2014年 · 第94卷第25期

Occult hepatitis B virus infection (OBI) refers to a negative serum hepatitis B virus surface antigen (HBsAg) and a positive DNA test for hepatitis B virus (HBV) in serum and/or liver tissue. In 2008, the European Association of Liver Diseases (EASL) convened a meeting of the OBI Working Group, which defined OBI as "serum HBsAg negative but HBV DNA positive in liver tissue, and recommended a margin of serum HBV DNA of<200 IU/ml "^[1]。 Therefore, the two main characteristics of OBI are HBsAg negativity and low levels of viral replication. However, liver biopsy should not be carried out extensively, and detection of the virus in the serum is very difficult (even with the most sensitive detection techniques), while positive hepatitis B virus core antibody (anti-HBc) ± positive hepatitis B virus surface antibody (anti-HBs) in OBI is common. Therefore, the accepted belief is that anti-HBc positive individuals are potential OBI (pOBI). It should be noted that about 7% to 20% of OBI were negative for all viral serological indicators^[2]。

Epidemiological studies have shown that decreased high-density lipoprotein cholesterol (HDL-C) levels are independent predictors of coronary heart disease, and that increased HDL-C levels are inversely correlated with the incidence of cardiovascular disease, even in patients with LDL-C levels below 1.82 mmol/L, high HDL-C levels remain protective against coronary heart disease. Therefore, HDL is another target in the field of anti-atherosclerosis research. Increasing HDL level may provide a new treatment for the prevention and treatment of coronary heart disease. At present, HDL is believed to mediate reverse cholesterol transportation (RCT), which transports cholesterol from atherosclerotic plaques in peripheral blood vessels to the liver for excretion, thereby reducing the deposition of lipids in blood vessel walls, improving endothelial function, antioxidant, anti-inflammatory and other effects to exert anti-artherosclerosis (AS) effects.

A 31-year-old female, pregnant with 5 deliveries and 1 flow 4, was pregnant with a uterine horn on April 27, 2013 due to irregular vaginal bleeding for 15 days? Treatment in the First People's Hospital of Qingdao Economic and Technological Development Zone. The patient usually had regular menstruation, 3~5/30 days. The last menstruation was on January 7, 2013. The patient had an induced abortion in Juye County People's Hospital of Shandong Province on March 6, 2013. No villus tissue was found during the operation, and the scraped tissue was sent to pathology for examination. The pathological results showed that villus tissue was seen in the scraped tissue. The postoperative vaginal bleeding was clean for 7 days, and there was no follow-up. About 1 month after surgery (about the beginning of April) intercourse once. The patient developed irregular vaginal bleeding on April 12, 2013. He thought that menstrual cramps began, but no diagnosis and treatment were performed. The amount of vaginal bleeding was about twice that of menstrual flow, and it was inexhaustible. On April 26 of the same year, the blood progesterone was 1.37 μ g/L and human chorionic gonadotropin (hCG) was 14 435 U/L in the First People's Hospital of Qingdao Economic and Technological Development Zone, Shandong Province. B-ultrasound examination showed that the uterine body size was about 5.1 cm ×6.3 m ×4.7 cm, the endometrium thickness was about 0.9 cm, and a strong echo mass of 2.1 cm ×1.4 cm was seen at the right uterine corner, and a cystoid echo of 0.7 cm ×0.5 cm was seen inside. No abnormal masses were observed in bilateral adnexal areas. Outpatient to horn pregnancy? Admitted to hospital for treatment. Admission physical examination: vital signs stable, gynecological examination: vulva married multipartum type, dark red blood in vagina, cervical third degree erosion, no lifting pain and swaying pain, uterine body posterior position, slightly larger, no tenderness, bilateral adnexal area no palpable mass, no tenderness. In order to confirm the diagnosis after admission, painless curettage and curettage was performed on the same day. No villus was found in the scraped tissue during the operation. The scraped tissue was sent to pathological examination. The next day, the blood hCG was re-examined at 13 956 IU/L, which was not significantly lower than that before curettage and curettage. Pathological examination showed that no villus tissue was found in the tissue submitted for examination. Vaginal color ultrasound examination was performed again: heterogeneous echo mass was seen at the right corner of the uterus, and interstitial pregnancy of the fallopian tube was considered. Laparoscopic diagnosis and treatment were performed on April 28 of the same year. Intraoperative findings: pelvic hemorrhage about 50 ml, no abnormalities in the appearance of bilateral fallopian tubes and ovaries, slightly larger uterus, slightly protruding right posterior wall of uterus, with an extent of about 3 cm ×3 cm (Figure 1), the assistance of a B-ultrasound doctor was asked during the operation. Under the B-ultrasound, a 0.5 cm ×0.5 cm cystic echo was seen between the muscle walls of the right posterior wall of the uterus. Intraoperative diagnosis: intramural pregnancy. During the operation, under the guidance of B-ultrasound, the muscular layer of the right posterior wall of the uterus was transversely cut with unipolar, which was about 3 cm long. After the muscular layer was cut, the villous tissue protruded (Figure 2), the villus tissue was clamped out with vascular forceps, and the ectopic lesion cavity was not communicated with the uterine cavity (Figure 3)。 1 – 0 absorbable thread continuous suture of uterine muscle wall molding. hCG 1 017 U/L was re-examined on 4 days after operation, and he was cured and discharged on 5 days after operation. hCG decreased to normal at 2 weeks after surgery.