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UDC： 密级： 重庆医科大学 硕士学位．论文 论文题目 高效液相色谱法检测ICP脐血胆汁酸谱及妊娠结局 作者姓名 刘雨
指导教师姓名 职称、单位名称 邵勇副教授 重庆医科大学附属第一医院 申请学位级别 硕 士 学科、专业名称 妇产型堂 论文答辩年月 2010年5月 201 0年5月 重庆医科大学 研究生学位论文独创性声明 本人申明所呈交的论文是我本人在导师指导下进行的研究工作及取得的研 究成果．据我所知，除了文中特别加以标注和致谢的地方外，论文中不包含其他 人已经发表或撰写过的研究成果，也不包含为获得重庆医科大学或其他教育机构 的学位或证书而使用过的材料，与我同工作的同志对本研究所做的任何贡献均已 在论文中作了明确的说明并表示谢意． ． 申请学位论文与资料若有不实之处，本人承担一切相关责任． o o 学位论文作者签名：
趔亟 日期． Io．S．1 学位论文版权使用授权书 本人完全了解重庆医科大学有关保护知识产权的规定，即：研究生在攻读学
位期间论文工作的知识产权单位属重庆医科大学。本人保证毕业离校后，发表论
文或使用论文工作成果时署名单位为重庆医科大学．学校有权保留并向国家有关
部门或机构送交论文的复印件和磁盘，允许论文被查阅和借阅．学校可以公布学
位论文的全部或部分内容 保密内容除外 ，可以采用影印，缩印或其他手段保
存论文． 论文作者签名： 指导教师签名： 日 期：杪仁／口
参考文献………………………………………………………………………………．．26
文献综述：妊娠期肝内胆汁淤积症胆汁酸谱研究进展……………………………．28
致谢…………………………………………………
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急性乙型肝炎感染: 新感染上乙型肝炎。
Adefovir (Hepsera): 食品药物管理局 (FDA) 于2002年9月核准的一种治疗慢性乙型肝炎的口服药。
丙氨酸转氨酶 (ALT): 一项用来检测肝细胞受损程度的重要检查。对所有慢性乙型肝炎患者的定期监测都包括ALT检测数值；在决定患者是否适宜治疗或在评估某项现行治疗的疗效时，此项检查亦十分有用。
甲胎蛋白 (AFP): 怀孕时或有癌细胞出现时分泌入血液的一种蛋白质。该蛋白浓度的增加可能表示肝脏发生癌变，因此医生要指定作此项检测。
抗体：&抗体通常保护身体不受感染。抗体的产生可为对某种苗疫的反应，或对乙型肝炎病毒等自然性感染的反应。
腹水： 因肝衰竭、肝硬化和肝癌而可能引起的异常性腹腔内大量积水。出现此种病情时必须立即就医。
无症状（Asymptomatic）: 指感染或疾病无病症显示。许多乙型或丙型肝炎患者在染病初期或慢性感染期间毫无任何症状；此类患者即可视为无症状患者。
慢性乙型肝炎感染：&检测结果显示阳性并已感染乙型肝炎病毒６个月以上的患者即可视作有慢性乙型肝炎感染。
肝硬化：一种造成肝脏纤维结节并可能导致肝衰竭的严重肝病。
临床试验：受试人自愿接受药物安全和疗效试验的研究。
e-抗体 (HBeAb 或anti-HBe)：此抗体因ｅ抗原（见下条）的出现而产生，并可见于乙型肝炎康复患者和有慢性感染的患者中间。但该抗体并不能抵御乙型肝炎病毒。
e-抗原 (HBeAg)： 由乙型肝炎病毒生成的一种蛋白质。此验血项常与慢性感染有关，并被认定为活动性乙型肝炎指针。
脑病（Encephalopathy): 一些晚期肝病患者的大脑功能会发生严重病变。常见症状包括神智混乱、失去定向感、失眠，并可能逐渐失去意识。
恩替卡韦（Entecavir）：经美国食品与药品管理局（FDA）
于2005年4月批准。
假阳性： 检测结果误以阳性反应呈现。
纤维化 (肝脏或肝部)：指因肝炎而引起的肝纤维增生。纤维化可导致更严重的肝病，即肝硬化。
食品药物管理局 (FDA)： 核准施用于人体药物的美国联邦机构。
肠胃病学（Gastroenterology）：专门从事消化系统功能与失调症研究的医学科目，研究内容包括食道、胃脏、胰脏、肠脏和肝脏。
肝炎： 谓指“肝脏发炎”，可由多种原因造成，如病毒、细菌感染、伤损、不良药物反应、或酗酒。由病毒引起的肝脏发炎亦称病毒性肝炎：
甲型肝炎：甲型肝炎病毒（HAV）造成的急性感染。多数患者在６至１０周内即可完全痊愈。甲型肝炎主要经由粪便以及污染食品与水传染。HAV可采用一种安全疫苗来预防。
乙型肝炎： 由乙型肝炎病毒（HBV）引起。患染者中约10% 的成年人演变为慢性乙型肝炎患者；患染HBV女性产下的新生儿中有90%会出现慢性感染。该病毒传染主要经由血液、 无保护性行为、共享针筒、以及由母亲在分娩时传染给新生儿。HBV可采用一种安全疫苗来预防。
丙型肝炎：由丙型肝炎病毒（HCV）引起。患染者中约85% 的成年人演变为慢性丙型肝炎患者。该病毒主要经由血液传染。无预防性疫苗。
丁型肝炎：由丁型肝炎病毒（HDV）引起。此病毒仅对乙型肝炎患者具感染性。无预防性疫苗。
HBIG (乙型肝炎免疫球蛋白)：须立即（或于２４小时之内）给予接触过乙型肝炎病毒者的一种药物。例如，患染HBV母亲的新生儿应接受HBIG，并在出生后的１２个小时内接受第一针HBV疫苗以便预防慢性感染。
乙型肝炎血清学检验：常用来诊断乙型肝炎感染的指标，化验内容有乙型肝炎表面抗原(HBsAg)、乙型肝炎表面抗体(anti-HBs)和乙型肝炎核心抗体(anti-HBc)。
&&1.&& 乙型肝炎表面抗原(HBsAg)： 此蛋白质数值被用作发现感染的指标。如验血结果呈阳性，则表示有乙型肝炎病毒存在。
&&2.&& 乙型肝炎表面抗体(HBsAb或anti-HBs)： 此抗体因注射疫苗或乙型肝炎感染痊愈后形成。如化验结果为阳性，则表示对乙型肝炎有抵抗力。
&&3.&& 乙型肝炎表面抗体 (HBcAb或anti-HBc)： 可说明过去或现有感染的指标。该抗体对HBV不具保护作用。此化验项常被血库用来筛查血液捐赠。阳性结果表示受测人接触过乙型肝炎病毒，但乙型肝炎病状须经HBsAg和 anti-HBs（见前文）结果的确认。
乙型肝炎DNA检查：检测血液中病毒含量的指标，用来评估乙型肝炎治疗的疗效。
乙型肝炎 e-抗体 (HBeAb或anti-HBe)：此抗体因ｅ抗原（见下条）的出现而产生，并可见于乙型肝炎康复患者和有慢性感染的患者中间。但该抗体并不能抵御乙型肝炎病毒。
乙型肝炎e-抗原 (HBeAg): 由乙型肝炎病毒生成的一种蛋白质。此项指标常与慢性感染有关，并被认定为活动性乙型肝炎指标。
肝癌 (HCC)：&谓指肝脏癌症。世界上所有肝癌病例的80%是由慢性乙型肝炎感染引起。
肝脏病专家： 专事肝脏疾病研究和治疗的医生。慢性乙型肝炎患者最理想的做法是应向一位“肝脏病专家”求诊。
肝脏病学：&专门研究肝脏疾病的医学科目，亦为肠胃病学的分科。
乙型肝炎核心抗体IgG（IgG
anti-HBc）：可说明过去或现有乙型肝炎感染的指标。如该指标和HBsAg均为阳性（在不存在乙型肝炎核心抗体IgM的情形下），则表示有HBV感染。
乙型肝炎核心抗体IgM（IgM
anti-HBc）：&可说明现有或最近乙型肝炎感染的指标。阳性化验结果表示感染期不超过六个月。
免疫系统： 身体用来抵御细菌、病毒和其它有害物质的防御系统。
干扰素（Interferon）： 身体为抵御感染而产生的一种蛋白质。包括肝脏细胞的许多细胞均能产生天然干扰素。干扰素亦可采用生化技术人工制造，用来治疗慢性乙型肝炎。
Interferon Alpha-2b (Intron A)： 一种模仿身体产生的抗感染物质的药物。此药作为第一种治疗慢性乙型肝炎的药物于１９９１年被获准上市。该药每周可注射数次。可供成人和两岁以上幼儿使用。
Peg Interferon Alfa-2a (Pegasys): 为另一种干扰素药物。此药于2005年5月获准用来治疗慢性乙型肝炎，每周注射一次，而且比interferon alpha的副作用要少。
黄疸： 以皮肤和眼部变黄为特征的病症。黄疸是许多失调症所显示的症状，其中可包括病毒性肝炎、酗酒、中毒、异常性红血球分解或胆囊疾病。出现此症状时须立即就医。
Lamivudine (Epivir-HBV, Zeffix, Heptodin)： 一种可以减缓或停止乙型肝炎病毒复制的药物。此药为第二种治疗慢性乙型肝炎的药物，并于１９９８年被获准上市。此药为口服药片，每日服用一片，成人和儿童均可使用。
肝脏：&身体内最大的器官。肝脏具有众多功能，包括制造蛋白质、胆固醇、胆汁和凝血因子﹔储存糖分并分解碳水化合物、脂肪和蛋白质。肝脏是能量的主要来源。
肝脏活检（Liver
Biopsy）：&采用特殊针刺法对肝纤维作切片。切片在显微镜下接受检查以便查看肝脏是否受损。
肝功能检查 (LFT’s)： 指一组用来评估肝功能的血清化验，如ALT浓度。化验结果可用于诊断和监测慢性乙型肝炎和其它肝病。
聚合酶DNA（Polymerase
DNA）： 一种复制乙型肝炎病毒的关键性物质。现有抗HBV病毒类药物大多以干扰ＤＮＡ聚合酶来阻止病毒复制。
疫苗：&一种刺激免疫系统产生抵御某种疾病抗体的药物。现有疫苗包括甲型肝炎疫苗、乙型肝炎疫苗和可以抵御甲型与乙型肝炎的综合疫苗。
病毒性肝炎：&由专门侵害肝脏的病毒造成的肝脏发炎：甲、乙、丙、丁、戊和庚型肝炎病毒。
病毒负荷量： 测量血液中乙型肝炎等病毒（见乙型肝炎DNA条）的实际含病毒量。
Acute Hepatitis Infection:& A new, suddenly
occurring infection. It occurs with a person&s first exposure
to the hepatitis B virus.
Adefovir dipivoxil (Hepsera): An oral nucleoside
analogue drug that interferes with the replication of the hepatitis
B virus (e.g. it can slow down or stop the virus from reproducing).
It was approved for chronic hepatitis B in September 2002.
Albumin: A protein made in the liver that assists
in maintaining blood volume in the arteries and veins. If the
liver is damaged, then the albumin can drop to very low levels,
which may cause fluid to leak into the tissues from the blood
vessels, resulting in edema or swelling. In acute liver failure,
there is an accumulation of fluid in the abdomen that is known
as &ascites&.
Alpha-fetoprotein (AFP): A protein secreted
into the blood during pregnancy or when cancer cells are present.
Increased levels may indicate the development of liver cancer,
which is why the simple AFP blood test is included in the regular
monitoring of those which chronic HBV.&
Antibody:& A protein molecule produced
by the immune system in response to a foreign body, such as the
hepatitis B virus. Antibodies can be produced in response to
a vaccine or to a natural infection. They circulate in the blood
to protect against future infections.
Anti-HCV (antibody to hepatitis C virus):&
The antibody produced against the hepatitis C virus (HCV). Its
presence in the bloodstream often indicates HCV infection.
This antibody has not been shown to protect people against
hepatitis C.
Antigen:& A protein on the surface of
a virus, bacteria or cell that can stimulate the immune system
to produce antibodies as a defense mechanism.
Ascites:& A large, abnormal accumulation
of fluid in the abdomen that can occur due to liver failure,
cirrhosis and liver cancer. This condition requires immediate
medical attention.
Asymptomatic:& Refers to infection or
disease without signs of illness. Many patients with hepatitis
B or C do not have any symptoms during a new
they are considered to be asymptomatic.
Bilirubin: The liver usually clears this end
product of hemoglobin (the portion of the red blood cell that
carries oxygen in the blood) when it normally breaks down. If
the liver is damaged and bilirubin accumulates in the blood,
a person can become jaundiced (yellowed eyes and skin).
Bloodborne Pathogens:& Substances present
in the blood that can cause infection or disease. Hepatitis B
and hepatitis C viruses are bloodborne pathogens since they are
spread through blood and can cause a liver infection.
Carcinoma:& A new growth or malignant
tumor that can occur throughout the body (e.g. hepatocellular
carcinoma refers to liver cancer).
Centers for Disease Control and Prevention (CDC):& This
federal organization is concerned with the prevention and control
of communicable diseases such as hepatitis B and C. It conducts
extensive research and provides information about public health
Chronic Hepatitis B Infection:& A patient
who tests positive for the hepatitis B virus for more than 6
months is considered to have a chronic hepatitis B infection.
Cirrhosis:& A serious liver condition
characterized by irreversible scarring of the liver that can
lead to liver failure and death. Alcohol and chronic viral hepatitis
(such as chronic hepatitis B and C) can cause continuous inflammation
of the liver, which can lead to excess scar formation or fibrosis.
Scarring results in the loss of liver cells and impairs liver
Clinical Trials:& Carefully controlled
studies that are conducted in humans who volunteer to test the
effectiveness and safety of new drugs, medical products or techniques.
All drugs in the United States undergo three phases of clinical
trials before being approved for general use.
Clotting Factors: Proteins made in the liver
that are important in maintaining normal blood clotting. Disruption
in the blood's ability to clot may indicate that the liver is
not creating enough clotting factors. A severe shortage in clotting
factors may indicate that a liver transplant is needed.
Complete Blood Count (CBC): A test that measures
the number of red blood cells, white blood cells, the amount
of hemoglobin, hematocrit, and platelets. Low white blood cell
and platelet counts may indicate liver scarring.&
Complications:& New medical problems that
arise while treating existing ones.
DNA Polymerase: An enzyme essential to the
replication of the hepatitis B virus. Most of the current antiviral
drugs used against HBV interfere with the DNA polymerase in order
to stop the virus from reproducing.
Decompensated Cirrhosis: A late-stage cirrhosis
accompanied by abnormal blood tests and other complications.
At this stage of the disease, evaluation for liver transplant
becomes an option.
E-Antibody (HBeAb or anti-HBe): Produced by
the immune system temporarily during acute HBV infection or consistently
during or after a burst in viral replication. Spontaneous conversion
from e-antigen to e-antibody (a change known as &seroconversion&)
is a predictor of long-term clearance of HBV in patients undergoing
antiviral therapy.&
Encephalopathy:& Serious brain function
abnormalities experienced by some patients with advanced liver
disease. Symptoms most commonly include confusion, disorientation,
insomnia, and may progress to a coma.
Entecavir: An oral nucloeside analogue drug
that interferes with the replication of the hepatitis B virus
(e.g. it can slow down or stop the virus from reproducing). It
was the third oral drug approved for chronic hepatitis B in April
Enzymes:& Naturally occurring chemical
substances in the human body that help a chemical reaction take
Epidemiology:& A field of medical science
that studies the incidence, distribution, and control of disease
in a population. This information is often used to determine
causes and methods of controlling diseases.&
False-Positive:& A test result that mistakenly
gives a positive reading.
Fatty Liver: Refers to a condition where fat
accumulates in liver cells. This accumulation of fat does not
generally cause liver damage, but it needs to be monitored. It
is detected by liver biopsy.
Fibrosis (hepatic): Growth of fibrous tissue
in the liver where there is usually liver cell damage or destruction.
Fibrosis can lead to cirrhosis, an even more serious liver disease.
Food and Drug Administration (FDA): A federal
organization charged with protecting the public health. It establishes
safety and effectiveness guidelines for healthcare products such
as the drugs that are used to treat hepatitis B and C.
Gastroenterology:& The field of medicine
that focuses on the function and disorders of the GI system,
which includes the esophagus, stomach, pancreas, intestines,
and liver.
Genome:& Refers to the genetic material
of an organism such as a human or a virus.
Genotype:& A pattern of genetic information
that is unique to an individual or group. The hepatitis B virus
has a pattern of genetic information unique to itself. Doctors
may determine the genotype to help decide the best treatment.
Currently, there are seven known genotypes for hepatitis B; however,
its significance is not well established for clinical use. Hepatitis
C treatment can be based on genotype.
Hepatitis:& Refers to &inflammation
of the liver&, which can be caused by many things such
as viruses, bacterial infections, trauma, adverse drug reactions,
or alcoholism. Inflammation of the liver caused by viruses is
called &viral hepatitis&. There are many different
viruses that attack the liver:
Hepatitis A: Formerly called &infectious
hepatitis&, it is caused by the hepatitis A virus (HAV)
and is an acute infection. There is no chronic infection. Most
patients recover completely within 6 to 10 weeks. Hepatitis A
is spread mainly via feces and contaminated food and water. There
is a safe vaccine for HAV.
Hepatitis B: Formerly called &serum hepatitis&,
it is caused by the hepatitis B virus (HBV).& Approximately
10% of infected adults progress to chronic hepatitis B; 90% of
newborns born to HBV infected women develo
and young children have a 30-50% chance of developing a chronic
infection. It is spread primarily through blood, unprotected
sex, shared needles, and from an infected mother to her newborn
during the delivery process. There is a safe vaccine for HBV.
Hepatitis C: Formerly known as &non-A,
non-B hepatitis&, it is caused by the hepatitis C virus
(HCV).& Approximately 85% of infected adults will develop
chronic hepatitis C infections. It is spread through infected
blood, primarily in those who use illicit street drugs and those
who received blood transfusions prior to1992 (the first year
that a blood test for HCV became available for screening the
blood supply). There is no vaccine.
Hepatitis D: Known as &delta hepatitis&,
it is caused by the hepatitis D virus (HDV). This virus can only
co-infect patients who are already infected with hepatitis B.
Hepatitis D infection is rare in the United States. It occurs
primarily in recipients of multiple blood transfusions, including
patients with hemophilia or those undergoing renal dialysis,
and among people who share contaminated needles. There is no
Hepatitis E: Also referred to as &enterically
transmitted non-A, non-B hepatitis&, it is caused by the
hepatitis E virus (HEV). It is spread through fecal contamination
occurs primarily in
and is found
rarely in the United States. Hepatitis E infection results in
an acute infection much like hepatitis A; it does not cause chronic
infection. There is no vaccine.
Hepatitis F: Only a handful of cases have been
reported from France with subsequent experimental transmission
to primates. The virology, epidemiology and clinical importance
of the hepatitis F virus are uncertain. There is no commercial
test nor is there a vaccine.
Hepatitis G: The hepatitis G virus (also called
hepatitis GB virus or HGBV-C) is a distant relative of the hepatitis
C virus. It appears to be transmitted through transfusions (one
to two percent of US blood donors have HGV RNA detectable in
their serum). Its role in acute and chronic hepatitis remains
unclear. Recent studies suggest that the virus may not even replicate
in the liver. At the present time, HGV does not appear to be
an important cause of clinical liver disease. There is no commercial
test nor is there a vaccine.
Hepatitis B Blood Panel:& There are three
common hepatitis B tests that make up the Hepatitis B Blood Panel.
This is a simple test that requires only one blood sample, which
can be obtained during an office visit to the doctor.
1.&&&&& Hepatitis
B Surface Antigen (HBsAg): The surface protein of
the hepatitis B virus that is used as a marker to detect infection.
If this blood test is positive, then the hepatitis B virus
is present.
2.&&&&& Hepatitis
B Surface Antibody (HBsAb or anti-HBs): The antibody
formed in response to the surface protein of the hepatitis
B virus. It can be produced in response to vaccination or recovery
from an actual hepatitis B infection. If this test is positive,
then the immune system has successfully developed a protective
antibody against the hepatitis B virus that provides long-term
3.&&&&& Hepatitis
B Core Antibody (HBcAb or anti-HBc): This antibody
only refers to a part it does not provide
any protection or immunity against HBV. This test is often
used by blood banks to screen blood donations. A positive test
indicates a person may have been exposed to the hepatitis B
virus, but the result can only be confirmed in relationship
to the above two tests.
HBeAg: A marker of a high degree of HBV infectivity,
it correlates with a high level of HBV replication. It is primarily
used to help determine the clinical management of patients with
chronic HBV infection.
Hepatitis B Immune Globulin (HBIG):& A
medication that is given as a &post-exposure& treatment
to prevent hepatitis B. This means that HBIG is given after a
person has been exposed to potentially infected blood or infected
bodily fluids, which can include but is not limited to - contact
with blood or through a needlestick, infants born to infected
women, and through sexual contact or close household contact
with an infected person. HBIG is often used as a post-liver transplant
treatment.
HBV-DNA: A marker of viral replication.&
It correlates well with infectivity.& It is used to assess
and monitor the treatment of patients with chronic HBV infection.
Hepatocellular Carcinoma (HCC):& A malignant
tumor of the liver, otherwise known as liver cancer. Chronic
hepatitis B and C infections may increase the risk of developing
liver cancer.
Hepatocyte:& A liver cell.
Hepatologist:& A doctor who specializes
in the study and treatment of liver disease. Ideally, patients
with chronic hepatitis B or C should see a &hepatologist&.
Hepatology:& The field of medicine that
focuses on diseases of the liver. It is a sub-specialty within
gastroenterology.
Histology:& The field of medicine that
studies tissue under the microscope. Histological evaluations
of liver biopsy samples are helpful in the diagnosis and monitoring
of possible liver damage in chronic HBV and HCV carriers.
IgG anti-HBc: A subclass of the hepatitis B
core antibody (HBcAb or anti-HBc) is a marker of past or current
infection with HBV.& If it and HBsAg are both positive (in
the absence of IgM anti-HBc), this indicates chronic HBV infection.
IgM anti-HBc:&A subclass of the hepatitis
B core antibody (HBcAb or anti-HBc).& Positivity indicates
recent infection with HBV (less than 6&months).& Its
presence indicates acute infection.
Immune System:& The body&s defense
system against invasion by foreign bodies such as bacteria, viruses,
fungi, parasites, and malignant cells.
Immunology:& The branch of medicine that
studies the immune system, immunity, and allergies.
Infection:& The results of the presence
of harmful microorganisms in the body. Infections can be acute
(sudden) or chronic (persistent).
Injection:& A method of administering
drugs or nutrients into the body using a needle.
Intramuscular (IM):& into muscle tissue.
Intravenous (IV):& into a vein.
Subcutaneous (SQ):& beneath the skin.
Interferon: A protein that is produced by the
body to protect against infection. Many different cells including
liver cells produce natural interferon. Interferon also can be
manufactured artificially through biotechnology for the treatment
of chronic hepatitis B and C.
Interferon Alpha-2b (Intron A): A drug that
mimics naturally occurring &interferon&, which is
an infection-fighting immune substance produced by the body.
It is self-administered at least three times a week by injection.
This was the first drug approved for chronic hepatitis B in 1991.
Available for both adults and children greater than 2 years old.
Investigational Drug:& A new drug that
is undergoing clinical trials to prove its effectiveness and
safety (see clinical trials).
Jaundice: A condition characterized by yellowing
of the skin and eyes. Jaundice is a symptom of many disorders,
which can include viral hepatitis, alcoholism, poisoning, and
abnormal breakdown of red blood cells or gallbladder disease.
This symptom requires immediate medical attention.
Lamivudine (Epivir-HBV, Zeffix, Heptodin): An
oral nucleoside analogue drug that interferes with the replication
of the hepatitis B virus (e.g. it can slow down or stop the virus
from reproducing). It was the second drug approved for chronic
hepatitis B in December 1998. Available for both adults and children.
Liver:& The largest glandular organ in
the body. The liver has many functions that include, but are
not limited to the production of protein and cholesterol, the
production of bile and clotting factors, the storage of sugar
in the form of glycogen, and the breakdown of carbohydrates,
fats, and proteins. The liver also breaks down and excretes many
medications.
Liver Biopsy:& The removal of a small
piece of tissue from the liver using a special needle. The tissue
is examined under a microscope to look for the presence of inflammation
or liver damage (see histology).
Liver Enzymes: Proteins that catalyze chemical
reactions needed for bodily functions. Levels of certain enzymes,
such as ALT and AST are higher when the liver is injured, as
they leak into the bloodstream when the cell is injured or destroyed.
Liver Function Tests (LFT&s):& Refers
to a group of blood tests used to evaluate the function of the
liver. The tests can be used to diagnose and monitor chronic
viral hepatitis as well as other liver diseases. The two most
common tests include the following liver enzymes:
Aspartate Aminotransferase (AST): An enzyme
that is released into the blood by the liver and other tissues
or organs. It is generally used as a marker for liver or biliary
Alanine Aminotransferase (ALT): An enzyme
that is released into the blood by damaged liver cell. It is
used as a marker for liver cell damage. The ALT test is considered
to be a more accurate reflection of liver inflammation than
AST because other organs such as the heart can also produce
AST. (e.g. the level of AST will increase on a blood test during
a heart attack). ALT levels are included in the regular monitoring
of all chronic hepatitis B this test can also useful
in deciding whether a patient would benefit from therapy or
evaluating the effectiveness of an ongoing treatment.
Needlestick:& Refers to an accidental
puncture of the skin while handling hypodermic needles or syringes.
This is most common among health care providers such as physicians,
nurses, and emergency response personnel.
Non-Responders:& Patients who do not respond
to therapy or a vaccine within a specific period.
Patient Compliance:& Patients who correctly
follow all the instructions about a course of therapy as directed
by their physician are considered to be &compliant& with
a treatment protocol (see protocol below).
PCR (polymerase chain reaction):& A highly
sophisticated scientific method of detecting the presence of
hepatitis B virus DNA or hepatitis C virus RNA in the blood.
This test can be conducted on the same sample of blood obtained
with the hepatitis B
no extra doctor&s
visit is needed.
Peg Interferon Alfa-2a (Pegasys): A pegylated
interferon drug that mimics naturally occurring &interferon&,
which is an infection-fighting immune substance produced by the
body. It is self-administered once a week by injection and seems
to have fewer side effects than the interferon alpha. Approved
for treatment of chronic hepatitis B in May 2005.
Percutaneous:& Passage or absorption of
substances into the body through unbroken skin.
Perinatal Transmission (vertical transmission):& Transmission
of an infectious disease, such as hepatitis B, from mother to
newborn. All pregnant women should be tested for hepatitis B
since newborns have a 90% chance of becoming chronically infected
if they do not receive the first dose of hepatitis B vaccine
and a single dose of HBIG within 12 hours after delivery. The
infant will also need additional doses of hepatitis B vaccine
at one and six months of age to ensure a complete immune response.
Persistent:& A disease or other medical
condition that returns or continues over a long time.
Platelets:& Cells that are produced in
the bone marrow. Platelets control bleeding by causing the blood
to clot. The liver produces the clotting factors involved in
this process. If the liver is damaged, then clotting will also
be impaired.
Post-Transfusion Hepatitis:& Liver inflammation,
or hepatitis, that occurs when the body reacts unfavorably to
a blood transfusion. This is now rare in the United States due
to careful blood screening procedures.
Protein:& A substance made of a string
of amino acids. Proteins are the &building blocks& of
the human body.
Protocol:& A detailed plan of a scientific
experiment or medical treatment. A specific step-by-step procedure
is used in clinical trials to test new drugs and treatments for
diseases such as chronic hepatitis B.
Recombinant DNA:& Genetic material that
has been altered and recombined in the laboratory by cutting
up DNA molecules and splicing together specific DNA fragments.
Many drugs, including the hepatitis B vaccines, are produced
using recombinant DNA methods.
Reconstitution:& The process of adding
liquid to a dry powder to make a new solution. Prescription drugs
that are given by injection are often provided as a dry powder,
which must be reconstituted (e.g. liquid must be added) before
it can be used.
Recreational Drugs (illicit drug use):& Illegal
drugs, such as marijuana, crack, cocaine, and heroin. People
who use these drugs have a much greater risk of acquiring a hepatitis
B or C infection as a result of sharing needles or engaging in
other behaviors that increase their risk of exposure to infected
Relapse:& The return (or recurrence) of
symptoms of a disease after a period of improvement.
Remission:& A period of time during which
all or some of the symptoms of a disease have disappeared or
decreased in severity. Remission may occur spontaneously or as
a result of medical treatment.
Retreatment:& Treatment that is restarted
after a patient has suffered a relapse or has not responded to
treatment the first time.
Risk Factors:& Refers to behaviors and
conditions that increase the possibility of an individual developing
a disease. Smoking is a risk factor for lung cancer. Jobs that
expose a person to blood or the use of illegal drugs are risk
factors for acquiring a hepatitis B or C infection.
Screening:& Testing blood samples or blood
donations for the presence of disease. Before blood donations
are accepted, they are screened for hepatitis B, hepatitis C,
and HIV/AIDS and other bloodborne pathogens.
Self-Administration:& Therapy, such as
interferon injections, that patients give to themselves rather
than having it done by a health care provider.
Seroconversion: A change in status from antigen
positive/antibody negative to antigen negative/antibody positive.
For example, seroconversion of e-antigen positive to e-antibody
positive indicates a significant decrease in the amount of hepatitis
B virus. Seroconversion of hepatitis B surface antigen positive/surface
antibody negative to surface antigen negative/surface antibody
positive connotes being &cured& of a chronic HBV infection
since the virus has been cleared from the liver and bloodstream.&
Serology: & Refers to the study of serum
(the clear portion of a body fluid) for its antibody content.
When a person is exposed to a microorganism, such as the hepatitis
B or C virus, the body produces specific antibodies against it.
In laboratory testing, the antibodies react with antigens in
specific ways that can be used to confirm the identity of the
microorganism, however, this test is not used to diagnose a current
infection.
Spleen:& An organ located in the left
upper abdomen that removes old red blood cell and other blood
cells from circulation. The spleen can enlarge in a person who
has cirrhosis.
STD (sexually transmitted disease):& A
disease that is transmitted through sexual contact.
Sustained Response:& A response to therapy
that continues over a long time period.& For example, a
patient treated for chronic hepatitis B or C who remains free
of the virus for at least 6 months after stopping treatment is
considered to have a sustained response to therapy.
Symptom:& Any change in the body or its
functions, as perceived by the patient, which could indicate
the presence of disease.
T-Cells:& A type of white blood cells
that are involved in rejecting foreign tissue, regulating immunity,
and controlling the production of antibodies to fight infection.
Therapy:& Treatment of a disease.
Transaminases:& Refers to SGOT or SGPT,
which are older terms for the ALT and AST amino transferases
(see liver function tests).
Transfusion:& The introduction of whole
blood or components of blood (such as plasma, platelets) from
one person to another.
Transmission: The way or method by which a
disease can be spread.
Vaccine:& A medication that stimulates
the production of antibodies to protect against a specific disease.
There is a hepatitis A vaccine, hepatitis B vaccine, and a combination
vaccine that provides protection against both hepatitis A and
B at the same time.
Variceal Bleeding:& Abnormal bleeding
from ruptured blood vessels in the esophagus that results from
severely impaired blood flow through the liver. Patients with
advanced cirrhosis are at greatest risk for this complication.
This is a life-threatening emergency and requires immediate medical
attention.
Viral hepatitis:& Inflammation of the
liver caused by viruses that specifically attack the liver: hepatitis
A, B, C, D, E, F, and G viruses.
Viral Load:& Measurement of the actual
amount of virus in the bloodstream such as hepatitis B and C.
Viremia: & Refers to the presence or amount
of a given virus in the bloodstream.
Virus:& A tiny microorganism, smaller
than bacteria, which can invade the body and cause disease. A
virus can reproduce itself exactly or mutate and make small changes.
The ability of a virus to change slightly in each infected person
is why treatment of viral diseases is so difficult.}