乙肝杂志回顾 2013年12月1日Christine M. Kukka

StephenW

Studies Find Hepatitis B Virus Can Mutate and Infect Even Immunized People
A growing number of studies are finding that the hepatitis B virus (HBV) is so adept at mutating that in some cases it is able to infect people who have been immunized against hepatitis B.

The hepatitis B vaccine contains only one particle (antigen) of the virus—the hepatitis B surface antigen (HBsAg)—which makes up the outer layer of the virus. When immunized with this antigen, the body's immune system creates the hepatitis B surface antibody to specifically target and eradicate HBsAg if a person comes in contact with the virus. To date, the vaccine has effectively protected millions against hepatitis B.

However, researchers are finding some people who were immunized and then exposed to the virus are now infected with HBV that is able to replicate without HBsAg. Scientists say these vaccinated people have "occult" or a "vaccine escape" version of the infection. They have HBV DNA in their bodies, but they test negative for normal HBsAg.

A new study published in the November issue of the Journal of Virology finds that the number of vaccinated Chinese children with mutated HBV has increased from 6.5% in 1992 to 15% in 2005.(1) And, as these vaccinated children age and become adults, the rate of mutations increases. Researchers also fear these mutated virus may cause more severe liver disease in patients than regular HBV.

"The vaccine has been successful in protecting millions of children from HBV, but there is concern that use of the vaccine puts selective pressure on the virus to develop 'breakout' mutations that could render the vaccine less effective," wrote M. J. Friedrich in an editorial citing the study, entitled, "Hepatitis B vaccination spurs virus mutation rise," in the November issue of the Journal of the American Medical Association.(2)

In the investigation, researchers from the U.S. and China compared blood samples taken from vaccinated children and unvaccinated adults before and after universal HBV immunization began in China in 1992. "They found that the prevalence of HBV mutants in children increased from 6.5% in 1992 to almost 15% in 2005, whereas in the adults, little difference was seen in HBV mutation prevalence from 1992 to 2005—as would be expected because the adults did not receive vaccines.

"Although the vaccine remains effective, this study indicates that HBV mutations should be monitored so that additional vaccination strategies can be implemented when necessary," Friedrich cautioned.

In another study, published in the November issue of the Journal of Viral Hepatitis, researchers compared outcomes in babies born to HBV-infected mothers who were given only the vaccine or a combination of the vaccine and HBIG, which is composed of hepatitis B surface antibodies derived from humans. They found occult hepatitis B, with HBsAg mutations, in 42% of 222 babies two years after their births.(3) The occult infection rate was higher in infants treated with both the vaccine and HBIG, and whose mothers had high rates of HBV DNA when they were born.

1. Source: www.ncbi.nlm.nih.gov/pubmed/24006443

2. Source: http://jama.jamanetwork.com/data ... 8/jwm130041.pdf.gif

3. Source: www.ncbi.nlm.nih.gov/pubmed/24168259

研究发现乙肝病毒可能变异并感染甚至免疫的人们
越来越多的研究发现，乙肝病毒（HBV）是如此善于变异，在某些情况下，它能够感染谁已经接种了乙型肝炎人

乙型肝炎疫苗含有病毒的乙型肝炎表面抗原（HBsAg） ，它构成了该病毒的外层中只有一个粒子（抗原） 。当使用这种抗原免疫，人体的免疫系统会创建乙肝表面抗体特异性靶向和消除乙肝表面抗原，如果一个人接触到这种病毒的接触。到目前为止，该疫苗有效地保护了数百万乙肝

然而，研究人员正在寻找一些人谁免疫，然后暴露于病毒，现在感染了乙肝病毒，能够无HBsAg的复制。科学家们说，这些接种疫苗的人有“隐匿性”或“疫苗逃逸”版本的感染。他们有HBV DNA在他们的尸体，但他们阴性正常的HBsAg 。

发表在病毒学杂志十一月号的一项新研究发现，接种疫苗的中国儿童乙肝病毒变异的数量已经从6.5 ％在1992年增至15 ％，2005年（ 1） ，因为这些儿童接种疫苗的年龄，成为成人，突变率增加。研究人员还担心这些变异病毒可能会在患者比普通乙肝病毒造成更严重的肝脏疾病。

“该疫苗已成功地保护数以百万计的乙肝病毒的孩子，但有人担心疫苗的使用使选择压力对病毒发展'突围'的突变，也可能使疫苗的效果较差， ”在一篇社论中写道MJ弗里德里希援引研究报告，题为， “乙肝疫苗接种骨刺病毒变异引起， ”在美国医学协会杂志十一月号。 （ 2 ）

在调查中，研究人员从美国和中国相比，从儿童接种和未接种疫苗的成年人采取前后普遍HBV免疫接种开始在中国于1992年血液样本。 “他们发现，在儿童HBV变异株的发生率从6.5 ％ ，1992年上升到近15 ％，在2005年，而在成人，几乎没有差别主要出现在HBV变异发生率1992年至2005年，正如所预期的，因为大人做不接受疫苗。

“虽然疫苗仍然有效，本研究表明，乙肝病毒的突变，应监测，以便更多的疫苗接种策略可以实施必要的时候， ”弗里德里希警告。

在另一项研究发表在病毒性肝炎的日记帐的11月问题，研究人员比较了在婴儿出生到谁被赋予唯一的疫苗或疫苗组合和乙肝免疫球蛋白，它是由B型肝炎表面抗体，乙肝病毒感染的母亲结局源自人类。他们发现隐匿性乙肝，乙肝表面抗原与突变，在222婴儿他们的出生两年后42 ％ 。 （ 3）隐匿性感染率较高，与两个疫苗和乙肝免疫球蛋白治疗婴儿和母亲有乙肝病毒DNA率高当他们出生。

1 。资料来源： www.ncbi.nlm.nih.gov/pubmed/24006443

2 。资料来源： http://jama.jamanetwork.com/data ... 8/jwm130041.pdf.gif

3 。资料来源： www.ncbi.nlm.nih.gov/pubmed/24168259

Hepatitis B Patients Appear to Be At Risk of Other Diseases
Several new studies report that people with chronic hepatitis B appear to be at higher risk of heart disease, eye problems and fibromyalgia.

Abnormally High Rates of Heart Disease Found in Hepatitis B Patients: Japanese researchers screened 47 hepatitis B patients, who had no overt signs of cardiac problems, for heart disease using a variety of tests.

Myocardial perfusion defects (injury to heart muscle and restriction of blood flow) were found in 47% of the hepatitis B patients (far higher than in an uninfected control group) and abnormal electrocardiography results were found in 9% of the patients, according, according to a report in the November issue of the Journal of Gastroenterology and Hepatology.

The severity of the heart disease was then monitored during and after interferon treatment in 10 patients—and researchers found that heart disease markers declined in those patients who responded well to the interferon treatment.

"Myocardial perfusion defects were found in 47% of the patients with chronic hepatitis B, and improved along with (viral load) reduction with interferon administration," they reported. (1)

乙型肝炎患者似乎在其他疾病的风险
一些新的研究报告说，患有慢性B型肝炎似乎是在心脏疾病，眼疾和纤维肌痛的风险较高。

异常高的价格心脏病的乙型肝炎患者中发现：日本研究人员筛选47乙肝患者，谁的心脏问题没有明显的迹象，心脏疾病使用各种测试。

心肌灌注缺损（伤到心脏肌肉和血液流动的限制）中发现的乙肝患者47 ％ （远远高于未感染的对照组）和异常心电图结果发现患者9 ％ ，按，按在胃肠病学和肝病学杂志十一月号的报告。

对心脏疾病的严重程度和期间10例和研究人员发现，心脏疾病标志物在谁反应良好，干扰素治疗的患者下降了干扰素治疗后，再进行监测。

“心肌灌注缺损中发现的慢性乙肝47 ％ ，并与（病毒载量）降低干扰素的管理改进的，”他们的报告。 （1）

Higher risk of macular degeneration reported in older, HBV-infected patients:
An article in the November issue of the journal of Investigative Ophthalmology and Visual Science reports that hepatitis B infection, in addition to other risk factors, increases risk of macular degeneration, which is a major cause of partial-blindness in people 50 and older.

The study surveyed 7,899 Koreans age 40 and older. The overall rate of early-onset age-related macular degeneration—which is a major cause of partial-blindness in people 50 and older—was estimated at 6.7% and that of late macular degeneration at 0.7%.

Significant risk factors for macular degeneration, according to researchers, included older age, high cholesterol, high blood pressure, and HBV infection.(2)


报道中老年， HBV感染患者黄斑变性的风险较高：
在调查眼科及视觉科学杂志十一月号的一篇文章报道说，乙肝病毒感染，除了其他危险因素，增加了黄斑变性，这是局部失明的人在50岁以上的主要原因风险。

该研究调查了7,899韩国40岁以上。早发性老年性黄斑变性，它的总税率为局部失明的人在50岁以上，估计为6.7 ％，而晚期黄斑变性在0.7 ％的主要原因。

显著危险因素黄斑变性，据研究人员，包括高龄，高胆固醇，高血压，以及HBV感染。 （ 2 ）

Fibromyalgia syndrome found in 22% of hepatitis B patients in small study: A Turkish study has found that 22% of 77 hepatitis B patients suffered from fibromyalgia—a syndrome with widespread fatigue, muscle pain, morning stiffness and sleep disturbance.

It made no difference if the patients had "active" hepatitis B with liver damage or high viral load. The syndrome affected both types of chronic hepatitis B patients, according to the report published in the September issue of the International Journal of Clinical and Experimental Medicine.

"Recognition and management of fibromyalgia in HBsAg-positive patients will aid in improvement of quality-of-life," researchers wrote. "We fully accept that our preliminary results require confirmation in (larger) studies... More work is needed to ... understand the role played by, and the relevance of, infections (including HBV) in fibromyalgia syndrome pathogenesis."(3)

1. Source: www.ncbi.nlm.nih.gov/pubmed/24224614

2. Source www.ncbi.nlm.nih.gov/pubmed/24204048

3. Source: www.ncbi.nlm.nih.gov/pubmed/24179575


在乙肝患者的小型研究中22 ％的人认为纤维肌痛综合征：一个土耳其研究发现， 77乙肝患者22 ％患有纤维肌痛综合征有广泛的疲劳，肌肉疼痛，晨僵和睡眠障碍。

它并没有区别，如果患者有肝损害或高病毒载量“活跃”乙肝。该综合征影响这两种类型的慢性乙型肝炎患者，根据发表在临床国际期刊和实验医学杂志九月号的报告。

“纤维肌痛承认在HBsAg阳性患者的管理，将有助于提高生活质量的， ”研究人员写道。 “我们完全接受我们的初步结果需要确认在（大）的研究...更多工作是需要...了解所发挥的作用，以及中，感染（包括乙肝病毒）的纤维肌痛综合征发病机制的相关性。 ” （ 3 ）

1 。资料来源： www.ncbi.nlm.nih.gov/pubmed/24224614

2 。来源www.ncbi.nlm.nih.gov/pubmed/24204048

3 。资料来源： www.ncbi.nlm.nih.gov/pubmed/24179575

咬牙硬挺

都是坏消息，哼哼

一路抵御

不紧紧是肝脏的问题