirely,there was no statistical difference between the two groups( x2 =0.274,P ＞ 0.05) ; and the positive rates of bacterial detection with bacterial culture were 0(0/31 ) and 13.33％(6/45) respectively,there was statistical difference between the two groups(x2 =4.488,P ＜ 0.05).Conclusions Compared to the ascites bacterial culture,less influence is found in ascites bacteria detection with 16S rRNA PCR-microarray in patients with SBP after treatment with antibiotics.

Objective To observe the clinical significance of the serum enzymes activity and CRP level in adult patients with type A H1N1 influenza.Methods 63 adult patients with type A H1N1 influenza were divided into pneumonia group(18 cases) and ordinary group(45 cases) according to whether concurrent pneumonia or not,meanwhile 31 cases of healthy check-up person were collected as control group.The serum enzymes activity and CRP level were detected in all patients and the correlation of index and illness were analyzed.Results The level of serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),lactate dehydrogenase(LDH),creatine kinase(CK),creatine phosphate isoenzyme(CK-MB) and CRP were increased significantly in pneumonia group compared to ordinary group(P<0.01).The serum enzymes activity was normal,but the CRP was mildly elevated in ordinary group.Conclusion Type A H1N1 influenza patients complicated with pneumonia is often associated with multiple organ damage including heart,liver and so on.Bacterium infection is another cause of pneumonia except virus.The damage of vital organs is not apparent and the inflammatory reaction is lighter in ordinary patients.

OBJECTIVE:To evaluate the significance of determining ascitic bacterial 16S rRNA by quantitative PCR combined with microarray (PCR-microarray) in the diagnosis of spontaneous bacterial peritonitis (SBP).METHODS:Ascitic bacterial 16SrRNA was determined by real time fluorescent quantitative PCR-microarray in 76 cases of suspected SBP and 6 cases of non-infectious ascites with chronic liver diseases. The results were compared with ascitic bacterial culture simultaneously.RESULTS:Of 76 ascitic samples, 17 were detected bacteria positive by PCR-microarray, including 8 Grams positive(G+) and 9 Grams negative(G-), which was higher than that by bacterial culture which had only 6 ascitic samples detected positive (all G-); the positive rates were 22.4% vs 7.9%, respectively (P < 0.01). The bacterial strains detected by both methods in 6 cases had a consistency with each other. No bacteria were detected in another 6 cases of non-infectious ascites with chronic liver diseases.CONCLUSIONS:Determination of ascitic bacteria 16S rRNA by PCR-microarray has a higher specificity and sensitivity in the diagnosis of SBP as compared with the bacteria culture. Application of this novel method can not only accelerate SBP diagnosis but also stratify the different pathogens.

Objective To evaluate clinical applications on the quantitative PCR detection of ascitic bacterial 16S rRNA genes in the diagnosis of spontaneous bacterial peritonitis with non-neutrophil ascites. Methods The bacterial 16S rRNA was detected by quantitative fluorescent PCR in 64 cases of suspected spontaneous bacterial peritonitis with nonneutrophil ascites, 6 cases of chronic liver disease accompanied with non-infected ascites at the same time period, as compared to the ascitic bacterial culture. Results Bacterial 16S rRNA quantitative PCR can detect DNA duplicate as low as 10 copies. The rate of detectable bacterial 16S rRNA by quantitative PCR( 15.63% ) was significantly higher than the rate of positive bacterial culture (3.13% ) ( x2 = 5.52, P ＜ 0.05 ); and 6 cases of non-infected ascites were negative analyzed by quantitative fluorescent PCR and bacterial cultures. Conclusions The ascitic bacterial 16S rRNA quantitative PCR detection is high specificity and sensitivity for the diagnosis of spontaneous bacterial peritonitis with non-neutrophils ascites, whtich is of important clinical significance.

OBJECTIVE:To evaluate the value of ascitic bacterial 16S rRNA gene determination in the rapid diagnosis of spontaneous bacterial peritonitis (SBP).METHODS:16S rRNA gene from bacterial DNA in ascites was determined by quantitative fluorescent polymerase chain reaction (PCR) in 76 patients with suspected SBP and 6 patients with non-infectious ascites. The results were compared with those obtained from bacterial culture.RESULTS:The positive rate of SBP was 22.4% among patients detected with ascitic bacterial 16S rRNA gene determination-based quantitative fluorescent PCR, which was significantly higher than that (7.9%) in patients only received bacterial culture (P<0.05). In addition,in 6 patients with non-infectious ascites,both the 16S rRNA gene determination-based quantitative fluorescent PCR and bacterial culture showed negative results.CONCLUSIONS:16S rRNA gene determination-based quantitative fluorescent PCR can be an effective tool for the rapid diagnosis of SBP. It is more sensitive than the bacterial culture.

Objective:Explore patients with hepatitis c virus and HCVRNA serum biochemical changes of liver function.Methods: For 180 cases of chronic hepatitis C and the healthy check-up of 30 cases of group,A group of 30 cases of healthy check-up,B group of 60 cases for positive,HCVRNA 1×103 copy/ml,C group of HCVRNA 1×103～9.99×105 copy/ml D group is positive,HCVRNA 1×106 copy/ml.At the same time to 210 cases,HCV,HCV-RNA quantitative and liver(ALT),respectively,the AST comparison between groups.Results: A group of 30 cases of 27 patients medical check-up ALT normal abnormal 3 cases,the AST.B group of 60 patients with normal ALT 51 cases anomalies in 9 cases,55 patients with abnormal AST normal 5 cases.80 cases of group C 20 cases of normal ALT abnormal 60 patients,27 AST normal abnormal 53 cases.D group 40 cases of normal ALT 37 cases,3 cases of abnormal AST normal abnormal 35 patients in 5 cases.Group A with B group(P0.05 compared between liver earthqyuake is A group project,respectively,group B and C,D group(P0.05 compared between liver,with A statistical significance,the group C group D withcomparison between the liver function was statistically significant(P0.05).Conclusion: Chronic hepatitis c virus replication HCVRNA serum ALT levels and liver function abnormal AST,positively correlated,chronic hepatitis c abnormal liver function is the most direct factors for HCVRNA copy may be caused.