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Study on HBcAg expression in multi-organ tissues of dead fetus puerperal deherated with hepatitis virus B.
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摘要: 观察乙型肝炎病毒通过母婴传播在胎儿多脏器组织中表达情况。采集 4 0例乙型肝炎产妇产下的死胎 ,常规尸检 ,取大脑、胸腺、心脏、肺、肝、脾、肾脏、脐带、胎盘组织 ,SP法检测HBcAg ;回访婴母产前静脉血HBV的检测结果。死胎多脏器组织中HBcAg阳性率以肺、肝、肾脏、脐带为最高 ,胸腺、心脏、脾、胎盘次之 ,大脑最低 (P<0 0 5 )。HBV呈单项阳性、小三阳、大三阳的婴母分娩的死胎同一脏器 (除胸腺外 )组织中HBcAg阳性率比较 ,差异不显著 (P >0 0 5 )。HBcAg阳性颗粒在死胎的大脑、胸腺、心脏、肺、肝、脾、肾脏、脐带、胎盘组织中呈点、灶状分布 ,脏器实质细胞核不着色。HBV对胎儿组织的嗜好与胎儿脏器种类有关 ;死胎同一脏器组织 (除胸腺外 )中HBcAg阳性率与孕妇HBV静脉中HBV标志无关 ;死胎多脏器组织中可能存在HBV复制。Abstract: Study the HBcAg expression in the tissues of cerebrum, thymus, heart, lungs, liver, spleen, kidney, umbilicord and placenta of dead fetus infected by HBV by maternal-fetal transmission. Tissues of 40 cases were detected for HBcAg by immunocytochemistry (SP) . Detection of HBV in mother veins before deheraty were also olone. The result showed that there were HBsAg in the tissues, the were mainly found in the tissue cells and the vessels. The positive cells were in single or clusters forms and distributed in the tissue vessels and the plasma of tissue cells. For the positive rate of HBcAg in the tissues were highest in lungs, liver, kidney, umbilicord, then lower in the spleen, the placenta and the last was the cerebrum ( P <0 05) . It was correlated with the type of the organ tissues that HBV has an affinity to these tissues. HBV in the same tissues (but except thymus) was not correlated with the HBVM in the pregnant womem veins. HBV maybe copied in the kidney tissue.
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Key words:
- Dead Fetus /
- Tissue /
- HBcAg /
- Maternal-Fetal Transmission
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据估计，长期暴露于甲氨蝶呤(MTX)导致严重肝纤维化的风险约为5%，这促使人们采取强化监测策略。然而，现有证据来源于回顾性研究，这些研究低估了肝病的风险因素。在Atallah等一项纵向队列研究中，使用两种非侵入性标志物评估了长期MTX治疗对肝纤维化的风险。
在2014年—2021年，笔者从6个英国研究中心前瞻性招募了诊断为≥2年类风湿关节炎或银屑病的成年患者。MTX组包括接受MTX治疗≥6个月的患者，而未暴露组包括从未接受MTX的患者。所有的患者都进行了完整的肝脏分析，包括瞬时弹性成像(TE)和增强肝纤维化(ELF)标志物测量。
共纳入999例患者，平均(60.8±12)岁，女性占62.3%。在976例有效TE值中，149例(15.3%)患者肝硬度≥7.9 kPa。在892例有效ELF值中，262例(29.4%)患者ELF≥9.8。年龄和BMI与肝硬度升高和肝纤维化独立相关。MTX累积剂量和持续时间都与肝硬度升高无关。糖尿病是与肝硬度≥7.9 kPa相关性最显著的危险因素(校正比值比=3.19，95%可信区间：1.95~5.20，P＜0.001)。定期使用非甾体类抗炎药与ELF≥9.8的相关性最强(优势比=1.76，95%可信区间：1.20~2.56，P=0.003)，表明类风湿性关节炎的关节炎症程度可能与作为肝纤维化的非侵入性标志物的ELF相混淆。
笔者认为，先前可能高估了MTX本身导致的肝纤维化风险，有必要考虑修改MTX目前的监测准则。
摘译自ATALLAH E, GROVE JI, CROOKS C, et al. Risk of liver fibrosis associated with long-term methotrexate therapy may be overestimated[J]. J Hepatol, 2023. DOI:
10.1016/j.jhep.2022.12.034 . [Oline ahead of print](吉林大学第一医院 肝胆胰内科 纪竹慧 辛桂杰 报道)
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