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Objective:To investigate the immunological features of 135 patients with corona virus disease 2019 (COVID-19), and to provide reference for the pathogenesis of the disease.Methods:The clinical and laboratory data of 135 confirmed COVID-19 patients in Guangzhou Eighth People′s Hospital from January 23 to February 29, 2020 were collected. The features of lymphocytes (CD4 + and CD8 + T lymphocytes, B lymphocytes, natural killer cells and natural killer T cells), and cytokines (interleukin (IL)-2, IL-4, IL-6, IL-10, tumor necrosis factor (TNF)-α and interferon (IFN)-γ) of patients at a median of 19 (14, 27) days of admission were analyzed. Kruskal-Wallis test, Mann-Whitney U test, chi-square test and Spearman rank correlation were used for statistical analysis. Results:Patients were divided into three groups according to the relevant diagnostic criteria, including mild group (14 cases), ordinary group (92 cases) and severe group (29 cases). Decreased CD4 + T lymphocytes were found in 44.4% (60/135) patients, while decreased CD8 + T lymphocytes were found in 42.2%(57/135) patients. Compared to mild group and ordinary group, level of CD4 + T lymphocytes in severe group was significant lower ( Z=4.379 and 3.799, respectively, both P<0.01), and level of CD8 + T lymphocytes was also significant lower ( Z=2.684 and 3.306, respectively, P=0.022 and 0.003, respectively). Decreased B lymphocytes were found in 25.3% (24/95) patients and significant different among the three groups, with the lowest levels ((88(56, 189)/μL; Z=6.199, P=0.045) and most frequency of decreased levels ((52.2%(12/23); χ2=11.723, P=0.003) in the severe group. Compared to the mild group and the ordinary group, IL-6 level in severe group was significant higher ( Z=-4.022 and -4.108, respectively, both P<0.01) and IL-10 level was also significant higher ( Z=-3.261 and -4.006, respectively, both P<0.01). Similar levels of IL-2, IL-4, TNF-α and IFN-γ were found among three groups (all P>0.05). The IL-6 level was positively correlated with the persistence of viral shedding ( r=0.301, P=0.007). Conclusion:The immune-mediated inflammation may be the important cause of disease deterioration of COVID-19, which might be the key target of the treatment of severe cases.
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Objective@#To investigate the clinical, immunological and virological characteristics of HIV-1 infected patients in the acute phase, for the sake of improving the diagnosis of acute infection with HIV-1.@*Methods@#We retrospectively analyzed the clinical manifestation and laboratory data of patients with acute HIV-1 infection who were admitted to the Center of Infectious Diseases, Guangzhou Eighth People’s Hospital from January 2012 to June 2017.@*Results@#Forty-four patients were enrolled into the study, 86.4% of them were male. 59.1% patients were homosexually transmitted. Clinical symptoms and signs mostly consisted of fever (84.1%), lymphadenopathy (56.8%) and so on, while 15.9% patients had central nervous system symptoms. Most common opportunistic infection included lung infection (50.0%) and oropharyngeal candidiasis (22.7%). Leucopenia (10 patients, 22.7%), and decreased CD4+ T cell count (267.5 cells/μl), inverted CD4+ /CD8+ ratio (86.4%) was mostly seen. Compared to patients who had HIV RNA load less than 6 lg copies/ml, the group of patients who had HIV RNA load more than 6 lg copies/ml had lower levels of CD4+ T cells (t=-3.724, P=0.001).@*Conclusions@#Patients with acute HIV infection have many different kinds of clinical symptoms and can be accompanied by opportunistic infection, and with high viremia.
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Objective@#To analyze the characteristic mutations of epitopes in HBV Pre-S/S region in HIV/HBV co-infected patients’ peripheral blood to provide basic data for studying the pathogenesis of HIV/HBV co-infection.@*Methods@#The chronic hepatitis B infected patients admitted to the Infectious Disease Center of the Eighth People′s Hospital of Guangzhou from January 2009 to December 2011 were enrolled into HIV/HBV co-infected group and HBV mono-infected group according to the result of HIV antibody detection respectively before treatment. HBV DNA in serum was extracted and Pre-S/S region of HBV DNA was amplified by nested-PCR. After sequencing of the obtained PCR products (direct sequencing), ContigExpress software was used for sequence splicing and BioEdit software was used for sequence alignment. With reference to the standard sequence of the matched genotype HBV, mutants of HBV Pre-S/S region in HIV/HBV co-infected group and HBV mono-infected group were analyzed respectively. Statistical analysis was performed by chi-square test with SPSS19.0 statistical analysis software.@*Results@#HBV Pre-S/S fragments were successfully amplified from 150 patients, including 90 cases of HIV/HBV co-infected group and 60 cases of HBV mono-infected group, with matched gender, age, genotype, HBeAg status, alanine aminotransferase (ALT), aspartate aminotransferase (AST). The result of analyzing mutants of HBV Pre-S/S region indicated that the incidence of mutation in all epitopes for cytotoxic T cells (CTL cells) was higher in the HIV/HBV co-infected group, and Pre-S2 aa1-15 epitope was significantly higher (χ2=6.964, P=0.008). The incidence of deletions in PreS2 aa1-15 epitope in HIV/HBV co-infected group (11.1%) was higher than HBV mono-infected group (3.3%) (χ2=2.959, P=0.085). In the B cell epitopes, the incidence of mutations in Pre-S2 aa1-26 in the HIV/HBV co-infected group was significantly higher than HBV mono-infected group (χ2=6.924, P=0.010), and there was no statistical significance between two groups in other B cell epitopes. No differences in helper T cell (Th cell) epitopes were found between the two groups.@*Conclusions@#Co-infection with HIV increased the CTL cell epitopes’ mutations in the HBV Pre-S/S region, especially the 5′ end epitope mutations in Pre-S2 region, which indicated that HBV mutation is related to the host immune status, and showed guiding information for further study on the pathogenesis of HIV/HBV co-infection
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Objective To investigate the relationship between HBV mutations in the precore (PC)/core promoter region and the liver histological changes in HBeAg negative CHB patients. Method A total of 71 HBeAg negative CHB patients with liver biopsy from April 2012 to Dec 2013 were enrolled. DNA was extracted from blood serum, then the HBV S gene and PC/core promoter region were amplified by semi-nested PCR and sequenced. The relationship between significant liver histological changes and viral factors were analyzed by Logistic regression analysis. Results The incidence of significant necroinflammation (15.8% vs. 27.3%, χ2 =1.398, P = 0.237) and significant fibrosis (71.1% vs. 84.4%, χ2= 1.926, P = 0.165) were found to be similar between patients infected with HBV genotype B and genotype C . By Logistic regression analysis including risk factors of age, sex, HBV genotype and mutations (T1753V,A1762T/G1764A,A1846T and G1896A), the A1762T/G1764A mutation in HBV associated with significant necroinflammation (OR = 4.296, P = 0.037), while factors of age, sex, genotype and other mutation were not associated with significant liver histological changes. (all P > 0.05). Conclusion Mutation in PC/core promoter region of HBV may act as a marker to evaluate the liver histological changes.
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Objective To investigate the diagnosis value of spleen stiffness measurement by transient elastography (FibroScan, FS) for esophageal-gastric varices (EV) in patients with HBV-related liver cirrhosis receiving anti-viral treatment. Method Total of 41 patients from Jan 2014 to Dec 2014 diagnosed with HBV-related liver cirrhosis receiving anti-viral treatment were enrolled. All patients were evaluated for spleen and liver stiffness measurement by FS and checked by gastroscopy for diagnosis of EV. Using gastroscopy as the gold standard, the area under receiver operating characteristic curve (AUROC) were used to evaluate the value of the spleen stiffness and liver stiffness in diagnosis of EV and its degree. Results The spleen and liver FS values in patients were (40.64 ± 25.45) kPa and (20.76 ± 13.21) kPa respectively, and they showed a positive correlation (r = 0.402, P < 0.001). The spleen FS values in patients without EV were significantly lower than those in patients with mild EV and moderate-severe EV (all P < 0.05). Furthermore, they showed significantly lower in patients with mild EV than those in patients with moderate-severe EV too (P < 0.05). The AUROC of spleen FS in patients with EV was 0.863, with sensitivity of 79.4% and specificity of 83.2%. Moreover, the AUROC of spleen FS in patients with moderate-severe EV was 0.924, with sensitivity of 87.9% and specificity of 91.3%. Both of them were much higher than those of liver FS. Conclusion Spleen FS may act as a non-invasive marker to predict EV and its degree in patients with HBV-related liver cirrhosis receiving anti-viral treatment.
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Objective To investigate the epidemiologic and clinical features of human immunodeficiency virus (HIV)/hepatitis B virus (HBV)co-infected patients.Methods Patients who confirmed with HIV infection and received highly active anti-retroviral therapy (HAART)at Guangzhou Eighth People′s Hospital were enrolled.HIV/HBV co-infected patients and HIV mono-infected patients were screened and their epidemiological and clinical features were analyzed before HAART.Comparison of the levels of alanine transaminase (ALT),aspartate transaminase (AST),CD4 + T lymphocyte and HIV RNA between the two groups were conducted.The data were statistically analyzed by chi-square test and nonparametric test.Results One hundred and sixty-five out of 1 218 (13.5 %)patients were hepatitis B surface antigen positive.The median ALT and AST levels of HIV mono-infected patients were 29 U/L and 34 U/L respectively,which were both higher than HIV/HBV co-infected patients (22 U/L and 25 U/L, respectively)(Z = - 4.270 and Z = - 5 .780,respectively,both P = 0.000 ).The median CD4 + T lymphocyte count of HIV/HBV co-infected patients was significantly lower than that of HIV mono-infected patients (Z = -2.980,P =0.003 ).The CD4 + T lymphocyte count was lower in hepatitis B e antigen (HBeAg)positive patients than HBeAg negative patients (Z =-2.660,P =0.008).The median CD4 + T lymphocyte count in patients with HBV DNA≥5 lg copy/mL was significantly lower than those with HBV DNA<5 lg copy/mL (Z = -2.311 ,P =0.021 ).The proportions of positive HBV DNA, HBV DNA≥5 lg copy/mL,abnormal ALT and AST in 54 patiens with CD4 + T lymphocyte counts <50/μL were 81 .5 %,66.7%,44.4% and 53.7%,respectively.All were significantly higher than patients with CD4 + T lymphocyte count≥50/μL(χ2 =6.159,P =0.046 ;χ2 =6.618,P =0.037 ;χ2 =7.144,P =0.028 andχ2 =9.586,P =0.008,respectively).Conclusions The prevalence of HBV/HIV co-infection is high in this study.The CD4 + T lymphocyte counts in HIV/HBV co-infected patients are lower,especially in patients with HBeAg positive and high HBV DNA level.The CD4 + T lymphocyte counts are associated with HBV DNA replication levels.
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<p><b>OBJECTIVE</b>To evaluate the renal function in treatment-naive patients with hepatitis B virus (HBV) related cirrhosis and to identify the risk factors for renal impairment.</p><p><b>METHODS</b>We collected the data of 860 HBV-related cirrhosis patients hospitalized in our unit between Jan 1, 2011 and Dec 31, 2011. Liver function of the patients was assessed with Child-Pugh score system, and the renal function with estimated glomerular filtration rate (eGFR) calculated by Modification of Diet in Renal Disease (MDRD) equation recommended by Kidney Disease Outcomes Quality Initiative (K/DOQI). We investigated the prevalence of renal impairment (eGFR>60 ml/min/1.73 m(2)) among these patients and explored the risk factors for renal impairment.</p><p><b>RESULTS</b>Of the 860 patients, 296 had complete clinical data and were included in our analysis. The overall incidence of renal impairment among the enrolled patients was 8.45% (25/296). Patients with Child-Pugh stage C showed a significantly higher incidence of renal impairment than those with stages B and A (17.17% [17/99] vs 6.67%[7/105] vs 1.09% [1/92], P<0.001). Age, history of hyperuricemia, and Child-Pugh score were identified as the risk factors for renal impairment in these patients.</p><p><b>CONCLUSION</b>In patients with HBV-related liver cirrhosis, the incidence of renal impairment increases significantly with deterioration of the liver function, and renal function should be regularly monitored in these patients for appropriate antiviral treatment.</p>
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Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tasa de Filtración Glomerular , Virus de la Hepatitis B , Hepatitis B Crónica , Incidencia , Riñón , Cirrosis Hepática , Virología , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Objective To investigate the epidemiological and clinical features of acute hepatitis E (AHE).Methods All the data of AHE patients from April 2005 to October 2011 were collected and their epidemiological features were retrospectively analyzed.Patients were divided into two groups:patients with single hepatitis E virus (HEV ) infection and patients with HEV/hepatitis B virus (HBV ) coinfection,to compare the biochemical parameters and outcomes and to find out the risk factors for AHE related liver failure.Kruskal-Wallis test,Chi square test,and Logistical regression analysis were used for statistical analysis.Results A total of 621 cases were included in the present study and most patients were elderly male and happened from February to May every year.The incidence of AHE related liver failure and mortality was 18.68% and 1 .93%,respectively.Compared to the single HEV group (n=331 ),the HEV/HBV group (n = 280 )had a longer hospital stay (46 d vs 40 d,Z = - 4.591 ,P < 0.01 ),a significantly lower prothrombin activity (55 .5 % vs 78.7%,Z =-7.998,P <0.01 )and a significantly higher incidence of AHE related liver failure (30.7% vs 9.1 %,χ2 =46.229,P <0.01 ).In single HEV related liver failure group (n=30),the percentages of early-stage,interim-stage and end-stage live failure were 53.33%,23.33% and 23.33%,respectively.While in the HEV/HBV related liver failure group (n=86),the corresponding numbers were 34.88%,31 .40% and 33.72%,respectively.The differences were not statistically significant (χ2 = 3.176,P = 0.204 ).Additionally,the clinical outcome between these two groups was also comparable (83.33% vs 91 .86%,χ2 =0.945 ,P = 0.331 ).The Logistic analysis showed that age over 50 years (OR=2.080,P =0.002)and coinfection with HBV (OR=5 .632, P <0.01)were risk factors for AHE related liver failure.Conclusions AHE is seasonal and mainly occurs in elderly male.Advanced age and HBV coinfection may be risk factors of severe AHE.
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Objective To evaluate the preventive effect of entecavir on liver injury in chronic HBV infected patients complicated with tuberculosis receiving anti-tuberculosis treatment.Methods A total of 102 chronic HBV infected patients complicated with tuberculosis were collected from Guangzhou Eighth People' s Hospital and Guangzhou Chest Hospital during January 2011 and May 2012.Patients were divided into three groups:group A (n =33) received entecavir plus anti-tuberculosis treatment,group B (n =29) received lamivudine plus anti-tuberculosis treatment,and group C (n =40) received anti-tuberculosis treatment only.Liver injury,termination of treatment,liver function and HBV DNA load before and after treatment were observed.SPSS 13.0 was used for statistial analysis.Results Two cases (6.1％) in group A,6 cases (20.6％) in group B and 22 cases (55.0％) in group C had liver injury,and the difference among three groups was of statistical difference (x2 =22.126,P ＜ 0.01),but the difference between group A and group B was not significant (x2 =3.024,P＞0.05).One case (3.0％) in group A,3 cases (10.3％) in group B and 15 cases (37.5％) in group C terminated the treatment,and the difference among three groups was of statistical significance (x2 =16.008,P ＜ 0.01),but the difference between group A and group B was not significant (x2 =1.410,P ＞0.05).ALT and AST in group A and group B were not of significant differences before and after anti-tuberculosis treatment,but those in group C were significantly higher (Z =18.306,16.821,P ＜ 0.01).There was no significant difference in HBV DNA load among three groups before the treatment (Z =0.460,P ＞ 0.05),while HBV DNA loads in group A and group B significantly decreased during the treatment,and the difference among three groups after the treatment was significant (Z =23.213,P ＜0.01).In addition,lower HBV DNA load was observed in group A compared with group B after one month anti-tuberculosis treatment (Z =8.109,P ＜ 0.01).Conclusion Early use of entecavir can effectively prevent liver injury during anti-tuberculosis treatment,ensuring anti-tuberculosis treatment and anti-HBV treatment carried out as planned.