国际感染病学（英文版）杂志

Objective A diagnostic model was established to discriminate infectious diseases from non-infectious diseases. Methods The clinical data of patients with fever of unknown origin (FUO) hospitalized in Xiangya Hospital Central South University, from January, 2006 to April, 2011 were retrospectively analyzed. Patients enrolled were divided into two groups. The ifrst group was used to develop a diagnostic model: independent variables were recorded and considered in a logistic regression analysis to identify infectious and non-infectious diseases (αin= 0.05, αout= 0.10). The second group was used to evaluate the diagnostic model and make ROC analysis. Results The diagnostic rate of 143 patients in the ifrst group was 87.4%, the diagnosis included infectious disease (52.4%), connective tissue diseases (16.8%), neoplastic disease (16.1%) and miscellaneous (2.1%). The diagnostic rate of 168 patients in the second group was 88.4%, and the diagnosis was similar to the ifrst group. Logistic regression analysis showed that decreased white blood cell count (WBC < 4.0×109/L), higher lactate dehydrogenase level (LDH > 320 U/L) and lymphadenectasis were independent risk factors associated with non-infectious diseases. The odds ratios were 14.74, 5.84 and 5.11 (P≤ 0.01) , respectively. In ROC analysis, the sensitivity and speciifcity of the positive predictive values was 62.1% and 89.1%, respectively, while that of negative predicting values were 75% and 81.7%, respectively (AUC = 0.76,P = 0.00). Conclusions The combination of WBC < 4.0×109/L, LDH > 320 U/L and lymphadenectasis may be useful in discriminating infectious diseases from non-infectious diseases in patients hospitalized as FUO.

作者： 刊期： 2014年第02期

Objective To investigate the infection rate of hepatitis C virus among the ambulatory patients and in-patients of a tertiary teaching hospital, and study the demographic factors related to the prevalence of hepatitis C virus infection.Methods All patients tested for hepatitis C virus antibody from July 2008 to July 2009 in Peking Union Medical College Hospital were enrolled in this cross-sectional analysis. The prevalence of hepatitis C virus infection was compared according to age, gender, and departments, respectively. Among patients with positive serology hepatitis C virus marker, the positivity of hepatitis C virus RNA was analysed.Results Among 29 896 subjects included, the hepatitis C virus antibody of 494 patients were positive (1.7%). When patients were divided into 9 age groups, the age speciifc prevalence of hepatitis C virus antibody were 0.2%, 1.7%, 1.2%, 1.1%, 1.5%, 1.9%,2.6%, 2.4%and 2%, respectively. The prevalence of hepatitis C virus antibody in non-surgical department and surgical department was 3%and 1%, respectively. The prevalence of hepatitis C virus antibody of males was higher than that of the females. Total of 194 patients with positive hepatitis C virus antibody were tested for hepatitis C virus RNA, the RNA level of 113 patients (58.2%) were higher than the low detection limit.Conclusions The prevalence of hepatitis C virus antibody was relatively high among patients of general tertiary hospital. Age group of 60-69, males and patients in non-surgical departments were factors associated with high rate of hepatitis C virus infection.

作者： 刊期： 2013年第04期

ObjectivesTo investigate the clinical features of tuberculosis (TB)-associated immune reconstitution inlfammatory syndrome (TB-IRIS) in patients co-infected with HIV/TB or latent infection during highly active antiretroviral therapy (HAART). Methods HIV-infected patients treated in the Third People’s Hospital of Shenzhen, China between March 2012 and March 2013 were recruited, and divided into 3 groups: 1) HIV/TB co-infection group (n = 50), 2) HIV/MTB latent infection group (n = 50), and 3) HIV infection group (n = 50), with 12-month follow-up. Patients in the HIV/TB co-infection group were treated with HAART 2 weeks after TB therapy. Patients were assessed at different time-points. ResultsThe incidence and mortality rates of TB-IRIS were 40% and 10% in the HIV/TB co-infected patients, and 2% (and no mortality) in the HIV/MTB group. The HIV infected group did not display TB-IRIS or death. About 95% HIV/TB co-infected patients were 20-39 years old when TB-IRIS occurred, and 65% of the patients developed TB-IRIS 2 weeks after HAART. For the co-infection group, those with TB-IRIS (20/20, 100%) had fever, with a signiifcantly higher incidence than those who did not develop TB-IRIS (6.7%, 2/30,P < 0.05). The patients with TB-IRIS in co-infection group displayed markedly higher clinical biochemical markers, acute phase reactants, increased CD4+ cell counts, and 2 log10-decreases of HIV RNA loads, compared with the patients not presenting with TB-IRIS (P < 0.05). Conclusion HIV/TB co-infected patients presented with a high-risk of developing TB-IRIS during HAART treatment. Early diagnosis and treatment could decrease mortality rates in TB-IRIS.

作者： 刊期： 2014年第03期

Objective To observe the biological function of human 3-hydroxyisobutyrate dehydrogenase (HIBADH). Methods Human 3-hydroxyisobutyrate dehydrogenase (HIBADH, 3-hydroxy-2-methyl propanoate: NAD+oxidoreductase) recombinant protein was expressed inE. coli BL21,and puriifed by Ni+ column. The special antisera was obtained from rabbits immunized by this purified antigen. On the distribution of HIBADH, it was found that HIBADH over-expressed in the injured liver cells when serious hepatitis occurred. The phenomenon was conifrmed in the animal models of SD rats with acute liver cell injury induced by CCl4, but this phenomenon did not exist in the models induced by endotoxin combined with galactosamine. Further more, HIBADH’s overexpression in liver cells will induce cell necrosis through the pathway of oxidative stress. Results When the liver cells injured by drug or other chemical materials, HIBADH will be compensationally over-expressed for the deifciency of energy, so liver cells can make enough ATP through brand-chain amino acid catabolism. However, the overexpression of HIBADH will be harmful for liver cells through the product of much more active oxygens which will induce the cell necrosis. Conclusions HIBADH over-expression is a signal of the liver cell metabolism injury, and it can aggravate the liver cell injury through oxidative stress.

作者： 刊期： 2014年第02期

Objective To analyze the clinical and laboratory features of patients with mild and severe HFMD to identify early predictive or diagnostic markers for severe cases. Methods Samples of feces, nasopharyngeal-swab specimens, peripheral blood, serum and cerebral spinal lfuid were collected. Postmortem pathological examination was conducted on 2 dead patients with complication due to neurogenic pulmonary edema. Reverse transcription-polymerase chain-reaction (RT-PCR), culture and isolation of enterovirus 71 (EV71) were performed to detect EV71 infection. Both univariate and multivariate logistic analysis were used to identify factors associated with severe cases. Results EV71 was mainly responsible for HFMD. In this study, 5 isolated EV71 strains belonged to C4 gene subtype. Compared with mild patients, EV71-RNA detection rate was higher and CoxA16 detection rate was lower among severe patients (P < 0.01). Inlfammatory cell inifltration in the lung, cardiac and liver tissues were mild by postmortem pathological examination. It was found that body temperature, vomitting, limb tremor, neutrophil, blood glucose and EV71 infection were significantly related to the severe cases by univariate logisticanalysis. However, after multivariate logistic regression analysis, only vomiting (OR 16.1, CI 2.3-110.5,P < 0.01) and limb tremor (OR 117.6, CI 13.8-1004.5,P < 0.01) were signiifcantly and independently correlated with the severe cases. Conclusions EV71 was mainly responsible for HFMD, particularly for severe cases. Vomiting and limb tremor were predictive markers for severe cases.

作者： 刊期： 2014年第02期

Objective To conifgure an immunoabsorption column for hepatitis B virus.Methods Being activated by epichlorohydrin, the human antibody HBsAb-IgG was bound to the carrier of agarose gel. The configuration process was as follows: the synthesis of epoxide matrix, the synthesis and activation of amino matrix, the synthesis of aldehydic matrix, the synthesis of immunoabsorption matrix, the end capping and reduction of unbound aldehydic, the blocking of unbound mass and the iflling of the column. Results The bound rate of activated agarose gel and antibody HBsAb-IgG is 85.07%. By plasma adsorption experiment, it is revealed that the immunoabsorption column can absorb and eliminate 58.97%of HBsAg and 53.1%of hepatitis B virus particles in extracorporeal plasma.Conclusions The immunoabsorption column for hepatitis B virus can absorb and eliminate HBsAg and hepatitis B virus particles in extracorporeal plasma.

作者： 刊期： 2013年第03期

Acute-on-chronic liver failure is a characteristic clinical liver syndrome, which should be differentiated from acute liver failure, acute decompensated liver cirrhosis and chronic liver failure. The pathogenesis of ACLF is not fully understood yet. Viral factors and immune injury have been reported to be the two major pathogenesis. This paper reviewed the researches on the pathogenesis of acute on chronic hepatitis B liver failure in recent years, to provide theoretical basis for prompt and accurate diagnosis and treatment of this syndrome. This would beneift for the prognosis and raise the survival rate of patients.

作者： 刊期： 2014年第01期

Objective To investigate the occurrence of basal core promoter (BCP) and pre-C mutations in patients with hepatitis B virus (HBV) infection in Gansu Province, China, and to analyze the correlation of HBV mutation and HBV genotype with primary hepatocellular carcinoma (HCC). Methods PCR-RFLP was applied to detect HBV subgenotypes, and the presence of the pre-C and BCP mutations in 62 patients with HCC, 70 patients with hepatitis B induced liver cirrhosis (LC) and 90 patients with chronic hepatitis B (CHB). Results In HCC patients, genotype C was the major genotype (70.97%). The pre-C mutation was found in 59.68%, 31.43% and 16.67% patients with HCC, LC and CHB, respectively. The frequency of BCP mutations was signiifcantly different between patients with HCC, LC and CHB (74.19%, 51.43% and 37.78%, respectively;χ2=30.727, 19.540, respectively,P < 0.01). Patients in HCC group had a higher incidence of pre-C as well as BCP mutations compared to the other groups. The prevalence of pre-C and BCP mutations was signiifcantly higher in patients with genotype C1 (44.32% and 69.32%, respectively) compared to patients with other subgenotypes (P < 0.05). Conclusions The incidence of pre-C and BCP mutations increases with disease progression. Pre-C and BCP mutations frequently occur in patients with genotype C1. HBV genotype C, pre-C mutations and BCP mutations are closely related to the occurrence of HCC.

作者： 刊期： 2014年第02期

A twenty-eight-year-old male patient with five-day’s fever (the highest body tempreture reached 39.4℃) and 10-hour’s rash (first on face) presented to the department of emergency for “drug rash”, at that time his temperature was 38.6℃. Two hours later, his temperature fell to normal. Then this patient’s entire body rash increased signiifcantly and lasted for 13 hours. Serum measles antibody IgM(+) conifrmed the measles diagnosis. He had received measles vaccine as a baby. Clinicians should be aware of this atypical clinical manifestation of adult measles. If this kind of patients were misdiagnosed as drug rash and given corticosteroid, measles disease may be aggravated. Speciifc serum measles antibody testing may be the only reliable method for differential diagnosis, but the earliest time point for examining the antibodies of measles still needs precise research.

作者： 刊期： 2014年第01期

Objective To investigate the association between HBV genotypes and characteristics of rtA181 mutation. Methods Total of 85 chronic hepatitis B (CHB) patients who appeared rtA181 mutation after nucleos(t)ide analogs (NAs) therapy were enrolled in this study. Levels of serum ALT, AST, HBV DNA and HBsAg titers were monitored during therapy. HBV reverse transcriptase genes were amplified and sequenced to identify genotypes and resistance mutations. Virions and HBsAg in HepG2 cell with rtA181 mutation were also compared between genotypes B and C. Results The majority of sera contained HBV genotypes B (15.7%) and C (84.3%). There were no significant difference of rtA181 mutant patterns between genotypes (P> 0.05). After emergence of rtA181 mutation, serum ALT, AST, HBV DNA levels and HBsAg titers were decreased than that at baseline (P<0.05), while these characteristics were not different between genotypes B and C (P>0.05). In cellular experiment, there were no significant differences between genotypes B and C not only in HBV virions but also in HBsAg titres (P>0.05). Conclusions No differences of clinical characteristics and cellular results were found in rtA181 mutation of HBV genotypes B and C.

作者： 刊期： 2014年第04期