Objective: This article investigated the clinical characteristics and distribution of drug resistance mutation sites in HBV RT region of hepatitis B infected patients. Methods: Retrospective analysis was made on 1 948 patients with HBV infection, who had been tested for NAs resistance mutation and had a medical history of NAs in the Laboratory Department of the Fifth Medical Center of the PLA General Hospital from January 2020 to December 2021. Basic clinical information and drug resistance related mutation information were recorded. Meanwhile, the serological index data of hepatitis B were collected. Drug resistance gene mutant group and non-mutated group were grouped according to whether the drug resistance genes had a mutation in HBV RT region, and the clinical characteristics and genotype distribution of the two groups were statistically analyzed. The pattern of drug resistance gene mutation, number of mutation sites, drug resistance type and mutation of NAs resistance-related sites were analyzed in 917 patients with drug resistance gene mutation in HBV RT region. χ2 Inspection was used for counting data. Meanwhile, two independent samples t-test and Wilcoxon rank sum test were used for measurement data. Results: Among the 1 948 patients with chronic HBV infection, 917 patients had drug resistance gene mutation in RT region (47.07%). The proportion of patients with acute hepatitis B and CHB in HBV RT resistance gene mutant group was lower than that in the non-mutated group, while the proportion of patients with HBV-related cirrhosis was higher than that in the non-mutated group, these differences were statistically significant. Compared with the non-mutated group in HBV RT region, the age, the positive rates of HBeAg and HBV DNA, and HBV DNA load of these patients were increased in drug resistance gene mutant group, these differences were statistically significant. Genotypes of patients in both groups were dominated by C, followed by B and D. The proportion of patients with genotype C in HBV RT drug resistance gene mutant group was higher than that of non-mutated group, the difference was statistically significant. There were 53 gene mutation patterns in 917 patients with drug resistance gene mutation in HBV RT region, and the main pattern was rtL180M+rtM204V+rtS202G (9.70%). The mutation sites were dominated by 3 (20.74%). There were 5 types of drug resistance, LAM+Ldt (21.25%) was the most. Among the 18 sites that were clearly associated with LAM, ADV, ETV and Ldt resistance in the HBV RT region, 14 sites were mutated, and the most common mutation sites were rtL180M, rtM204V, rtM204 and rtS202G. what's more, the proportion of patients with NAs drug resistance was LAM>Ldt>ETV>ADV. Conclusion: In order to prevent adverse consequences of this study such as disease recurrence or disease progression caused by HBV drug resistance, HBV infected patients, who have long-term use of NAs antiviral therapy, should monitor the level of HBV DNA and drug resistance genes in HBV RT region in order to optimize the treatment plan in time or guide individualized treatment.

Objective:In this article, we analyzed and discussed the clinical characteristics and S region gene sequencing of hepatitis B virus in HBsAg anti-HBs coexistent patients.Methods:Data of 5 serologic markers of hepatitis B and quantitative result, liver function and HBV DNA load of HBsAg positive patients were collected, and their basic clinical information were recorded. According to the positive and negative result of Anti-HBs, the clinical and virological characteristics of these two groups were analyzed. At the same time, among 17 320 patients with HBsAg positive HBV infection, 994 cases were tested by gene sequencing. The S region amino acid mutation, site mutation detection rate and genotype of 994 HBV infected patients with gene sequencing were statistically analyzed.Results:The positive rate of HBsAg and Anti-HBs was 4.36% (756/17 320). HBV-related cirrhosis in HBsAg+ /Anti-HBs+ group (19.71%) was significantly higher than that in HBsAg+ /Anti-HBs-group (15.94%), while chronic hepatitis B (62.04%) was significantly lower than that in HBsAg+ /Anti-HBs-group (67.06%). At the same time, the positive rates of HBsAg-quantification (QN) and ALT in HBsAg+ /Anti-HBs+ group were significantly lower than those in HBsAg+ /Anti-HBs-group, the positive rate of HBeAg was significantly higher than that in HBsAg+ /Anti-HBs-group, and the HBV DNA was higher than that in HBsAg+ /Anti-HBs-group, but the difference was no statistical significance. Gene sequencing was performed in 994 HBV patients. Genotype C (81.79%) had the highest proportion, genotype B (17.40%) was the second, and genotype D (0.80%) was the least in two groups. In genotype C HBV infected patients, the detection rate of sP120Q/T/A/S mutant in HBsAg+ /Anti-HBs+ group was significantly higher than that in HBsAg+ /Anti-HBs-group. Meanwhile, regardless of genotype B or C or overall comparison, the detection rate of sG145A/E/K/R mutant of HBV infected patients in HBsAg+ /Anti-HBs+ group was significantly higher than that in HBsAg+ /Anti-HBs-group, these differences were all statistically significant.Conclusions:The hepatitis B patients with coexistence of HBsAg and Anti-HBs were more likely to develop cirrhosis, and the hepatitis B patients with HBV gene sequencing results were mainly type C2. The drug resistance variation of S-region sP120Q/T/A/S and sG145A/E/K/R mutants of patients with HBV infection is an important reason for the coexistence of HBsAg and Anti-HBS.

Objective:To understand the characteristics of serological detection indicators of patients with hepatitis B virus (HBV) infection in three hospitals in Beijing from 2018 to 2021.Methods:The five markers of hepatitis B, liver function tests, HBV DNA load, AFP and PT test results and basic clinical information of HBsAg positive HBV infected patients in three hospitals in Beijing from 2018 to 2021 were collected. Then the diagnosis of HBV infection, the positive patterns of serological indicators for five markers of hepatitis B and the clinical characteristics of hepatitis B patients were analyzed by SAS 9.4 statistical software.Results:Among the 1 026 604 patients who were tested for the five markers of hepatitis B or hepatitis B surface antigen quantification (HBsAg-QN) in three hospitals in Beijing from 2018 to 2021, the positive detection rate of HBsAg was 53.50%. The annual positive detection rate of HBsAg was 57.22%, 55.05%, 53.64% and 47.69% successively, showing a downward trend year by year. 111 709 hepatitis B patients were divided into 1-30, 31-60 and>60 years old groups according to their age. The main diseases of the three groups of HBV infected patients was chronic hepatitis B (CHB), and the proportion of patients with acute hepatitis B (AHB) and CHB decreased with age, while the proportion of patients with HBV-related liver cirrhosis, HBV-related liver cancer, liver cancer surgery and liver transplantation increased with age, the difference of which was statistically significant (all P<0.05). In this research, a total of 24 positive patterns of the five markers of hepatitis B were detected, including 7 common patterns (the main pattern was 145), 14 rare patterns (the main pattern was 1345), and 3 unusual patterns (the main pattern was 12345). The age, male ratio, HBeAg positive detection rate, HBV DNA positive detection rate and load, TBIL, ALT, AFP and PT results in the HBsAg positive group (90 011cases) were higher than those in the HBsAg negative group (21 698 cases), and the above results of the two groups of hepatitis B patients were higher than those of the healthy control group (20 623 cases). The albumin (ALB) results were the lowest in the HBsAg positive group and the highest in the healthy control group. And the differences were statistically significant (all P<0.05). Conclusions:From 2018 to 2021, the positive rate of HBsAg among the patients who received the five markers of hepatitis B or HBsAg-QN test in three hospitals in Beijing decreased year by year. Age was associated with disease progression in patients with hepatitis B. The positive patterns of five markers of hepatitis B in HBV infected people showed diversity.

目的 分析不同献血总次数的男性单采血小板献血者血常规中血小板与白细胞相关指标的变化,评估献血次数对献血者外周血液学相关指标的影响.方法 选择2020年4月23日～2021年4月23日在本中心成功捐献单采血小板且献血总次数分别为初次、十的整数倍次及百次以上的448名男性自愿无偿献血者,其中十次以上的献血者年献血次数≥8次,比较献血者末次单采前外周血中PLT、PDW、MPV、P-LCR、PCT、WBC、NEUT#、LYMPH#、MONO#、EO#和BASO#指标的变化.结果 总献血次数百次以上男性单采血小板献血者的WBC、PLT、PCT、NEUT#和LYMPH#相较于初次男性单采血小板献血者差异有统计学意义(P<0.01),其中WBC、PCT、NEUT#虽差异有统计学意义,但两组献血者三项指标中位数仍在正常参考值范围内,PLT则在可捐献单采血小板血液检查要求(≥150×109/L且<450×109/L)范围内.百次以上男性单采血小板献血者LYMPH#低于正常参考值发生率为86.21％,初次男性单采血小板献血者LYMPH#低于正常参考值发生率为6.37％,差异有统计学意义(P<0.01);献血次数越多的单采血小板献血者,LYMPH#水平整体显著更低;献血次数为20、30次的单采血小板献血者中LYMPH#低于正常参考值者高达46.38％,且随着献血次数的增多,LYMPH#低于正常参考值者占比逐步增高.结论 多次数捐献单采血小板会导致献血者LYMPH#水平低于正常参考值,采供血机构在单采血小板献血者招募工作中应重视该现象.

目的 了解十二指肠乳头癌行Whipple手术患者术前贫血及围术期输血情况.方法 回顾性分析1959例十二指肠乳头癌行Whipple手术患者临床资料.结果 十二指肠乳头癌行Whipple手术患者术前贫血率为54.87％(1075/1959),从低到高3个年龄段患者贫血发生率分别为44.92％(≤50岁,190/423)、52.82％(51～64岁,506/958)、65.57％(≥65岁,379/578) (P＜0.05),贫血率最高的年龄段为65岁以上.不同身体质量指数(BMI)患者贫血发生率也有较大的差异(P＜0.05).中重度贫血患者相比轻度贫血患者围术期输注了更多的红细胞(P＜0.05).输血患者平均住院时长为27.25d,未输血组为22.22d(P＜0.05).腹腔镜、机器人手术患者术中出血量、住院时长均显著低于开腹手术患者(P＜0.05).住院期间单纯使用药物进行贫血干预的患者仅占24.09％ (186/772),大部分患者通过输血来干预贫血(75.91％,586/772).结论 十二指肠乳头癌行Whipple手术患者术前贫血发生率存在显著差异,BMI指数偏小、WBC异常、围术期输血均为住院时间延长的高危因素,而贫血则不会导致患者住院时间延长.

目的 针对母婴垂直传播,分析300例HBsAg阳性乙肝产妇所产新生儿的乙肝血清学标志物的表现模式及HBV DNA拷贝数,探讨其对宫内胎儿的影响及临床意义;同时,根据婴儿出生7个月后的随访结果,进一步探讨抗病毒药物对乙肝产妇母婴阻断的效果.方法 回顾300例HBsAg阳性孕妇及其所生婴儿的血清乙肝标志物和HBV DNA拷贝数,对结果进行统计学分析.同时,对出生7个月后新生儿进行随访,收集其乙肝五项和HBV DNA检测结果,对结果进行汇总和统计学分析.结果 300例HBsAg阳性乙肝产妇所产新生儿的乙肝五项模式共有13种.其中,179例HBsAg(+)HBeAg(-)产妇所产新生儿的乙肝五项模式有9种,121例HBsAg(+)HBeAg(+)产妇所产新生儿的乙肝五项模式有11种.新生儿血清中的HBeAg水平与其母亲的HBV DNA高拷贝数和强传染性有关.在HBsAg阳性母亲中,血清HBV DNA阳性的母亲所生婴儿被感染的危险度高于血清HBV DNA阴性的母亲所生婴儿,两组比较差异有统计学意义.HBV DNA阳性的产妇自28周起开始服用药物(替比夫定/富马酸替诺福韦二吡呋酯)组(69例)和未服药组(127例)其所产新生儿HBV DNA比较,差异具有统计学意义.结论 HBsAg阳性孕妇所生婴儿的乙肝血清学标志物模式具有多样性.孕妇HBeAg和HBV DNA阳性是宫内胎儿HBV感染的高危因素.乙肝孕妇怀孕28周服用抗病毒药物可显著降低新生儿感染HBV的风险.

目的 分析成分血献血者献血前筛查项目不合格主要原因,以制定策略降低献血者献血前筛查不合格率.方法 回顾性分析2018年11月26日至2019年8月26日4 679例成分血献血者的献血前筛查结果.结果 2018年11月26日至2019年8月26日期间成分血献血者献血前筛查总不合格率为21.29％,其中因WBC计数、PLT计数、ALT、Hb/HCT、乳糜、其他原因(健康征询、查体、病毒快速检定等)导致不合格的人数构成比分别为19.28％、6.93％、6.02％、56.62％、6.83％、4.32％,其中以Hb/HCT不合格者占比最多.将献血前筛查项目中因WBC计数、PLT计数、ALT、乳糜、其他原因不合格的献血者排除,对Hb/HCT合格与不合格献血者进行分组并分析两组人群的MCV、MCH、MCHC、RDW-CV,发现Hb/HCT不合格献血者群体的红细胞参数符合缺铁性贫血的血液学特征.结论 成分血献血者中因Hb/HCT不合格导致献血前筛查被淘汰的比例较大,对于献血前筛查贫血的这部分成分血献血者,采供血机构应当积极关注其铁代谢指标,必要时给予其铁营养支持或补铁指导,在维护献血者健康的同时提升献血前筛查合格率.