乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)病死率高，目前发病机制不明确，大量肝细胞坏死是其发病的关键因素之一，除肝移植外，尚无特效治疗。细胞信号共抑制分子疱疹病毒侵入介导因子(HVEM)-B和T淋巴细胞衰减因子(BTLA)参与多种免疫细胞的免疫应答过程并通过调控Janus激酶3-信号转导及转录激活蛋白3通路影响炎症细胞因子表达，可能在HBV-ACLF的发病中发挥重要的调节作用。本综述阐述了HVEM-BTLA通路在乙型肝炎病毒相关免疫中的作用机制和研究现状，以及其在HBV-ACLF免疫触发和疾病发生、发展中可能发挥的作用与机制，并讨论了HVEM-BTLA通路作为HBV-ACLF潜在治疗靶点、短期或长期临床预后生物标志物的可能性和应用前景。

Abstract Background Human brucellosis has become one of the major public health problems in China, and increases atypical manifestations, such as fever of unknown origin (FUO), and misdiagnosis rates has complicated the diagnosis of brucellosis. To date, no relevant study on the relationship between brucellosis and FUO has been conducted. Methods We retrospectively reviewed the medical charts of 35 patients with confirmed human brucellosis and prospectively recorded their outcomes by telephone interview. The patients were admitted to the Second Affiliated Hospital of Nanchang University between January 01, 2013 and October 31, 2019. Patient data were collected from hospital medical records. Results The percentage of males was significantly higher than that of female in FUO (78.95% vs. 21.05%, P < 0.05), and 80% of the patients had a clear history of exposure to cattle and sheep. Moreover, 19 (54%) cases were hospitalized with FUO, among which the patients with epidemiological histories were significantly more than those without (P < 0.05). The incidence of toxic hepatitis in FUO patients was higher than that in non-FUO patients (89% vs. 50%, P < 0.05). Meanwhile, the misdiagnosis rate was considerably higher in the FUO group than in the non-FUO group (100% vs. 63%; P < 0.05). Conclusion Brucellosis is predominantly FUO admission in a non-endemic area of China, accompanied by irregular fever and toxic hepatitis. Careful examination of the epidemiological history and timely improvement of blood and bone marrow cultures can facilitate early diagnosis and prevent misdiagnosis.

Objective To analyze the clinical characteristics and outcomes of 74 cases of scrub typhus in Jiangxi area.Methods The clinical data of patients with scrub typhus treated in the Second Affiliated Hospital of Nanchang University from January 2012 to December 2020 were analyzed retrospectively. The patients were assigned to two groups based on the acute physiology and chronic health evaluation（APACHE II） score to compare the clinical features, treatment and outcome between groups. Binary logistic regression was used to analyze the independent risk factors for severe scrub typhus. Results Most of the 74patients with scrub typhus were middle-aged（59.46%） or elderly（35.14%）. The elderly patients were associated with significantly higher severity of disease than the middle-aged patients（χ2=5.923, P = 0.015）. Farmers and forestry workers accounted for 77.03%and 16.22% of the patients, respectively. Majority（81.08%） of the patients had a history of exposure and 43.24% had used antibiotics before. Most of the cases ocurred in summer（48.65%） and autumn（32.43%）. Most of the cases were found in Fuzhou（43.24%） and Yichun（22.97%）. Characteristic eschar was found in all cases. The clinical manifestation included fever（95.95%）, headache（41.89%）,lymphadenopathy（56.76%）, and hepatosplenomeqaly（47.30%）. Eosinophils decreased in all cases. Platelets decreased in 54.05% of the cases. Serum albumin decreased in 94.59% of the cases. Liver transaminases increased in 91.89% of the cases. Serum creatinine increased in 21.62% of the cases. Forestry workers [odds ratio（OR）, 12.913], pulmonary infection（OR, 3.600）, elevated urinary protein（OR, 6.600）, longer time to defervescence（OR, 3.440）, serum creatinine（OR, 1.079） and misdiagnosis（OR, 134.923） were the significant risk factors of severe scrub typhus（all P ＜ 0.05）. Conclusions The cases of scrub typhus in Jiangxi area are mainly found in Fuzhou and Yichun. Most of the patients are middle-aged and elderly forestry workers who are busy in summer and autumn. The scrub typhus is characterized by high fever, characteristic eschar, and vascular extravasation. Laboratory tests showed normal or decreased white blood cell count, significantly decreased albumin and eosinophils. The patients may be complicated with toxic hepatitis and pulmonary infection and progressed to severe condition in case of misdiagnosis.

Aspirin decreases liver fibrosis index and inflammation levels. However, the exact mechanism underlying the effects of aspirin are yet to be elucidated. The aim of the study was to investigate the potential protective effects of aspirin on carbon tetrachloride (CCl4)-induced hepatic fibrosis in Sprague-Dawley rats. Rats were divided into four groups, including healthy and CCl4 control and low-(aspirin 10 mg/kg + CCl4) and high-dose aspirin group (aspirin 300 mg/kg + CCl4). After 8 weeks treatment, the histopathological examinations of hepatocyte fibrosis in liver and serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), IL-1β, transforming growth factor-β1 (TGF-β1), hyaluronic acid (HA), laminin (LN) and type IV collagen (IV.C) were determined. Histopathological examination suggested that aspirin decreased CCl4-induced hepatic fibrosis and liver inflammation. The high-dose aspirin group significantly decreased the serum levels of ALT, AST, HA and LN compared with the CCl4 control group. High-dose aspirin group significantly decreased the levels of pro-inflammatory cytokines IL-1β compared with CCl4 group. The high-dose aspirin group significantly inhibited the expression of TGFβ-1 protein compared with CCl4 group. Overall, the present study indicated that aspirin exhibited potent protective effects against CCl4-induced hepatic fibrosis via inhibition of the TGFβ-1 pathway and pro-inflammatory cytokine IL-1β.

Amoxicillin is widely used by the Chinese population and available in pharmacies without prescription. We performed a retrospective study on patients with fever who took amoxicillin before going to the fever clinic of the Second Affiliated Hospital of Nanchang University from March 1, 2020 to March 31, 2021. Among the total of 9093 patients attending the fever clinic, 446 patients had a history of taking amoxicillin, from which 100 cases were randomly selected to evaluate the therapeutic effects of non-prescribed amoxicillin by changes in clinical symptoms, counts of white blood cells, neutrophils, and lymphocytes, and levels of C-reactive protein (CRP). The control group consisted of 100 randomly selected patients for who it was verified that they did not take antibiotics before attending the fever clinic. Our study showed that there were no significant differences between the group of patients taking amoxicillin and the control group in terms of symptom improvement, white blood cell, neutrophil or lymphocyte counts, or the levels of CRP. Therefore, our study indicated that although non-prescribed amoxicillin is widely used among patients with fever, it does not provide significant beneficial therapeutic effects. There is still a long way to go to standardize the application of antibiotics and popularize knowledge on proper antibiotics use among the population.

目的 了解慢性乙型肝炎(CHB)患者抗病毒治疗不同阶段的血清HBV RNA及HBV DNA的变化,探讨在抗病毒治疗中HBV RNA的临床意义.方法 收集2015—2018年于南昌大学第二附属医院感染性疾病科就诊的CHB患者的病例资料.并根据治疗不同阶段分为:治疗前、治疗12周、治疗48周、治疗48周以上、停干扰素随访;根据治疗方案不同将治疗12周、治疗48周以及治疗48周以上的患者进一步细分为两个亚组;检测各组患者的HBV RNA及HBV DNA,分析抗病毒治疗中HBV RNA的变化趋势;分析HBV RNA与HBV DNA之间的关系以及不同治疗方案下HBV RNA变化的差异性.结果 使用干扰素抗病毒治疗的患者中,HBV RNA、HBV DNA双阴性患者占HBV DNA阴性患者84.6％;使用恩替卡韦抗病毒治疗患者中,HBV RNA、HBV DNA双阴性患者占HBV DNA阴性患者27.8％;停用干扰素后随访时HBV DNA阳性患者的HBV RNA水平显著高于HBV DNA阴性患者的HBV RNA水平.无论干扰素还是恩替卡韦抗病毒,HBV RNA、HBV DNA平均滴度水平整体呈下降趋势,不同时间段的变化差异有统计学意义(P<0.05);恩替卡韦治疗期间HBV RNA与HBV DNA无显著相关性;干扰素治疗48周、干扰素治疗48周以上、干扰素停药随访时HBV RNA与HBV DNA呈正相关,相关系数r分别为0.867、0.811、0.574,P<0.05.结论 抗病毒治疗过程中,血清HBV RNA变化与抗病毒药物及疗程有关,总体呈下降趋势;在判断抗病毒治疗疗效方面具有一定的临床意义,尤其体现在使用干扰素抗病毒治疗的患者.