High Risk of Viral Reactivation in Hepatitis B Patients with Systemic Lupus Erythematosus

HBV reactivation (HBVr) can occur in hepatitis B surface antigen (HBsAg)-positive and negative patients. Here, we determined the incidence of HBVr and its related hepatitis in patients with systemic lupus erythematosus (SLE). From 2000 to 2017, 3307 SLE cases were retrospectively reviewed for episodes of hepatitis. The incidence, long-term outcomes and risk factors associated with HBVr, including HBsAg reverse seroconversion (RS) were analyzed. Among them, 607 had available HBsAg status. Fifty-five (9.1%) patients were positive for HBsAg and 63 (11.4%) were HBsAg-negative/antibody to hepatitis B core antigen (anti-HBc)-positive (resolved hepatitis B infection, RHB). None of them received antiviral prophylaxis before immunosuppressive treatment. During a mean 15.4 years of follow-up, 30 (54.5%) HBsAg-positive patients developed HBVr and seven (23.3%) died of liver failure, whereas only two (3.2%) RHB cases experienced HBsAg reverse seroconversion (RS). Multivariate logistic regression analysis showed that age ≥ 40 years at diagnosis of SLE (HR 5.30, p < 0.001), receiving glucocorticoid-containing immunosuppressive therapy (HR 4.78, p = 0.003), and receiving glucocorticoid ≥ 10 mg prednisolone equivalents (HR 3.68, p = 0.003) were independent risk factors for HBVr in HBsAg-positive patients. Peak level of total bilirubin ≥ 5 mg/dL during HBVr was an independent factor of mortality (p = 0.002). In conclusion, the risk of HBVr was associated with glucocorticoid daily dose. Antiviral prophylaxis is mandatory for SLE patients diagnosed at age of ≥40 years who receive ≥ 10 mg daily dose of oral prednisone or equivalent.     

乙型肝炎免疫实施方案及效果考核

目的 评价乙型肝炎疫苗免疫实施方案和远期效果。方法 考核乙肝疫苗接种率、及时率、孕妇HBV筛检率和阳性率,并对1986年出生时接种乙肝疫苗的对象随访采血,检测HBsAg、抗-肿s、抗-HBc。并设免前本区及邻区乙肝疫苗未免疫者为内、外对照。结果 免后14年HBsAg阳性率在1％以下,与内、外对照相比下降幅度达90％,远期保护效果为81.23％。结论 免后14年仍无需加免。     

重组乙型肝炎病毒核心抗原的免疫原性及其对乙型肝炎病毒表面抗原的免疫增强作用

目的探讨重组乙型肝炎病毒核心抗原(HBcAg)的免疫原性及其对重组乙型肝炎病毒表面抗原(HBsAg)的免疫增强作用。方法用透射电镜观察HBcAg、HBsAg及HBcAg+HBsAg混合抗原病毒样颗粒(Virus-like particle,VLP)的形态。将小鼠随机分为6组:阴性对照组(NS)、HBcAg组(C)、HBsAg组(S)、HBsAg+铝佐剂组(S+Al)、HBsAg+HBcAg混合组(S+C)及HBsAg+HBcAg+铝佐剂组(S+C+Al),用相应抗原免疫各组小鼠,分别于第0天、第14天经小鼠双侧大腿肌肉进行初次和加强免疫1次,间接ELISA法检测各组小鼠血清中HBsAg和HBcAg的特异性抗体水平,分析HBsAg特异性抗体亚类,ELISPOT法检测各组小鼠脾细胞中HBsAg特异性IFNγ、HBcAg特异性IFNγ及HBsAg特异性IL-4水平。结果电镜观察可见HBsAg和HBcAg均呈大小均一的VLP结构,二者混合后有聚集现象。初次免疫后,S+C组的HBsAg特异性抗体水平与S组差异无统计学意义(P=0.074),加强免疫后,S+C组HBsAg特异性抗体水平明显高于S组(P=0.002),C组和S+C组均可产生高水平HBcAg特异性抗体。S组HBsAg抗体亚类以IgG1为主,S+C组以IgG2a为主。S+C组HBsAg特异性IFNγ斑点数明显高于S组、S+Al组和S+C+Al组(P<0.05),C组与S+C组HBcAg特异性IFNγ斑点数均较高,与S+C+Al组比较,S+Al组HBsAg特异性IL-4斑点数明显升高(P=0.026)。结论 HBcAg具有良好的免疫原性,可增强HBsAg的免疫反应,使反应向Th1方向极化,为治疗性乙肝疫苗的研发奠定了基础。     

10850例患者手术前肝炎病毒血清标志物分析

目的分析10850例患者手术前各型肝炎病毒的血清标志物,为加强医院生物安全防护和减少医院感染提供依据。方法采用化学发光微粒子免疫分析法检测HBsAg、Anti-HBs、HBeAg、Anti-HBe、Anti-HBc和Anti-HCV,酶联免疫法检测HAV-IgM和HEV-IgM。结果 10850例患者手术前HBsAg阳性率为6.52%,Anti-HBs阳性率为46.69%,HBeAg阳性率为1.85%,Anti-HBe阳性率为22.62%,Anti-HBc阳性率为45.83%,Anti-HCV阳性率为0.33%,HAV-IgM阳性率为0.17%,HEV-IgM阳性率为0.75%;男性HBV感染率明显高于女性(P<0.05);不同年龄段间HBV的感染率差异有统计学意义(P<0.01),0～20岁年龄段人群HBV的感染率明显低于其他年龄段(P<0.01),且该年龄段人群对HBV的保护力明显提高;不同年龄段人群间HAV感染率差异无统计学意义(P>0.05),而HCV和HEV感染率差异均有统计学意义(P<0.05);10850份标本共有17种乙肝标志物组合模式。结论 10850例患者手术前HBV感染率较高,HAV、HCV和HEV感染率不高,但也应引起重视。应进一步加强患者手术前肝炎病毒血清标志物的检测及医院的生物安全防护。     

不同乙型肝炎表面抗原配制的免疫复合物的免疫原性

目的研究不同乙型肝炎表面抗原配制的免疫复合物(IC)的免疫原性,并进一步优选治疗性乙型肝炎疫苗最佳抗原。方法用不同重组乙型肝炎表面抗原(HBsAg)与不同的乙型肝炎表面抗体(anti-HBs)制备IC,分别免疫BALB/c小鼠,检测体液免疫及细胞免疫应答水平。结果IC诱生的抗-HBs效价、抗-HBsIgG2a/IgG1的比值及IFN-γ形成细胞数,YHB-IC组总体上略高于CHO-IC组,但差异无显著意义。结论IC的免疫效果优于单独HBsAg;不同乙型肝炎表面抗原配制的IC之间免疫原性差异无显著意义。     

Hepatitis B Virus Cure: Targets and Future Therapies

Chronic hepatitis B virus (HBV) infection is a major global health problem. It can cause progressive liver fibrosis leading to cirrhosis with end-stage liver disease, and a markedly increased risk of hepatocellular carcinoma. In the last two decades, substantial progress has been made in the treatment of chronic hepatitis, B. However, HBV is often reactivated after stopping nucloes(t)ide analogues because antivirals alone do not directly target covalently closed circular DNA, which is the template for all viral RNAs. Therefore, although currently available antiviral therapies achieve suppression of HBV replication in the majority of patients, hepatitis B surface antigen (HBsAg) loss and seroconversion is rarely achieved despite long-term antiviral treatment (HBsAg loss of less than 10% in 5 years). Various clinical trials of agents that interrupt the HBV life cycle in hepatocytes have been conducted. Potential treatment strategies and new agents are emerging as HBV cure. A combination of current and new anti-HBV agents may increase the rate of HBsAg seroclearance; thus, optimized regimens must be validated. Here, we review the newly investigated therapeutic compounds and the results of preclinical and/or clinical trials.     

干扰素α2a与白细胞介素-2联合作用对体外HepG2.2.15细胞增殖及乙型肝炎病毒复制的影响

目的探讨干扰素α2a(interferonα2a,IFNα2a)与白细胞介素-2(interleukin-2,IL-2)联合作用对体外肝癌细胞HepG2.2.15增殖及乙型肝炎病毒(hepatitis B virus,HBV)复制的影响。方法用不同浓度的IFNα2a(5 000、10 000、15 000 IU/ml)和IL-2(2 500、5 000、10 000 IU/ml)单独及联合作用HepG2.2.15细胞96 h后,采用WST-1法检测细胞增殖情况,倒置相差显微镜观察联合作用组细胞形态学变化,ELISA法检测联合作用组细胞上清中HBsAg和HBeAg的表达,斑点杂交法检测联合作用组细胞HBV-DNA的复制情况。结果与不同浓度的IFNα2a和IL-2单独作用相比,二者联合作用对HepG2.2.15细胞增殖的抑制作用明显增强(P<0.05);IFNα2a与IL-2联合作用组HepG2.2.15细胞显微镜下可见细胞逐渐变圆,胞浆中颗粒增多,增殖变慢,细胞间接触不紧密,细胞周围碎片增多;联合作用组细胞培养上清中HBsAg和HBeAg的表达明显受到抑制(P<0.05);5 000 IU/ml IFNα2a+10 000 IU/ml IL-2、10 000 IU/ml IFNα2a+10 000 IU/ml IL-2和15 000 IU/ml IFNα2a+10 000 IU/ml IL-2对HepG2.2.15细胞HBV-DNA的复制有抑制作用。结论 IFNα2a与IL-2联合作用对HepG 2.2.15细胞增殖及HBV-DNA复制均有抑制作用。本实验为后续体内动物实验及筛选合适的疫苗佐剂奠定了基础,也为新型乙型肝炎疫苗及治疗性乙型肝炎疫苗的研究提供了参考。     

Hepatitis B Flare in Hepatitis B e Antigen-Negative Patients: A Complicated Cascade of Innate and Adaptive Immune Responses

Chronic hepatitis B virus (HBV) infection is a dynamic process involving interactions among HBV, hepatocytes, and the host immune system. The natural course of chronic hepatitis B (CHB) is divided into four chronological phases, including the hepatitis B e antigen (HBeAg)-positive and HBeAg-negative phases. During HBV flare, alanine aminotransferase (ALT) levels abruptly rise to >5× the upper limit of normal; this is thought to occur due to the immune response against an upsurge in serum HBV DNA and antigen levels. Hepatitis flares may occur spontaneously, during or after antiviral therapy, or upon immunosuppression or chemotherapy in both HBeAg-positive and HBeAg-negative patients. The clinical spectrum of HBV flares varies from asymptomatic to hepatic decompensation or failure. HBeAg seroconversion with ≥ 1 year of consolidation therapy is accepted as an endpoint of oral antiviral therapy in HBeAg-positive patients, but recommendations for treating HBeAg-negative patients differ. Thus, the management of HBeAg-negative patients has attracted increasing interest. In the current review, we summarize various types of HBV flares and the associated complex cascade of innate and adaptive immune responses, with a focus on HBeAg-negative CHB patients. Hopefully, this review will provide insight into immunopathogenesis to improve the management of HBV flares in HBeAg-negative CHB patients.     

重组HBcAg与HBsAg混合抗原的免疫效果

目的观察重组HBcAg与HBsAg混合抗原免疫BALB/c小鼠后体液免疫与细胞免疫的效果。方法配制含Al(OH)3佐剂与不含佐剂的混合抗原,分别免疫BALB/c小鼠,采用ELISA法测定抗体滴度和细胞因子水平;采用流式细胞仪分析T细胞亚群。结果HBcAg与HBsAg混合抗原免疫小鼠产生的IFN-γ量明显高于二者单独免疫,CD3+和CD4+水平显著增高;含Al(OH)3佐剂的混合抗原CD8+水平明显高于阴性对照组;混合抗原免疫小鼠血清产生的抗-HBs抗体与2倍剂量的HBsAg单独免疫相比,差异无显著意义。含Al(OH)3佐剂与不含佐剂的疫苗免疫效果差异无显著意义。结论重组HBcAg与HBsAg混合抗原表现出良好的体液免疫与细胞免疫效果,为治疗性乙肝疫苗的开发提供了依据。     

乙型肝炎疫苗和卡介苗同时或分别接种的抗-HBs持久性

对乙肝疫苗和卡介苗同时或分别接种的抗-HBs的持久性进行了研究。同时接种组(1组)和分别接种组(2、3A、3B组)的抗-HBs阴转率和GMT均无显著差异,提示乙肝疫苗和卡介苗可以同时接种。抗-HBs的持久性与全程免疫后抗-HBs的峰值呈正相关,峰值<100 mIU/ml者,3年后有43.48％抗体转阴。建议全程后抗-HBs<100 mIU/ml者,3年后宜加强一针。     

Molecular Mechanisms to Control Post-Transplantation Hepatitis B Recurrence

Hepatitis B often progresses to decompensated liver cirrhosis requiring orthotopic liver transplantation (OLT). Although newer nucleos(t)ide analogues result in >90% viral and hepatitis activity control, severely decompensated patients still need OLT because of drug-resistant virus, acute exacerbation, or hepatocellular carcinoma. Acute hepatitis B is also an indication for OLT, because it can progress to fatal acute liver failure. After OLT, the hepatitis B recurrence rate is >80% without prevention, while >90% of transplant recipients are clinically controlled with combined hepatitis B immunoglobulin (HBIG) and nucleos(t)ide analogue treatment. However, long-term HBIG administration is associated with several unresolved issues, including limited availability and extremely high cost; therefore, several treatment protocols with low-dose HBIG, combined with nucleos(t)ide analogues, have been investigated. Another approach is to induce self-producing anti-hepatitis B virus (HBV) antibodies using an HBV envelope (HBs) antigen vaccine. Patients who are not HBV carriers, such as those with acutely infected liver failure, are good candidates for vaccination. For chronic HBV carrier liver cirrhosis patients, a successful vaccine response can only be achieved in selected patients, such as those treated with experimentally reduced immunosuppression protocols. The present protocol for post-OLT HBV control and the future prospects of newer treatment strategies are reviewed.     

HBsAg与GM-CSF基因双表达载体的构建及其免疫效果

目的构建乙型肝炎表面抗原基因(HBsAg)与GM-CSF基因的双表达载体,提高乙肝病毒DNA疫苗的免疫效果。方法将微小病毒内部核糖体进入位点(IRES)基因克隆到质粒pVAXⅠ多克隆位点,再将HBsAg基因和GM-CSF基因依次克隆到IRES的上、下游多克隆位点处,构建双表达载体pHIG。将pHIG转染到COS-7细胞中,检测瞬时表达情况,并用双表达质粒pHIG免疫BALB/c小鼠,检测免疫后小鼠血清中抗-HBs及其脾脏T细胞表面CD4+、CD8+分子的数量。结果在转染pHIG质粒的COS-7细胞上清液中有HBsAg的表达,pHIG双表达质粒组比pVAX/HBs组抗体产生时间提前2周,抗体阳转率提高2倍,小鼠脾脏T细胞表面CD4+分子数量及CD4+/CD8+值均高于pVAX/HBs组。结论HBsAg与GM-CSF基因双表达质粒能引起小鼠特异性免疫应答,并可提高免疫效果。     

HCV/HBV联合抗原免疫原性研究

目的 探讨HCV/HBV联合抗原PCX/S免疫原性。方法 将纯化的HCV复合多表位抗原蛋白PCX与HBV的S蛋白按一定比例混合并免疫小鼠,用ELISA的方法检测抗-HBs和抗-HCVAb;~3H-TdR掺入法检测免疫小鼠T淋巴细胞增殖;~(51)Cr释放法检测免疫小鼠特异性CTL杀伤作用。结果 免疫后5、10及15μg的3组均能诱导抗-HBsAb和抗-HCVAb,但抗HCVAb水平明显低于抗-HBsAb水平。免疫小鼠可诱发针对PCX或S蛋白的CTL反应,前者更明显,并刺激T细胞增殖。结论 HCV/HBV联合抗原PCX/S蛋白可诱导特异性免疫应答,为HCV/HBV双价疫苗的研究提供一定实验基础。     

鸡卵黄乙肝病毒特异性转移因子的制备及鉴定

目的制备鸡卵黄乙肝病毒特异性转移因子(EYHBV-TF),并检测其免疫活性。方法用乙肝疫苗免疫母鸡,收集鸡蛋,取卵黄进行透析,制备EYHBV-TF,参照药典要求,采用光谱法、高效液相色谱法(HPLC)、Lowry法等检测其理化性质。采用白细胞粘附抑制法(LAI)和迟发型皮肤超敏试验(DTH)检测特异免疫活性。结果EYHBV-TF是一种可透析、含有18种氨基酸、相对分子质量小于12000的小分子物质,其多肽含量为1·2mg/ml,核糖含量为152·94μg/ml,pH6·9±0·5,蛋白反应阴性,最大紫外吸收光谱在270nm处。该EYHBV-TF能明显抑制小鼠白细胞粘附(P<0·01),并能诱导小鼠跖趾部皮肤的迟发型超敏反应(P<0·01),与猪脾淋巴细胞制取的乙肝特异性转移因子(PSHBV-TF)检测结果接近(P>0·05)。而正常卵黄提取液组、非特异性转移因子和甲肝抗原(HAAg)对照组均不能表现出这两种效应(P>0·05)。结论EYHBV-TF与PS-TF主要理化性质和作用相类似,均具有乙肝抗原特异性细胞免疫活性。     

康赛宁对体外培养的人肝癌细胞的影响及与乙肝疫苗联合免疫对小鼠的免疫增强作用

目的研究A群溶血性链球菌制剂(康赛宁)对体外培养的人肝癌细胞系Hep3B和HepG22.2.15的影响及与乙肝疫苗联合免疫对小鼠的免疫增强作用。方法用不同浓度的康赛宁作用于人肝癌细胞Hep3B和HepG22.2.15,观察细胞形态学,MTT比色法检测细胞活性,EIA法检测培养上清HBsAg、HBeAg含量,吖啶橙直接染色检测细胞凋亡,Southernblot分析细胞DNA片段。给NIH小鼠腹腔注射康赛宁和乙肝疫苗,检测血清中HBs抗体、转氨酶水平。给普通小鼠腹腔注射康赛宁和乙肝疫苗,观察注射前后的体重变化。结果康赛宁可抑制HBsAg及HBeAg的分泌,使染色体DNA发生有规律的断裂,促使细胞发生凋亡。与乙肝疫苗联合免疫,可提高小鼠血清中HBs抗体水平。无论单用或合用康赛宁,对小鼠均无明显毒副作用。结论康赛宁对体外培养的人肝癌细胞系有影响,与乙肝疫苗联合免疫对小鼠有免疫增强作用。     

两种乙型肝炎病毒核酸定量试剂对315例样本检测结果的比较

目的采用国内和国外乙型肝炎病毒核酸(HBV DNA)定量检测试剂盒检测315份血清样本,比较两种试剂检测能力的差异。方法采用Abbott Architect i2000化学发光检测试剂盒检测315份样本的乙型肝炎血清学五项指标后,再用进口(简称"Roche试剂")及国产(简称"国产试剂")乙型肝炎病毒核酸定量试剂盒进行复检,比较两种试剂检测结果的一致性。结果两种试剂定性结果阳性符合率为60.6%(134/221),阴性符合率为100%(94/94),总符合率为72.4%,检测结果差异有统计学意义(P<0.01);无论对HBsAg阳性或阴性样本,Roche试剂的阳性检出率均明显高于国产试剂(P均<0.01),灵敏度为导致二者检测结果产生差异的主要原因;定量结果相关性和一致性分析表明,两种试剂定量检测结果有较好的一致性。结论不同试剂盒检测HBV DNA灵敏度差异较大,本实验国产HBV DNA定量试剂盒灵敏度较低,质量有待提高。     

慢性乙型肝炎患者血清前S_1抗原与HBV DNA的相关性及临床意义

目的 探讨慢性乙型肝炎患者血清前S_1抗原与HBV DNA的相关性。方法 采用ELISA及荧光定量PCR法检测180例慢性乙型肝炎患者血清前S_1抗原及HBV DNA含量。结果 前S_1抗原阳性者108例,HBVDNA阳性者130例,130例,HBV DNA阳性率显著高于前S_1抗原阳性率(P<0.05);130例HBV DNA阳性者中,前S_1抗原阳性者80例;108例前S_1抗原阳性者中,HBV DNA阳性者80例。结论 前S_1抗原与HBV DNA的联合检测及动态观察慢性乙型肝炎患者血清HBV DNA水平的变化,有助于临床诊断、疗效观察及预后判断。     

重组G145R HBsAg亲和纯化方法的建立及其应用

目的建立重组乙型肝炎病毒G145R变异HBsAg抗体亲和纯化方法。方法用抗-HBs单克隆抗体(D12- McAb)制备亲和层析胶,对2A8细胞(分泌G145R变异HBsAg)培养上清盐析物进行亲和纯化。采用SDS-PAGE、Western blot及ELISA,对纯化产物的纯度、特异性、含量和回收率进行鉴定,并与同法纯化的HBsAg阳性血清及r-wHBsAg提取物进行比较。结果D12-McAb对重组真核表达G145R变异HBsAg、HBsAg阳性血清及r-wHBsAS三者具有相似的亲和性,产物纯度分别为90.3%、95.2%和93.1%,回收率分别为43.3%、72.0%和66.4%。结论已成功地建立了重组G145R变异HBsAg抗体亲和纯化方法,为G145R变异以及其他HBV免疫逃逸变异感染的深入研究奠定了重要的技术基础。     

乙型肝炎病毒核心抗原与前S1抗原融合蛋白的原核表达、纯化及其免疫原性

目的 原核表达、纯化乙型肝炎病毒(HBV)核心抗原(HBcAg)(1～155)与前S1抗原(PreS1)(3～55)融合蛋白,并分析其免疫原性.方法 从HBeAg阳性慢性乙型肝炎患者血清中提取HBV DNA,以其为模板,PCR分别扩增HBeAg和preS1部分基因片段及融合基因CS1,将CS1基因亚克隆入原核表达载体p...     

携带乙肝表面抗原基因的质粒DNA在小鼠体内的免疫应答

将携带HBsAg基因的质粒DNA,直接注射到小鼠肌肉作为实验组;对照分成2组,一组注射携带β－半乳糖苷酶基因的质粒DNA,另一组注射商品化的血源性乙型肝炎疫苗、4周后从小鼠尾静脉采血,用ELISA方法检测血清中的抗－HBs。结果显示,实验组和注射乙型肝炎疫苗的对照组小鼠血清阳转率分别为5／6和4／6,而注射携带β－半乳糖苷酶的质粒DNA对照组小鼠血清全部为阴性。实验组小鼠血清中抗－HBs的水平与注射乙型肝炎疫苗的对照组小鼠类似,均在免疫后6～16周达到高峰,之后开始下降。抗体持续至少达半年以上。