Level of the cytokine secreted by periferal blood mononuclear cells in patients with chronic hepatitis C before antiviral therapy / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To study the immune state of patients with chronic hepatitis C before antiviral therapy by detecting the levels of the cytokines interleukin (IL)-2, IL-4, IL-10, IL-12, interferon (IFN)-gamma, and tumor necrosis factor (TNF)-alpha secretion by periferal blood mononuclear cells (PBMC).</p><p><b>METHODS</b>The level of the cytokine secreted by PBMC in patients with chronic hepatitis C after culturing for 72 hours in vitro was detected by ELISA.</p><p><b>RESULTS</b>(1) Compared with the cytokine level of normal controls, the level of IFN-gamma, TNF-alpha, and IL-10 of patients with chronic hepatitis C significantly increased (P < 0.05) while IL-2, IL-4, and IL-12 were not detected in the culture supernatant of PBMC from both normal control and patients with chronic hepatitis C. (2) There was no statistically significant difference in secretion of the cytokines among patients with different severity of the disease.</p><p><b>CONCLUSION</b>PMBCs from patients with chronic hepatitis C tend to secret Th2 type cytokines. Restoring the imbalance of TH1/TH2 may help to clear the hepatitis C virus.</p>

Peripheral blood T cell subsets and TH1/TH2 cytokines secretion in children with chronic hepatitis C virus infection / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To determine the cellular immunological abnormalities in children with chronic hepatitis C virus infection.</p><p><b>METHODS</b>(1) The quantity of the peripheral blood T cell subsets in 16 children with chronic hepatitis C virus infection and 10 healthy blood donors was detected by FACS. (2) The levels of the TH1/TH2 cytokines secretion of PBMC in patients and healthy blood donors were detected by ELISA.</p><p><b>RESULTS</b>(1) Compared with normal controls, there was no significant difference in the percentage of CD4+ cells. The percentage of CD8+ cells was significantly higher than that of controls (P < 0.05). The percentage of CD3+ cells was higher and the ratio of CD4+/CD8+ cells was lower, but the difference was not significant (P > 0.05). (2) Compared with the cytokine level of normal control, the levels of IFN-gamma, IL-10 and TNF-alpha notably increased (P < 0.01) while IL-2, IL-4, and IL-12 were not detected in the culture supernatant of PBMCs from both normal control and patients.</p><p><b>CONCLUSION</b>There is an imbalance in peripheral blood T cell subsets and disturbance in cellular immunity in children with chronic hepatitis C virus infection, which may be associated with HCV persistent infection.</p>

An open-label pilot study evaluating the efficacy and safety of peginterferon alfa-2a combined with ribavirin in children with chronic hepatitis C / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of peginterferon alfa-2a plus ribavirin in the treatment of children with chronic hepatitis C (CHC) in China.</p><p><b>METHODS</b>Totally 54 children with CHC were treated with peginterferon alfa-2a plus ribavirin from July 2003 to July 2004. The dose of peginterferon alfa-2a was 104 microg.(m2)-1 per week. An inductive treatment with interferon 1-3 MIU q.o.d for a week was given before peginterferon for the reduction of possible side effects. Initially 1/3 to 1/2 dose of ribavirin was given and then the was gradually increased to an ideal level of 15-20 mg.kg(-1).d(-1).</p><p><b>RESULTS</b>The mean age of the patients was 11.3 years. Twenty three patients (42.6%) had received interferon plus ribavirin but the disease relapsed or did not respond to the treatment. The HCV of 70.8 percent of patients was genotype 1 and 14.8 percent of patients had a high viral load (>/=10(-6)/L). After 3-month treatment, 87.5% (42/48) and 8.3% (4/48) of the patients became HCV RNA negative or the viral load reduced by >/= 2 log, respectively, and only 8.3% (4/48) of the patients failed to respond. After 6-month treatment, 87.9% (29/33) and 6.1% (2/33) of the patients became HCV RNA negative or had a >/= 2 log reduction of HCV RNA, respectively, and only 6.1% (2/33) failed to respond. The adverse events were the typical of those reported in the treatment with interferon and ribavirin. Pyrexia occurred in 48.1% of patients, fatigue in 46.3%, decreased appetite in 9.3%, and skin rash in 3.7%. The absolute neutrophil counts of 51 patients (94.4%) were reduced to </= 2.0 x 10(-9)/L, and in 35.2% of them to < 1.0 x 10(-9)/L. Hemoglobin were reduced in only 2 patients (in one case to < 100 g/L, and in the other to < 110 g/L).</p><p><b>CONCLUSION</b>The regimen consisted of peginterferon alfa-2a and ribavirin achieved a high virologic response in Chinese children patients with chronic hepatitis C. No severe adverse events occurred and most of the patients well tolerated the treatment.</p>

Analysis on prognostic factors of liver failure in children / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To analyze the prognostic factors of liver failure in children.</p><p><b>METHODS</b>The clinical data of 105 children with liver failure treated in the No. 302 Hospital in the past 17 years were retrospectively analyzed. The related factors were analysed by EXCELL 2000 and STATA 7.0, multivariate statistical analysis was performed by Logistic regression.</p><p><b>RESULTS</b>(1) A total of 72 children died and the mortality was 68.6%. (2) Univariate statistical analysis showed that the factors significantly correlated with death were age, clinical type and stage of liver failure, decrease in prothrombin activity (PTA) and albumin (AIB) level, increase in serum level of total bilirubin (TBIL), appearance of deviation of TBIL and ALT, complications and hepatic encephalopathy. There was no significant difference between boys and girls. (3) There was no significant difference among etiological diagnoses such as HBV infection, Wilson's disease, and unknown pathogeny. (4) Multivariate statistical analysis showed that PTA (P = 0.000) and TBIL (P = 0.029) were independent risk factors of mortality of the children.</p><p><b>CONCLUSION</b>The prognosis of liver failure in children is poor and mortality is high. PTA and TBIL might be useful for indicating prompt diagnosis and treatment to improve survival rate of the children with liver failure.</p>

Study on treatment effectiveness and safety in children with chronic hepatitis B or C using bicyclo tablets / 中华实验和临床病毒学杂志

<p><b>BACKGROUND</b>To evaluate treatment effectiveness and safety of bicyclo tablets in children with chronic hepatitis B or C.</p><p><b>METHODS</b>A randomized controlled trial was conducted in 148 children with chronic hepatitis B or C for evaluating safety, tolerability, and efficacy of treatment with bicyclo tablets or Hugan tablets. Children in therapy group were treated with bicyclo tablets and control group treated with Hugan tablets.</p><p><b>RESULTS</b>(1) ALT and AST level decreased more prominently in therapy group than in control group (P<0.01). (2) Bicyclo was more effective than Hugan tablets (P<0.01). (3) Symptoms were ameliorated more prominently in bicyclo group than in control group (P<0.01). (4) Both groups had no significant adverse events.</p><p><b>CONCLUSION</b>Satisfactory therapeutic effect and safety were obtained with bicyclo tablets in children with chronic hepatitis B or C.</p>

Clinical features of liver failure in children / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To analyze the etiology, clinical and laboratory characteristics of hepatic failure in 105 children.</p><p><b>METHODS</b>The clinical data of 105 children with hepatic failure treated in our hospital from January 1986 to June 2003 were retrospectively analyzed by EXCELL 2000 and t test.</p><p><b>RESULTS</b>(1)Of the 105 children with hepatic failure, 9 were cases with fulminant hepatic failure, 38 with subacute hepatic failure and 58 with chronic hepatic failure. (2)Morbidity was the highest in 7-12 years old children (43/105, 41.0%) followed by infants (30/105, 28.6%). (3)CMV infection could be confirmed in 9 infants (30.0%), etiological diagnosis was not possible in 13 infants (43.3%). Etiological diagnosis could be confirmed in children over 1 year of age, which included hepatitis B (n=22, 29.3%), Wilson's disease (n=15, 20.0%), hepatitis A (n=10,13.3%). Etiology in 21 cases (28.0%) could not be confirmed. (4)Seventy-one cases (67.6%) had ascites, 34 of them (47.9%) had spontaneous peritonitis. Thirty-five cases were complicated with other infections. The commonest complication was pulmonary infection and sepsis was the next. Fifty-one cases (48.6%) had hydroelectrolyte imbalance. Forty-eight cases (46.2%) had hepatic encephalopathy, which may be subclinical in children under three years of age. (5)The incidence of hypoglycemia was 77.2%(71/92).</p><p><b>CONCLUSION</b>The etiology of liver failure was related to age. CMV infection was the commonest in infants. HBV, HAV infection was the commonest in children over 1 year of age and Wilson?s disease was the next. It is necessary to prevent and manage the associated complications as early as possible such as spontaneous peritonitis, hepatic encephalopathy, hydroelectrolyte imbalance and hypoglycemia etc.</p>

Association of T cell subsets with clinical status and hepatic pathology in children with chronic hepatitis B virus infection / 中华实验和临床病毒学杂志

<p><b>BACKGROUND</b>To study characteristics of peripheral T cell subsets in 94 children with chronic hepatitis B and to elucidate its relationships with clinical status and hepatic pathology.</p><p><b>METHODS</b>Peripheral T cell subsets were detected using flow cytometric analysis with specific monoclonal antibodies staining in 94 patients with HBV infection. The authors simultaneously detected their serum ALT, markers of HBV infection and examined liver biopsy material for pathological changes.</p><p><b>RESULTS</b>In patients with serious liver lesion, the ratio of CD4+/CD8+ cells was significantly higher than those with mild lesion (1.41+/-0.54 vs 1.08+/-0.35, P less than 0.05), which seemed to be associated with the various liver lesions among the patients. In female cases, the levels of CD4+ T cells and the ratio of CD4+/CD8+ T cells were higher than their counterpart in male cases (33.1+/-5.39 vs 28.8+/-6.28, 1.28+/-0.32 vs 1.02+/-0.36, P less than 0.05), but the level of CD8+ T cells was lower than those in males (26.79+/-4.66 vs 30.51+/-7.17, P less than 0.05). There was no obvious correlation between T cell subsets and circulating HBV viral load, the size of spleen among the HBV-infected children.</p><p><b>CONCLUSION</b>The characteristics of peripheral T cell subsets probably suggests the immune disorder occurred in these children with hepatitis B compared with healthy controls and its mechanism needs further investigation.</p>

Clinical features of hepatitis A in 1,629 children / 中华实验和临床病毒学杂志

<p><b>BACKGROUND</b>To investigate the clinical features of hepatitis A in 1 629 children under 14 years of age treated in our department at various periods of time.</p><p><b>METHODS</b>The patients were divided into two groups: 1. Group A consisted of 883 patients treated from January 1984 to December 1990; 2. Group B consisted of 746 patients treated from January 1991 to December 2000. The clinical data of all the patients were retrospectively analyzed.</p><p><b>RESULTS</b>1. The average age was 7.17+/-3.27 and 8.78+/- 3.28 years (chi2=0.54, P>0.05) and the mean course of disease 26.25+/-16.96 and 25.65+/-12.58 days (chi2=0.29, P>0.05). 2. Double peak or multi-peak serum ALT was found in 89 patients. Four peaks of serum ALT was found in one patient. 3. HBsAg was found positive in 143 patients (8.80%). The mean course of disease was 34.40+/-25.86 and 25.20+/-15.43 days (chi2=146.5, P<0.001) in HBsAg positive and negative patients, respectively. 4. Liver puncture biopsy in 26 patients with hepatitis A showed that there was piecemeal necrosis in 2 patients.</p><p><b>CONCLUSIONS</b>1. There was no significant delay in age of children with HAV infection in 1990s. There was no marked difference in the course of disease between the patients simultaneously receiving various drugs and those receiving one or two drugs. 2. The double peak or multi-peak of serum ALT in patients with hepatitis A might be related to liver damage caused by HAV and immune mechanism. 3. The major type of virus for combined infection in patients with hepatitis A is HBV. The course of disease was prolonged with combined infection of HBV. 4. Piecemeal necrosis might be seen in the liver of a small proportion of patients with hepatitis A alone, which may not be enough to suggest chronicity.</p>