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·医学检验·2012年10月第19卷第28期乙型肝炎（hepatitis B，简称乙肝）是一种严重危害人类健康、传播广泛的病毒传染性疾病，据世界卫生组织报道，全球约有20亿人感染乙型肝炎病毒，每年有超过60万人死于乙型肝炎病毒所致肝硬化或肝癌[1]。
乙型肝炎病毒侵入人体后，刺激人体免疫系统中的B淋巴细胞分泌出一种特异的免疫球蛋白G，也就是常说的乙型肝炎病毒表面抗体（HB-sAb），它可以与表面抗原特异地结合，与人体的其他免疫功能共同作用消除掉病毒，保护人体不再受HBV的感染[2]。
所以，乙型肝炎表面抗体（HBsAb）是一种中和抗体，具有保护作用，它的检测是判断疫苗接种效果的重要指标[3]。
目前，乙型肝炎表面抗体的检测主要还依赖于酶联免疫吸附试验（ELISA）来判断是否阳性，并不能说明HBsAb是否能达到对机体的保护作用。
电化学发光法（ECLIA）作为一种新型标记免疫分析技术，在临床工作中也得到了越来越广泛的应用。
笔者2011年8～11月对本院536例HBsAb阳性的标本分别使用电化学发光法和ELISA方法进行检测，并对检测结果进行分析比较。
1材料与方法1.1标本来源选取沈阳医学院奉天医院2011年8～11月门诊和住院患者HBsAb为阳性的血液标本536份。
1.2仪器及试剂ECLIA采用Roche E170型全自动电化学发光免疫分析仪，HBsAb试剂盒、校准品、质控品均由Roche公司提供。
严格按照仪器和试剂说明书进行校准、质控、检测等操作。
ELISA法采用上海科华HBsAb试剂盒检测，实验仪器为安图酶标仪和洗板机。
所有试剂均在有效期内使用。
1.3阳性标准ECLIA法≥10IU/L为阳性；ELISA法按照说明书确定临界值：为2.1×阴性对照（阴性对照<0.05按0.05计算），每次标本测定值（S/CO）≥临界值为阳性。
1.4统计学处理数据采用SPSS11.0软件进行四格表分析。
乙肝表面抗体阳性、核心抗体阳性（Hepatitis B surface antibody is positive, core antibody is positive）Hepatitis B surface antibody positive, hepatitis B core antibody positiveHepatitis B surface antibody is a protective antibody of human body, which can protect the body from HBV infection. Hepatitis B core antibody positive is infection or previous infection marker. These two simultaneous positive, indicating that the body was originally infected with hepatitis B, is in recovery or has recovered.Is hepatitis B antibody positive to be vaccinated?Whether to need to fight hepatitis B vaccine has the following two kinds of circumstances:1, if you are through hepatitis B vaccine to obtain hepatitis B antibody, it is recommended that every three years you strengthen the injection of a hepatitis B vaccine. Since the production of antibody by hepatitis B vaccine, the antibody level decreases with time. Most of our scholars suggest that it is better to strengthen the injection once three years after immunization. No matter how long apart, as long as the surface antibody titer in 10 international units more than /ml, indicating that the body has immunity to hepatitis B virus (variation hepatitis B invalid). Conversely, if the hepatitis B surface antibody titer is below this value, the injection should be enhanced.2, if the hepatitis B surface antibody is not obtained by injection of hepatitis B vaccine, but because of infection with hepatitis B virus obtained, at this time do not need to inject hepatitis B vaccine. The hepatitis B immune antibody obtained by hepatitis B infection has a relatively long duration.Hepatitis B surface antibody is positive, can be effective against hepatitis B virus invasion, thereby protecting the body from hepatitis B virus infection. The previous generation is generally believed that the injection of hepatitis B vaccine antibody 3-5 and sustainable, if often contact with hepatitis B patients if antibody offset faster, in recent years, clinical evidence of hepatitis B vaccine, hepatitis B surface antibody positive stimulation of antibody titer reached more than 10, most can play a protective role in 8-10, and often with hepatitis B patients contact person although antibody offset faster, but because the trace of hepatitis B virus stimulation, the body may also produce antibodies. If the hepatitis B surface antibody positive, generally do not have to worry about the daily life of infection, suggest that 3-5 check, in order to observe the existence and degree of antibodies, and antibody in weak timely to ensure the continuation of hepatitis B vaccine, antibody titer, and effective against hepatitis B virus, better maintenance of human health.Hepatitis B surface antibody appears weak positive, may have been infected with hepatitis B virus, has been restored to health. Or inoculation of hepatitis B vaccine may also lead to this phenomenon, indicating resistance already. The hepatitis B surface antibody is weak positive, generally is not contagious, but the hepatitis B antibody titer will graduallydecline along with the time, so generally strengthens injection once every 4-5 years. It's better to check two, half a titer below 10 micrograms, and every liter should be strengthened.The commonly used method of injecting hepatitis B vaccine is "0, 1 and June injection", that is, the second needle is injected 1 months after the first injection, and the third needle is injected 6 months after the first needle. According to the hepatitis B vaccine specific instructions, each subcutaneous injection of 5 - 10 micrograms. Seventh months, hepatitis B should be tested five items, the effect of vaccination. If the hepatitis B surface antibody is positive, that is effective, or else to play. Hepatitis B surface antibody is a protective antibody that can protect the body against hepatitis B virus, and its presence is the most important indicator of the effectiveness of hepatitis B vaccine injection.(1) if the hepatitis B surface antibody positive antibody titer is >10, showed that the protective antibody is enough, can to some extent in the prevention of hepatitis B virus attacks, without injection of hepatitis B vaccine to strengthen the needle, after check regularly.(2) if the surface antibody of hepatitis B is weak positive, that is, the titer of antibody is 4-10, then a hepatitis B vaccine should be inoculated to strengthen the needle.Hepatitis B surface antibody quantitative detection of normal value is less than 10 10mIU/m1, significantly negative, the body is not enough to resist the invasion of hepatitis B virus,hepatitis B is susceptible to the crowd, this time the need to fight hepatitis B vaccine booster, thereby enhancing the anti HBV effect; if more than 10mIU/m1, can effectively resist the infection of hepatitis B, and numerical better.Hepatitis B surface antibody (HBsAb) reached its peak in 6-12 months and gradually declined thereafter,Turn negative in 10 years (sometimes very fast).= = =Two half of hepatitis B is the most commonly used hepatitis B virus (HBV) infection detection serum marker in domestic hospitals. There are a total of 3 pairs of hepatitis B virus immunological markers, namely surface antigen (HBsAg) and surface antibody (anti HBs or HBsAb), e antigen (HBeAg) and e antibody (anti HBe or HBeAb), core antigen (HBcAg) and core antibody (anti HBc or HBcAb). Hepatitis B two half, also known as hepatitis B five, and its significance is: check whether the hepatitis B infection and the specific circumstances of infection, distinguish big Sanyang, small sanyang.Because core antigen is not easy to be measured in blood, at present the reagent box does not pass, so there are two half of antigen antibody, this is what people often say "hepatitis B two half and half" inspection, or called "hepatitis B five" inspection.Before the "two half and half", and later added a HBcAb-Igm (core antibody Igm), became the three, and now there is a Pre-S1(hepatitis B virus S1 antigen, S1 antigen), "two half and half" into the "three half and half".Hepatitis B two half of each index significance1 (HBsAg- hepatitis B surface antigen) as a sign of the virus has been infected, does not reflect whether the virus replication, replication, infectious intensity2 (HBsAb- hepatitis B surface antibody) is the hallmark of neutralizing antibodies, whether or not a major marker of recovery or resistance. Hepatitis B vaccination, if only the positive, should be regarded as a normal phenomenon after hepatitis B vaccination; hepatitis B virus infection on their own after the elimination of hepatitis B virus immunity will also have the body of hepatitis B surface antibody, this is a good phenomenon3 (HBeAg- hepatitis B virus e antigen) is a marker of viral replication. Continued positive for more than 3 months have affinity4 (HBeAb- hepatitis B virus e antibody) is a stop sign for viral replication. Viral replication decreases and infectivity is weaker than the HBV virus pattern, but not entirely without infection5 (HBcAb- core antibody) is a sign of a person who has been infected or is infected. The core antibody, IGM, is a marker of recent infection or viral replication. The core antibody IgG is produced after infection and has some relevance forassisting the two half of the test.Surface antigen: indicated that the hepatitis B virus (HBV) has been infected, because the surface antigen is the hepatitis B virus's shell, only this positive is not infectious. 70% - 90% surface antigen positive long-term, such as no symptoms, and liver function is normal, no symptoms of hepatitis B surface antigen carriers, without treatment, do not interfere with the work and study, the antigen positive in the population of China accounts for about 10%.Surface antibody: This is a protective antibody that neutralizes the hepatitis B virus. Clew: it is a kind of good phenomenon to obtain immunity after inoculation hepatitis B vaccine; second, hepatitis B recovery period or once suffered from hepatitis B already more, expressed already had immunity.E antigen: hepatitis B virus replication (reproduction) active, infectious stronger, and its close contact, the possibility of infection is greater. This antigen, such as persistent, suggests chronic hepatitis B virus carriers.E antibody: the condition that expresses hepatitis B patient is relieved, stability or incline to rehabilitation, prognosis is good, infectivity decreases, but do not assure the hepatitis B virus has disappeared completely.This is not the core antibody antibody neutralizing antibody, can not clear the virus, and once was in the body to exist for a long time, he recovered sustainable positive, the positive only recently infected with hepatitis B virus or viruscontinues to replicate (reproduction), or had hepatitis B virus infection, and can not distinguish between past or current infection is sick.9 common patterns1 - the past and present have not been infected with HBV.2 + - (1) previous infection failed to detect resistance to -HBs;(2) recovery stage HBsAg disappeared and anti -HBs did not appear; (3) asymptomatic HBsAg carriers.3 - - + + (1) had previously been infected with HBV; (2) acute HBV infection recovered; (3) a few specimens were still infectious. HBV infection has passed; the window period before the emergence of anti HBs. HBeAg appeared later in the latent period of hepatitis B, but disappeared later than the appearance of HBsAg,Closely related to HBV-DNA. Its clinical significance is as follows: (1) it can be used as an auxiliary diagnosis and prognostic indicator of acute hepatitis B. The recovery of acute hepatitis B usually disappears with the disappearance of HBsAg. If 3-4 months after the onset of acute hepatitis B, HBeAg is positive from Yang, anti -HBE appears, which means the prognosis is good. Onset of 3-6 months, still HBeAg (+), may be the earliest evidence of acute hepatitis becoming chronic.(2) it can help to determine the infectivity of hepatitis B patients or HBV carriers. HBeAg exists in the serum of HBsAg positive patients, indicating that there are Dane granules in the blood, most of which are HBV-DNA positive, and the threeare basically parallel. Therefore, HBeAg (+) is highly infectious. Anti -HBe (+) is generally less contagious. However, if serum HBV-DNA (+) may exist in the HBV variant, there is still a certain infectivity; (3) HBeAg positive suggests HBV replication in vivo. HBeAg appears to be resistant to -HBe before and after disappearance, and this phase is called seroconversion, from the HBV replication phase to the non replicative phase. Resistance to -HBe often indicates a decrease or termination of HBV proliferation. But if the nucleotide sequences of C before the change of HBV gene prevents the formation of HBeAg, HBV still exist in the blood circulation, liver disease may continue to develop, and gradually evolved into cirrhosis; (4) in primary hepatocellular carcinoma, the positive rate of HBeAg decreased, and the anti -HBe, a-FP in HBsAg (+ increased. The patients with liver cirrhosis), anti -HBe (+), a-FP increased, suggesting that early hepatocellular carcinoma; (5) maternal transmission in pregnant women during childbirth (HBeAg +) may spread between the rate of mother to child.4 - + - - (1) immunization with hepatitis B vaccine; (2) previous infection; false positive.5 + + + + acute HBV sensation rehabilitation.6 + + - (1) acute HBV infection; (2) chronic HBsAg carriers;(3) infectious weakness.7 - + - + infected with hepatitis B virus in the past, the virus has been basically cleared, the body in rehabilitation. However, there are still some patients with abnormal liver function andDNA positive. Whether or not there is a variation of the virus, it is still necessary to continue the treatment and still be immune. HBV infection, recovery stage.8 + - + + (1) acute HBV infection tended to recover; (2) chronic HBsAg carriers; (3) infectious weakness. Commonly known as "little Sanyang"".9 + + + - acute or chronic hepatitis B infection. Suggest HBV replication, infection is strong. Commonly known as "big Sanyang"".16 rare patterns10 + - - (1) acute HBV infection early, acute HBV infection incubation period; (2) chronic HBV carriers, infectious weak.11 + + - - (1) chronic HBsAg carriers tend to be negative; (2) acute HBV infection tends to recover.12 + + - - (1) acute HBV infection early, (2) chronic carriers, infectious strong.13 + - + + + (1) acute HBV infection tended to recover; (2) chronic carriers.14 + + - - (1) subclinical HBV infection early; (2) different subtypes of HBV two infection.15 + + - + (1) subclinical HBV infection early; (2) different subtypes of HBV two infection.16 + + + - subclinical or atypical infection.17 + + + + subclinical or atypical infection.18 + + + + - subclinical or atypical infection early. HBsAg immune complexes are newly infected with different subtypes.19 - - + - (1) atypical acute infection; (2) in the early stage of infection before the emergence of anti -HBc, HBsAg titer was low and negative, or false positive.20 + + + atypical acute infection.21 + + + acute HBV infection metaphase.22 - + - + - HBV infection has been restored.23 + + - atypical or subclinical HBV infection.24 + + + - atypical or subclinical HBV infection.25 - + - acute HBV infection tends to recover.7 rare patterns26 + + + + + + a subtype of HBsAg and profiled anti HBs (common); II. Serum converting from HBsAg to anti HBs (Shao Jian).27 - + + + -28 - + + + +29 - + + -30 + - + + -31 + + + -32 + + + + -3 normal modesThe following hepatitis B two half and half result index combination form, all indicated that now is the healthy person, has not infected the hepatitis B virus1. - + - +2. - + -3. - -1, hepatitis B symptoms are often manifested as loss of appetite, nausea, nausea and oil, abdominal discomfort, abdominal distension and so on.2, weak, tired, tired, listless, insomnia and dreaminess.3, jaundice is a more prominent symptom of hepatitis B symptoms, often manifested in urine color becomes dark, eyes, skin yellow.4, hepatitis B patients also often appear in right upper abdomen and right hypochondrium discomfort, pain and other symptoms.Hepatitis B two half of 135 positive, that is commonly known as the "hepatitis B big Sanyang", generally means that hepatitis B virus replication in vivo is more active, relatively strong infection. But the two semi hepatitis B 135 positive and can not explain the severity and the degree of liver damage in hepatitis B patients, to check liver function, liver B and hepatitis B virus load DNA related examination, comprehensive analysis and judgment can generally understand the severity of the replication of hepatitis B virus, and infectious size, and to determine the appropriate treatment according to the situation, to achieve the targeted drug, standardized treatment.Hepatitis B two pairs of semi positive 135, check if the liver function is normal, no other clinical symptoms, ultrasound examination showed no obvious damage to the liver, dynamic observations suggest that a HBV serological and biochemical indicators of liver function and ultrasound examination every 3-6 months.Hepatitis B two pairs of semi positive 135, check if the abnormal liver function, normal transaminase exceed more than 2 times, HBV-DNA positive, is suggestive of chronic active hepatitis, the immune has started, you should grasp the timing of treatment, the need for antiviral and protective therapy under the guidance of professional doctors.Hepatitis B two half of 145, positive refers to in the blood test, hepatitis B surface antigen, e antibody and core antibody is positive, we call it hepatitis B small sanyang.Where appear hepatitis B, two half of 145 positive (hepatitis B, small three yang), all indicate acute or chronic hepatitis B, in vivo viral replication, for hepatitis B virus replication.Hepatitis B two, half of 145 positive, should be further examination of liver function, blood routine, alpha fetoprotein and B ultrasound, so that they and doctors to understand the changes in the condition. Hepatitis B two half of 145 positive (hepatitis B small Sanyang) examination, HBV, DNA is still positive, indicating that hepatitis B virus still exists, is still infectious. Every transaminase is high, virus activity is small, 3 worlds need treatment. Otherwise, the liver will develop toward fibrosis - cirrhosis - liver cancer.In addition, hepatitis B two, half a 145 positive, HBV-DNA negative, normal liver function, many people believe that no treatment. However, liver biopsy showed that 90% of the patients had chronic liver inflammation and had a tendency to liver fibrosis. Some patients even had early cirrhosis and the most serious was cancer. This part of hepatitis B, small Sanyang patients should consider anti fibrosis treatment.Hepatitis B two pairs of semi positive 15 also known as hepatitis B 2 Yang, indicating that patients with infectious is relatively weak, if patients with acute or chronic hepatitis, the patients are contagious: if it is changed from hepatitisand viral replication, suggesting that tends to stop infectious. As long as the regular review of liver function and hepatitis B two half and half, as long as the function of the liver is normal, patients do not have to worry too much.Hepatitis B five, first HBsAg positive, indicating that the presence of hepatitis B virus in the body, is now being infected; hepatitis B five, fifth HBcAb positive, indicating that hepatitis B virus had been infected.To determine the severity of hepatitis B, we should make a more accurate judgement in addition to the five items of hepatitis B (two and a half), combined with liver function tests, hepatic fibrosis indexes and B ultrasonography, and CT findings. 15 hepatitis B positive, suggest further liver function and HBV-DNA examination. Take corresponding measures according to the inspection results.Hepatitis B two half to 245 positive refers to hepatitis B surface antibody, E antibody and core antibody is positive. Hepatitis B surface antibody is an antibody produced by hepatitis B surface antigen to stimulate the immune system,Can protect the body from hepatitis B virus attacks again.About hepatitis B two, half a 245 positive whether contagious, according to liver function, HBV-DNA, liver B ultrasound examination, to determine whether there is no virus replication. If two of 245 patients with positive hepatitis B, liver function is normal, DNA negative without virus replication, neither infectious hepatitis B virus; hepatitis B can exist in two veryfew 245 Yang, but positive for HBV-DNA virus replication, then there may be infected with hepatitis B virus.General hepatitis B two pairs of semi positive 245 January, when second after antibody after hepatitis B e antibody anti -HBe e antibody of hepatitis B will disappear; if the long time does not disappear, there may be a mutation of hepatitis B virus, need to do the relevant checks, timely treatment.Hepatitis B two half of the different combinations of its significance is not the same, the most common patterns are:1. hepatitis B five, 1 Yang, the remaining Yin: shows that the incubation period of acute viral infection is late; HBsAg virus carriers.2. hepatitis B five, 2 Yang, the remaining Yin: once vaccinated hepatitis B vaccine, and immune; second, have been infected with hepatitis B virus, but there have been immune antibodies; may appear false positive.3., hepatitis B five, 5 Yang, the remaining Yin: previously infected with hepatitis B virus, is now in convalescence.4. hepatitis B five, 15 Yang, the remaining Yin: commonly known as the "small two Yang" acute HBV infection; II. Chronic HBsAg carriers.5. hepatitis B five, 25 Yang, the remaining Yin: shows that previously infected with hepatitis B virus, has now recovered and has immunity.6. hepatitis B five, 45 Yang, the remaining Yin: (1) the past infection HBV; II acute HBV infection recovery period, the presence of hepatitis B surface antibody before the window period.7., hepatitis B five, 135 Yang, the remaining Yin: commonly known as the "big three yang" acute or chronic hepatitis B infection; II. Viruses in activity and replication period.8., hepatitis B five, 245 Yang, the remaining Yin: acute HBV feeling, rehabilitation period, has a certain immunity.9. hepatitis B five, 13 Yang, the remaining Yin: commonly known as "big second Yang" acute HBV infection; II chronic HBsAg carriers.10. hepatitis B five, 145 Yang, the remaining Yin: commonly known as "small Sanyang", suggesting acute or chronic hepatitis B, viral replication in vivo, hepatitis B virus replication statusHepatitis B two half and half liver function testDistinguish one: check different indicators(1) the target of the project is hepatitis B five, that is: surface antigen (HBsAg) and surface antibody (anti HBs or HBsAb), e antigen (HBeAg) and e antibody (anti HBe or HBeAb), core antibody (anti HBc or HBcAb).(2) liver function index: routine examination for alanine aminotransferase (ALT), alanine aminotransferase (AST), Gu Cao Gu Cao (AST/ALT), the valley of glutamyl transferase (GGP), alkaline phosphatase (ALP), total bilirubin (TBILI), direct bilirubin (DBILI), indirect bilirubin (IBILI), the total protein (TP), albumin (ALB) and globulin (GLB), than the white ball (ALB/GLB), glucose (GLU), urea nitrogen (BUN), creatinine (CRE), lactate dehydrogenase (LDH-L), creatine kinase (CK), total cholesterol (CHOL), triglyceride (TRIG), uric acid (UA).Difference two: the clinical significance is different(1) the second half of hepatitis B two check significance is: check whether the infection of hepatitis B and the specific circumstances of infection, distinguish big Sanyang, small sanyang.(2) liver function is to reflect the physiological function of the liver, liver function test is to detect whether the liver has disease, the extent of liver damage, as well as to identify the causes of liver disease, to judge the prognosis and to identify the cause of jaundice. Liver function tests are especially sensitive and important to the diagnosis of liver diseases such as hepatitis and cirrhosis.Many patients with hepatitis B will encounter such a situation, check the two semi hepatitis B, the doctor to check the hepatitis B virus DNA, HBVDNA is the hepatitis B virus can replicate the genetic material of the new virus, hepatitis B virus gene. Hepatitis B virus only antigen, and no HBVDNA, it will not infect others, because it does not replicate theability of the virus, the patient will be completely cured. The doctor is measuring the condition of the hepatitis B patient,Need measurement of the blood is contained in the HBVDNA (i.e. qualitative, positive or negative), to determine whether there are infectious; but also the check number with the virus (viral load), is to determine the level of infection, usually in the copy number per milliliter containing the number of virus (copy / ml) with the blood of patients with virus load.Two half of hepatitis B can only reflect the carrying pattern of antigen and antibody in the body and the immunity of the organism under certain conditions, so as to provide indirect evidence for the hepatitis B virus infection. The presence of HBVDNA is the direct evidence of hepatitis B virus infection, and is the gold standard for diagnosis.Hepatitis B two, half a check, and metabolism is not directly related, eating does not affect the HBV antigen antibody indicators, that does not affect the accuracy of the results of the examination. So you don't need an empty stomach.Hepatitis B two half and half examination, do not need fasting examination, but hepatitis B two half and half, often with liver function or hepatitis B ultrasound examination together, to determine the hepatitis B situation. The liver function and hepatitis B ultrasound examination must be fasting, while checking the day before eating light, check the first three days can not drink, in order to ensure the accuracy of inspection. So, if want to check hepatitis B at the same time two half, liver function (hepatitis B, b) must be empty stomach.1, for healthy people, through the injection of hepatitis B vaccine can produce sufficient hepatitis B antibody, 3-5 years to check once five hepatitis B can be, but there are chronic liver disease symptoms, but also need to check the hepatitis B five.2, for regular contact with hepatitis B patients, it is best to go every year to check the hepatitis B antibody titer, once the titer is less than 10, should be timely vaccination hepatitis B vaccine, strengthen the needle.3, for hepatitis B patients, hepatitis B five checks interval depends on their own circumstances, neither between the interval is too long, but too frequent inspection is meaningless. If patients are not treated with special antiviral therapy, there is no need to examine HBV markers and viral variants frequently, and each patient's condition must be selected for an examination to be performed. Under normal circumstances, it is recommended that every three months or six months of the patient's friends to check the hepatitis B five checks. There are five clinical hepatitis B is often carried out with the liver function, especially the hepatitis B patients who have manifested the symptoms of hepatitis B, if the feeling is a little unusual, go to the hospital for examination.Big 3 this world is infectivity, small, 3 this world infectivity is lower, healthy carrier is not infectivity.HBsAg carriers account for about 10% of China's totalpopulation.Hepatitis B is transmitted mainly through the bloodstream, occasionally through saliva and semen, and in daily life, general contact is unlikely to infect others."Small Sanyang," who, usually without hepatitis symptoms, liver function has been normal people, also known as hepatitis B virus carriers.It is estimated that there are about 215 million people living with hepatitis B virus in the world, about 120 million of them in china.。
DOI：10.16662/ki.1674-0742.2024.05.020丁二磺酸腺苷蛋氨酸治疗乙型肝炎病毒性肝硬化合并胆汁淤积的预后效果分析李征江苏新沂市人民医院肝病科，江苏新沂221400［摘要］目的探讨乙型肝炎病毒性（Hepatitis B Virus, HBV）肝硬化合并胆汁淤积患者采用丁二磺酸腺苷蛋氨酸（Adenylmethionine Succinate, SAMe）开展治疗的预后效果。
方法单纯随机选取2022年2月—2023年2月新沂人民医院消化内科收治的80例HBV肝硬化合并胆汁淤积确诊患者作为研究对象，采用奇偶数字法分为对照组和研究组，每组40例。
对照组以常规方案开展用药，研究组以对照组用药为基础增加使用SAMe。
对两组肝功能、胆汁代谢指标、预后疗效以及不良反应进行对比观察。
结果治疗后，研究组谷草转氨酶、总胆红素以及谷丙转氨酶水平均低于对照组，差异有统计学意义（P均<0.05）。
研究组血清甘胆酸、总胆汁酸水平低于对照组，差异有统计学意义（P均<0.05）。
研究组治疗总有效率为97.50%，高于对照组的80.00%，差异有统计学意义（χ2=6.135，P<0.05）。
但两组药物不良反应发生率比较，差异无统计学意义（P>0.05)。
结论针对HBV肝硬化同时合并有胆汁淤积的患者，于常规保肝用药为基础上增加使用SAMe可有效提升预后疗效，促进患者肝功能与肝汁代谢功能改善，且不会导致不良反应增加，安全有效。
［关键词］乙型病毒性肝炎；肝硬化；胆汁淤积；丁二磺酸腺苷蛋氨酸；预后［中图分类号］R4 ［文献标识码］A ［文章编号］1674-0742（2024）02(b)-0020-05Prognostic Effect of Adenosylmethionine Butadisulfonate in the Treatment of Hepatitis B Viral Cirrhosis Complicated with CholestasisLI ZhengDepartment of Hepatology, Xinyi People's Hospital, Xinyi, Jiangsu Province, 221400 China[Abstract] Objective To explore the prognostic effect of treating patients with hepatitis B virus (HBV) cirrhosis com⁃plicated by cholestasis with adenylmethionine succinate (SAMe). Methods A total of 80 patients diagnosed with HBV cirrhosis combined with cholestasis admitted to the Gastroenterology Department of Xinyi People's Hospital from Feb⁃ruary 2022 to February 2023 were simply and randomly selected as the study objects. They were divided into control group and study group by odd-even number method, with 40 cases in each group. The control group was treated with the usual regimen, and the study group was treated with SAMe based on the control group. Liver function, bile metabo⁃lism indexes, prognostic efficacy and adverse reactions were compared between the two groups. Results After treat⁃ment, the levels of aspartate transaminase, total bilirubin and alanine transaminase in the study group were lower than those in the control group, and the differences were statistically significant (all P<0.05). The levels of glycholic acid and total bile acid in the study group were lower than those in the control group, and the differences were statistically significant (both P<0.05). The total effective rate of the study group was 97.50%, which was higher than that of the control group (80.00%), and the difference was statistically significant (χ2=6.135, P<0.05). There was no statistically significant difference in the incidence of adverse drug reactions between the two groups (P>0.05). Conclusion For pa⁃tients with HBV cirrhosis combined with cholestasis, the addition of SAMe on the basis of conventional liver protec⁃tion drugs can effectively improve the prognosis, improve the liver function and liver juice metabolism of patients, and will not lead to increased adverse reactions, and is safe and effective.[作者简介] 李征（1971-），男，本科，副主任医师，研究方向为肝硬化。
肝硬化血小板减少的病理生理发生机制肖函;王利【期刊名称】《实用肝脏病杂志》【年(卷),期】2019(022)004【总页数】4页(P462-465)【关键词】肝硬化;血小板减少;发生机制【作者】肖函;王利【作者单位】400010重庆市重庆医科大学附属第一医院血液科;400010重庆市重庆医科大学附属第一医院血液科【正文语种】中文血小板减少是肝硬化并发的最常见血液系统病症。
以往认为肝硬化患者血小板减少主要系门静脉高压脾脏长大、脾脏功能亢进，脾脏巨噬细胞吞噬及脾脏滞留大量血小板所致。
近年新认识的肝硬化血小板减少病理生理机制表明，除了脾脏因素外，其它导致血小板减少的机制应该引起临床医师的关注，了解这些新的理念，有助于调整临床治疗策略。
1 血小板生成的生理过程巨核细胞是从骨髓造血干细胞、原始巨核细胞、幼稚巨核细胞分化而来的细胞，是正常骨髓中一种能生成血小板的成熟细胞，核很大，数量非常少。
成熟的巨核细胞又经历了:①颗粒型巨核细胞:胞核大，胞质丰富，染粉红色，夹杂有蓝色，质内含有大量细小的紫红色颗粒，常聚集成簇，但无血小板形成；②产生血小板型巨核细胞（产板细胞）:胞体巨大，有时可达100μm，胞核高度分叶状，胞质呈均匀粉红色，质内充满大小不等的紫红色颗粒或血小板。
胞膜不清晰，多呈伪足状，其内侧及外侧常有血小板的堆集；③裸核型巨核细胞：产板细胞的胞浆解体后，释放出大量血小板，仅剩一裸核。
这些被细胞膜包围的与巨核细胞胞质分离的小块胞质，进入血循环成为血小板。
每个巨核细胞产生约300～4000个血小板。
新生血小板先通过脾脏，约有1/3在此贮存，约2/3在末梢血循环中。
贮存的血小板可与进入循环中的血小板自由交换，以维持血中的正常量。
血小板寿命约7～14天，每天约更新总量的1/10，衰老的血小板大多在脾脏中被清除。
循环中血小板正常值为100～300×109/L。
血小板的生成受血液中的血小板生成素（thrombopoietin，TPO）调节。
在学校做乙肝的作文英文回答：Hepatitis B is a viral infection that affects the liver. It is caused by the hepatitis B virus (HBV), which is transmitted through blood and other body fluids. This virus can lead to both acute and chronic infections.As for me, I have personal experience with hepatitis B. When I was in high school, one of my close friends was diagnosed with chronic hepatitis B. It was a shocking revelation for all of us, as we didn't know much about the disease at that time. My friend had to undergo regularcheck-ups and take medication to manage the condition. Seeing her struggle with the disease made me realize the importance of raising awareness about hepatitis B.One of the main ways to prevent hepatitis B is through vaccination. The hepatitis B vaccine is highly effectiveand provides long-term protection against the virus. Iremember getting vaccinated myself and encouraging my friends and family to do the same. It was a small step towards protecting ourselves and others from this potentially serious infection.Apart from vaccination, it is also crucial to practice safe behaviors to prevent the transmission of hepatitis B. This includes using condoms during sexual intercourse, avoiding sharing needles or other drug paraphernalia, and ensuring that any medical equipment is properly sterilized. These precautions can greatly reduce the risk of contracting hepatitis B.It's important to note that hepatitis B is not transmitted through casual contact such as hugging, sharing food or drinks, or even shaking hands. This misconception often leads to stigma and discrimination againstindividuals with hepatitis B. Education plays a vital role in dispelling these myths and promoting understanding and empathy.中文回答：乙肝是一种影响肝脏的病毒感染。
In the realm of healthcare, prevention is often considered to be better than cure, and this principle holds true when it comes to the hepatitis B virus (HBV). Hepatitis B, a highly contagious liver infection caused by the HBV, can lead to severe health complications if left undetected or untreated. Given its potential severity and the fact that children, including primary school students, are particularly vulnerable, it is crucial to implement and emphasize hepatitis B screening in this age group. This essay aims to delve into the multi-faceted significance of hepatitis B screening for primary school students, considering aspects such as disease prevalence, long-term implications, early detection benefits, preventive measures, and the role of schools in promoting screening.I. Disease Prevalence and Vulnerability of Primary School StudentsHepatitis B remains a global health concern, with the World Health Organization estimating that around 296 million people worldwide are living with chronic HBV infection. Children, particularly those under the age of five, are at heightened risk due to their immature immune systems, which may struggle to effectively combat the virus. This vulnerability extends to primary school students who, if exposed to HBV during childhood, have a 90% chance of developing chronic infection. In contrast, adults infected with HBV have only a 5-10% likelihood of progressing to chronicity.Moreover, HBV transmission is often asymptomatic, making it challenging to identify infected individuals without proper screening. In primary school settings, where children engage in close physical contact and share personal items, the risk of transmission is further exacerbated. Thus, routine hepatitis B screening becomes imperative to identify infected students, prevent further spread, and initiate timely treatment.II. Long-Term Implications of Undiagnosed Hepatitis BChronic hepatitis B infection can lead to serious health complications later in life, including cirrhosis, liver failure, and hepatocellular carcinoma. These conditions not only pose a significant threat to an individual's quality of life but also carry substantial economic burdens on families and healthcare systems.Early detection and intervention through screening can significantly reduce the likelihood of these complications, as well as the associated morbidity and mortality rates.Furthermore, the psychological impact of undiagnosed hepatitis B should not be overlooked. Children diagnosed with chronic HBV may face stigma, discrimination, and social isolation, which can negatively affect their emotional wellbeing and academic performance. Regular screening and subsequent education can help mitigate these issues by fostering understanding and empathy within the school community.III. Benefits of Early Detection and InterventionScreening primary school students for hepatitis B allows for early detection and intervention, which is crucial for mitigating the long-term health consequences of the disease. Once diagnosed, children can receive appropriate medical care, including regular monitoring of liver function, vaccination of household contacts, and antiviral therapy if indicated. Early treatment can effectively suppress viral replication, slow disease progression, and significantly lower the risk of liver cancer.Additionally, identifying HBV-positive students enables the implementation of preventive measures within the school environment. This includes raising awareness among staff and peers about the importance of hygiene practices, safe handling of blood and bodily fluids, and the provision of first aid training specific to HBV exposure. By doing so, schools can create a safer and more inclusive environment for all students, reducing the risk of transmission and fostering a culture of understanding and support.IV. The Role of Schools in Promoting Hepatitis B ScreeningSchools play a pivotal role in promoting hepatitis B screening among primary school students. They can collaborate with local healthcare providers to organize on-campus screening programs, making testing accessible and convenient for both students and parents. Educational campaigns can be integrated into the curriculum, teaching children about hepatitis B transmission, prevention, andthe importance of screening. Such initiatives can help dispel misconceptions, alleviate fears, and encourage open dialogue about the disease.Moreover, schools can serve as advocates for policy change, pushing for the inclusion of hepatitis B screening in routine health check-ups or as a prerequisite for school enrollment. This would not only increase screening rates but also ensure that all students, regardless of their socioeconomic background, have equal access to life-saving diagnostic services.V. ConclusionIn summary, hepatitis B screening for primary school students is of utmost importance due to the high disease prevalence, vulnerability of children to chronic infection, and the severe long-term implications of undiagnosed HBV. Early detection through screening offers numerous benefits, including timely intervention, disease management, and the implementation of preventive measures within the school setting. Schools, as key stakeholders, have a vital role to play in promoting hepatitis B screening, fostering a culture of awareness, and advocating for policy changes that ensure universal access to this life-saving service. By prioritizing hepatitis B screening in primary schools, we can take a significant step towards eradicating this silent epidemic and safeguarding the health and future of our youngest generation.。
关于乙肝英语全文共四篇示例，供读者参考第一篇示例：Hepatitis B, commonly known as HBV, is a viral infection that attacks the liver and can cause both acute and chronic diseases. It is a major global health problem and the most serious type of viral hepatitis. According to the World Health Organization (WHO), an estimated 257 million people are living with chronic HBV infection worldwide.第二篇示例：乙肝是一种由乙型肝炎病毒引起的慢性传染病。
乙肝病毒主要通过血液或其他体液传播，如母婴传播、输血、注射毒品、性接触等途径。
患有乙肝的人可能没有任何症状，也可能出现疲劳、恶心、厌食、黄疸等症状。
长期患有乙肝可能导致肝硬化、肝癌等严重并发症，甚至危及生命。
乙肝是全球范围内的公共卫生问题，根据世界卫生组织的统计，全球约有2亿人感染了乙肝病毒，其中约有3500万人患有慢性乙肝。
亚洲和非洲地区是乙肝的高发地区，尤其是中国、尼日利亚、孟加拉国等国家乙肝患病率较高。
乙肝的预防和控制非常重要。
首先是疫苗接种，乙肝疫苗是预防乙肝最有效的方式之一。
根据世界卫生组织的推荐，所有新生儿应在出生后24小时内接种第一剂乙肝疫苗，并在接种完整个疫苗程序后获得长期免疫保护。
避免与感染者直接接触、避免共用注射器、采取安全性行为等也是预防乙肝传播的重要措施。
对于已经感染乙肝的患者，及时的治疗和管理也至关重要。
目前主要的治疗方式包括抗病毒治疗和肝功能支持治疗。
抗病毒治疗主要是通过使用干扰素、抑制核苷酸逆转录酶等药物抑制病毒数量，减轻肝脏炎症，并预防肝硬化、肝癌等并发症的发生。
2023年慢性乙型肝炎的防治全文指南英文版Complete Guide for Prevention and Treatment of Chronic Hepatitis B in 2023Chronic Hepatitis B is a serious liver infection caused by the hepatitis B virus that can lead to long-term health problems. In order to effectively prevent and treat this condition in 2023, it is important to focus on a comprehensive approach that includes vaccination, regular screening, lifestyle modifications, and medication.VaccinationVaccination is the most effective way to prevent Hepatitis B infection. It is recommended that all infants receive the hepatitis B vaccine shortly after birth, followed by additional doses to ensure long-term immunity. Adults who are at high risk of infection, such as healthcare workers and individuals with multiple sexual partners, should also be vaccinated.Regular ScreeningRegular screening for Hepatitis B is essential for early detection and treatment. It is recommended that individuals at high risk of infection, such as those born in regions with high prevalence of the virus or with a family history of Hepatitis B, undergo regular blood tests to monitor their liver function and viral load.Lifestyle ModificationsMaintaining a healthy lifestyle can help prevent the progression of chronic Hepatitis B. This includes avoiding alcohol and tobacco, eating a balanced diet, and getting regular exercise. Individuals with Hepatitis B should also avoid sharing personal items such as toothbrushes and razors, as the virus can be transmitted through blood and bodily fluids.MedicationIn addition to lifestyle modifications, medication may be necessary to manage chronic Hepatitis B. Antiviral medications can help reduce the viral load in the body and prevent liver damage. It is important for individuals with Hepatitis B to work closely with their healthcareprovider to determine the most appropriate treatment plan based on their individual needs.By following these guidelines for prevention and treatment of chronic Hepatitis B in 2023, individuals can effectively manage their condition and reduce the risk of long-term complications. It is important to stay informed about the latest advancements in Hepatitis B research and to seek regular medical care to ensure optimal health outcomes.。
丙肝医学文章英文版Hepatitis C is a viral infection that causes liver inflammation, sometimes leading to serious liver damage. 丙肝是一种病毒性感染，会导致肝脏发炎，有时会导致严重的肝损害。
It is estimated that around 71 million people worldwide have chronic hepatitis C infection. 据估计，全球大约有7100万人患有慢性丙肝感染。
Hepatitis C can be transmitted through contact with infected blood, most commonly through injecting drug use. 丙肝可以通过接触感染的血液传播，最常见的是通过注射毒品使用。
Other modes of transmission include sharing needles, sex with an infected partner, or from mother to baby during childbirth. 其他传播方式包括共用针头、与感染伴侣发生性行为，或在分娩时通过母亲传给婴儿。
Effective treatments for hepatitis C are available, with the goal of curing the infection and preventing further liver damage. 有效的丙肝治疗方法已经出现，旨在治愈感染并防止进一步的肝脏损伤。
Chronic hepatitis C often presents no symptoms in its early stages, leading to many cases being undiagnosed until liver damage has already occurred. 慢性丙肝在早期通常没有症状，导致许多病例在肝损伤已经发生之前未被诊断。
