Objective To investigate the incidence and possible related factors for fatty liver among workers engaged in light manual labor in Tianjin, China. Methods Among 800 healthy workers engaged in light manual labor randomly selected from a company in Tianjin, a total of 602 healthy workers completed physical examination and data collection. The content of fat and liver stiffness were determined by controlled attenuation parameter (CAP) using FibroScan, and the disease history, body mass, height, blood pressure, and living habits in all subjects were investigated. The possible related factors for different degrees of fatty liver were analyzed. Between-group comparison of continuous data was performed using the Kruskal-Wallis H test, and comparison of categorical data was performed using χ2 test with row×column tables. Pairwise comparison was performed using χ2 segmentation method, and the agreement between CAP and color ultrasound was analyzed using the Kappa coefficient. Results Among the 602 subjects, there were 180 (29.9%), 195 (32.3%), and 227 (37.7%) subjects with severe fatty liver, moderate fatty liver, and no fatty liver, respectively. There were significant differences in age, body mass index, waist-hip ratio, smoking, drinking, history of diabetes, and family history between the above three groups according to CAP (P＜0.05 for all). With higher sensitivity, CAP achieved a significantly higher detection rate of fatty liver than traditional color ultrasound (62.3% vs 44.0%, P=0.000). The agreement between two methods was poor (Kappa value ＜0.4). Conclusion Among the so-called “healthy people” engaged in light manual labor, the incidence of fatty liver has exceeded 60%, which is associated with body mass index, waist-hip ratio, bad living habits, history of diabetes, and family history of fatty liver. CAP can noninvasively detect fatty liver with higher sensitivity and less time; however, its clinical significance needs further studies.

目的 了解慢性乙型肝炎病毒感染患者部分肾功能早期损伤指标变化及其影响因素. 方法 对2012年4月～2013年6月于武警后勤学院附属医院和天津市第三中心医院就诊的慢性乙型肝炎病毒感染患者90名进行调查,患者分别诊断为慢性乙型肝炎、乙型肝炎肝硬化及乙型肝炎病毒相关肝癌.进行尿微量白蛋白、尿转铁蛋白、尿IgG、血清β2微球蛋白检测评价患者早期肾脏功能.并同时检测患者肝肾功能,测算患者eGFR水平,并记录患者性别、年龄、血压、体质量及药物使用情况等一般信息.比较不同诊断乙型肝炎感染患者肾脏早期功能损伤的程度是否存在不同.随后按照是否存在肾功能早期损伤将患者诊断、一般情况等纳入多因素分析,找出慢性乙型肝炎病毒感染者肾功能早期损伤指标异常可能相关因素.结果 所有检测慢性乙型肝炎病毒感染者的血清肌酐水平均在正常检测范围.所有患者的eGFR异常率为12.7％,但肾功能早期损伤指标异常率高达72.2％(x2=56.25,P=0.000).患者疾病状态不同则肾功能早期损伤指标异常情况也不相同.尿转铁蛋白在慢性乙型肝炎、乙型肝炎肝硬化及肝癌患者数值分别为(1.91±1.06) mg/L、(2.66±3.01)mg/L、(6.73±8.32) mg/L,3组间比较差异有统计学意义(F=7.669,P=0.001);尿IgG的异常率在3组分别为4/30 (13.3％),15/29 (51.7％),11/30 (36.7％),差异有统计学意义(F=10.39,P=0.006);血清β2微球蛋白异常率分别为10/30 (33.3％),18/29 (62％),23/30(76.7％),差异有统计学意义(F=12.75,P=0.002).经Logistic回归分析,慢性乙型肝炎病毒感染者肾功能早期损伤指标异常的独立危险因素为患者年龄及疾病状态.结论 我们的研究初步表明,慢性乙型肝炎病毒感染者中,肾功能早期损伤异常率明显高于eGFR异常率,患者年龄和疾病状态是导致肾功能早期损伤指标异常的独立危险因素.但这种异常的具体临床意义有待进一步观察研究.

<正>病例1,男,49岁。2002年6月查体发现HBV感染,肝功能正常,未治疗。2002年11月自觉乏力明显,化

<正>乙型肝炎病毒(HBV)慢性感染是一个全球性的健康问题,仅中国就有约3000万慢性乙肝患者。笔者于2004年3～5月,应用水林佳(由天津天士力制药股份有限公司生产)治疗肝功能异常的慢性乙型肝炎患者34例,现将结果报告如下。

乙肝病毒携带者就是指乙肝表面抗原呈阳性而无明显的临床症状,肝功能及B超等检查结果完全正常的乙肝病毒感染者.在这些乙肝病毒携带者中,有些人的病情会逐渐进展为乙肝、肝硬化或肝细胞癌,但也有一部分人可以长期和乙肝病毒"和谐相处",一辈子都不发病.那么,乙肝病毒携带者是否需要进行药物治疗呢?

目的 探讨HBV感染母亲所产婴儿HBV感染情况以及生后免疫效果.方法 以新生儿出生2 h内静脉血定量检测HBsAg作为新生儿HBV感染指标,治疗组新生儿在出生后0、1、4、6个月使用重组乙型肝炎疫苗(酵母)各一次,每次10 μg,乙型肝炎免疫球蛋白用量根据新生儿出生后即刻检测结果而定,使新生儿体内的抗-HBs水平达到500～600 U/L,6个月龄评价疗效;与以未针对性免疫的6个月龄婴儿作为对照组进行比较.结果 治疗组共纳入1 460例婴儿,189例出生后感染,6个月龄时15例HBV阳性,占1.0%;对照组共纳入653例,6个月龄时64例HBV阳性,占9.8%(P＜0.01).结论 生后免疫在阻断HBV母婴传播方面有一定意义.

Objective To investigate the clinical and pathological characteristics of patients with chronic hepatitis B virus(HBV)infection in immune tolerant phase.Methods Ninety-eight chronic HBV carriers in immune tolerant phase were enrolled in this study.The age,gender,serum HBV DNA level,hepatic inflammatory activity and fibrosis,hepatic HBsAg and HBcAg expressions were analyzed.The grade of inflammatory activity and stage of fibrosis were also compared in patients with different levels of serum alanine aminotransferase(ALT).Data analysis was done by chi-square test. Results In 98 patients,83(84.7%)were＜30 years old and 15(15.3%)were≥30.Patients whose mother was HBsAg positive were 48.0%.High levels of serum HBV DNA were found in all patients, with 78.5% were＞1×107 copy/mL.Only 5 cases(5.1%)were G0 of the inflammatory grade;whereas,64 cases(65.3%)were G1,29(29.6%)were G2.There were 56 patients(57.1%)had no significant liver fibrosis;and 23 cases(23.5%)were S1,14(14.3%)were S2,5(5.1%)were S3;none of patients had cirrhosis.The HBsAg and HBcAg in liver tissues were positive in 79(80.6%)and 80(81.6%)cases,respectively.The fibrosis stages of patients with higher ALT levels were significantly greater than patients with lower ALT levels(X2=8.112 3,P=0.043 7).Conclusions Most of patients with chronic HBV infection in immune tolerant phase present mild inflammation in liver,some of them have already developed fibrosis.Therefore,liver pathology is recommended for these patients to help understand the patients' conditions and make correct therapeutic decisions.

Objective: To establish a direct gene sequencing method of HBV DNA P gene and discuss YMDD mutation of HBV DNA P gene in chronic hepatitis B patients and related factors. Methods: HBV DNA P genes were amplified by PCR and HBV YMDD mutations were identified by direct sequence compared with Genebank standard sequence. HBV P gene sequence analysis was conducted in 107 chronic hepatitis B (CHB) patients. Results: YMDD mutation, rate was 32.7% in 107 chronic hepatitis B patients including YIDD mutation in 17, YVDD mutation in 15 and multi-mutations in 3. Serum ALT level before therapy in patients without YMDD mutation was higher than those in patients with YMDD mutation, and HBV DNA level in pretreatment patients without YMDD mutation was much higher than those in YMDD mutation patients. There was no significant difference between the pretreatment patients without YMDD mutation and with YMDD mutation in sex, age and the state of HBeAg. Conclusion: HBV YMDD mutation may be related to ALT and HBV DNA level before treatment and not related to sex, age and the state of HBeAg.

OBJECTIVES To study the relationship between HBV genotypes and the efficacy of antiviral therapies. METHODS HBV genotypes of 90 hepatitis B e antigen positive patients with chronic hepatitis B (CHB) were determined by PCR sandwich hybridization-ELISA technique. Forty-one patients with CHB were treated with lamivudine (100 mg/day) for 48 weeks and 49 patients with CHB were given alpha-interferon (3 MU/QOD) therapy for 48 weeks. The serological, biochemical and virological symbols were measured before, during and after treatment for all the patients. RESULTS Of the 90 patients, genotype B HBV was found in 16 and C in 74. There was no difference in the rate of response to lamivudine treatment between patients with genotype B or C HBV (33.3% vs. 20.0%) after 48 weeks treatment with lamivudine in the 41 patients. Of the 49 HBeAg positive CHB patients treated with alpha-interferon for 48 weeks, in HBV genotype B and C patients the rates of normalization of ALT were 60.0% and 20.5%; the rate of HBeAg turning to negativity was 50.0% and 17.9%; and the rate of HBV DNA undetectability was 50.0% and 17.9%. The rate of response to the interferon treatment was significantly higher in patients with HBV genotype B compared to those with genotype C. CONCLUSIONS Our study shows that there is no influence on the lamivudine treatment effects for the HBV genotype B and C CHB patients, but the alpha-interferon treatment for HBV genotype B CHB patients is more effective than that for the genotype C ones.

<正>HBV所激发的免疫应答和免疫病理反应是乙型肝炎发病机制的关键。其中细胞毒性T淋巴细胞(CTL)是细胞免疫反应的主要执行者,而针对HBcAg的CTL应答决定病毒是否被清除。当HBV基因发生变异,可改变氨基酸分子的表达,尤其当CTL识别的重要表位发生变异会改变机体对病毒的免疫反应。本研究通过对HBV DNA C基因区进行核苷酸序列分析,并同时检测患者外周血

Almost all patients with HCV has HCV recurence after liver transplantation.Its pathogenesis is different according to different phases of this diseases.Fctors affecting its recurence includes HCV genetype,quasispecies,virus load,HLA matching between donator and recepptor,recurrence time,donator age and so on,in which the application of immunosuppressant is the most important influencing factor.There is still disputation about starting therapeutic time of antiviral drug because of its high price,limited efficacy and low tolerance.At present,the most possible therapeutic plan is to apply interferon with prolonged action alone.

OBJECTIVE To investigate the liver pathological changes and the clinical features of patients with hepatitis B virus (HBV) infection in their immune tolerant phase and non-active status. METHODS Fifty-four patients with chronic HBV infection in their immune tolerant stage and another 47 patients with the same infection but in non-active status were involved in this study. Statistical analysis including the ages and sex of the patients, their serum levels of HBV DNA, hepatocytic expression of HBsAg and HBcAg and their liver pathology were studied and statistically analyzed. Histological grading of inflammation and staging of fibrosis in the livers were also compared and analysed in patients with different levels of serum ALT. RESULTS The sex ratio of the two groups was of no significant difference. The average age of the patients in the non-active status [(28.11+/-8.60) years.] was older than that of the patients in the immune tolerant stage [(24.93+/-7.21) years], showing a significant difference (P < 0.05). The serum levels of HBV DNA of the patients in the immune tolerant stage were high and 94% of them had a HBV DNA higher than 106 copies/ml. In the non-active status group, 89% of the patients were HBV DNA negative. Between the two groups of patients there were no significant differences in the histological grades of liver inflammation or in the hepatocytic expressions of HBsAg and HBcAg. The stage of fibrosis was higher in the non-active status group than in the immune tolerant stage group, showing a significant difference between these two groups (u = 2.004, P < 0.05). The fibrosis stages of the livers of patients of a higher but within normal ALT level were markedly higher than those of a lower but within normal ALT level patients (u = 3.274, P less than 0.01). CONCLUSION Patients infected with HBV in non-active status may have experienced some occult courses of immune active stages; they are older in age and have higher levels of fibrosis. ALT sustained at a high level but within the normal range may indicate a higher degree of fibrosis, therefore liver pathological studies should be recommended for this kind of patient.

根据乙型肝炎病毒(HBV)全基因组序列差异≥8%或S基因序列≥4%,可将HBV分为A～H 8个基因型.不同基因型的产生反映了HBV变异进化的特点.目前有很多研究显示,HBV基因型与病情轻重有较密切的关系.本研究用S基因序列测定法对天津地区223例HBV DNA阳性的乙型肝炎患者进行基因分型,并分析其与临床的相关性.

Objective To study the relationship between the HBV genotype and its clinical status.Methods HBV gene sequencing analysis were conducted in 185 chronic asymptomatic.The damage of the histology was diagnosed by pathology.Results Most genotypes were B and C types(12.1%and 86.7% respectively).The different damage of the liver in genotype distributing were significantly different,and there was a statistical significance in two types.Compared with genotype B,genotype C was more commonly found in severe damage,but heavy damage of patients has no statistical significance in B and C types. HBeAg positive rate in patients of genotype C was higher than that of genotype B,but HBeAb positive rate in patients of genotype C was lower than that of genotype B.Conclusion Genotype C is associated with the development of severe hepatitis B,and genotype B has a relatively good prognosis.

干扰素是目前国际公认的治疗慢性乙型及丙型肝炎的药物,但在抗病毒治疗过程中常造成白细胞和血小板减少,部分患者常因此而延续或中断治疗,从而不能完成疗程,使疗效大大降低.重组人粒细胞巨噬细胞集落刺激因子(GM CSF)刺激骨髓造血虽然效果较好,但因其价格昂贵,应用受到限制[1].我们应用地榆升白片预防和治疗慢性乙型及丙型病毒性肝炎干扰素抗病毒治疗过程中,所致的白细胞减少症,现报告如下.

HBV血清分型并不能真正反映病毒的异质性以及病毒真正的种系关系,通过对HBV全基因组的比较,HBV分为8个基因型,分型标准依据全基因序列测定,基因型间同源性>92%或基因型间异质性≥8%,S基因序列测定,基因型间同源性>96%或基因型间异质性≥4%[1,2].本研究通过建立乙型肝炎病毒S基因直接测序分型方法,初步探讨HBV基因分型的意义.

Objective: In order to cut off validly HBV from mother to new born, it is divided into different types according to the embryo acquired HBV-markers and HBV DNA degrees. Methods: HBV-markers and HBV DNA were tested for 831 new born within 2 hours from 825 HBsAg positive mothers and divided into 5 types in order to run several immunity methods of HBIG(hepatitis B immunity globulin ) and hepatitis B vaccine. Six hundred and sixty five new born as a treatment group and control group of 166 were retested in 7～8 month old. Results: The immunity effect were significant different between the treatment and control groups(P 0.05). Conclusion: The effect of running immunity according different types is better than the traditional immunity. It is an important step to prevent HBV from morthers to their infants effectively.

目的:了解严重急性呼吸道综合征(SARS)患者外周血细胞及生化指标的变化特点.方法:观察54例SARS患者发病初及整个发病过程中外周血细胞及血清谷氨酸转氨酶、乳酸脱氢酶、肌酸激酶变化情况.结果:54例患者中重症型31例,普通型23例.入院时19例(35.19%)白细胞降低,29例(53.70%)淋巴细胞减少,8例血小板减少;全病程中49例(90.74%)白细胞升高,43例(79.63%)淋巴细胞减少,17例(31.48%)血小板减少,9例(16.67%)血小板升高.重症型和普通型患者淋巴细胞减少发生率差别有显著性(P<0.05).有29例(59.8%)血清谷氨酸转氨酶升高,39例(72.22%)乳酸脱氢酶升高,43例(79.63%)肌酸激酶升高,其中重症型和普通型乳酸脱氢酶异常发生率差别有显著性(P<0.01).结论:SARS病毒可能通过各种机理影响外周血细胞及生化学指标,观察上述指标变化有助于了解病情.尤其动态观察淋巴细胞及LDH变化对判断疾病的严重程度及预后有重要意义.

Objective:To evaluate the efficacy of silibinin capsules for patients with chronic hep- atitis B (CHB). Methods: Sixty-eight patients with chronic hepatitis (abnormal ALT level) were equally randomized to receive either silibinin capsules (360mg) plus inosine (1200mg) daily or inosine monotherapy (1200mg) daily for 12 weeks. The primary endpoints were to monitor the improvement of abnormal ALT and AST in weeks 4,8 and 12 after the administration of the study drugs. Results:79.4 percent of patients treated with silibinin plus inosine experienced an ALT and AST normalization, compared to 32.3 percent of patients treated with inosine alone (P0.05). No serious adverse events were reported in the bicombination group in the course of the therapy. Conclusion: Addition of silibinin capsules to inosine regimen achieves a significant normalizatoin of the ALT and AST levels in patients with CHB.