重叠丙型肝炎病毒感染在慢性乙型肝炎患者肝脏病变中的作用  

Role of hepatitis C virus superinfection in hepatic pathologic changes of patients with chronic hepatitis B:a retrospective short-term and long-term comparative study

作　　者：商庆华[1] 于建国[1] 徐传镇[1] 肖德明[2] 尹燕明[3] 陈崇兴[1] 张光曙[1] 

机构地区：[1]解放军第八十八医院济南军区肝病研究所,泰安271000 [2]泰安市中心医院感染病科 [3]泰山医学院附属医院感染病科

出　　处：《中华实验和临床病毒学杂志》2005年第1期32-34,共3页Chinese Journal of Experimental and Clinical Virology

摘　　要：目的　观察重叠丙型肝炎病毒 (HCV)感染对慢性乙型肝炎 (CHB)患者肝脏病变的近期及远期影响。方法　选择 0 5～ 15 0年间以Mengnihi法进行 2次肝脏穿刺活体组织学检查的CHB患者 2 30例 ,2次同期血清标本应用逆转录聚合酶链反应 (RT PCR)技术进行HCV RNA检测 ,并将血清HCV RNA阳性与阴性患者近期肝脏病变及血清HCV RNA持续阳性患者与具有可比性的持续阴性患者远期肝脏病变分别进行了回顾性对比分析。结果　血清HCV RNA阳性患者为 4 1例 (17 83% ) ,其近期肝组织炎症活动度 (G1～G4例数分布分别为 5、8、16、12 )与纤维化程度 (S0～S4分布分别为 1、3、8、19、10 )和阴性患者相比 (G1～G4例数分布分别为 37、6 0、5 7、35 ;S0～S4分布分别为 8、2 0、6 3、6 9、2 9)差异有统计学意义 (P <0 0 5 )。随访结束时血清HCV RNA持续阳性患者 2 9例 ,其远期肝组织炎症活动度与 116例持续阴性患者相比 (加重、无变化、好转例数分布分别为 12、10、7;2 4、2 4、6 8)与纤维化程度 (加重、无变化、好转例数分布分别为 15、8、6 ;2 7、2 6、6 3)差异有统计学意义 (P <0 0 1)。结论　重叠HCV感染可加重CHB患者肝脏病变 。Objective To observe the effect of hepatitis C virus (HCV) superinfection on the short-term and long-term hepatic pathological changes in patients with chronic hepatitis B (CHB). Methods HCV-RNA of twice corresponding period serum samples was detected via reverse transcription polymerase chain reaction assay from 230 patients with CHB for whom liver biopsy was performed at an interval of 0.5-15 years, respectively. The hepatic pathological changes of the patients with CHB who were serum HCV-RNA positive at the beginning of observation and persistently positive between the starting and ending of observation were respectively compared with those of serum HCV-RNA negative and persistently negative patients. Results 41 patients (17.83%) were positive for serum HCV-RNA at the beginning of observation. There were significant differences in the severity of hepatic inflammatory activity grade and fibrosis stage between serum HCV-RNA positive and negative patients with CHB (P<0.05). Twenty-nine patients were persistently positive for serum HCV-RNA in the beginning and end of observation. Compared with persistently negative patients who were 116 patients selected from the above-mentioned 230 patients and they were comparable with HCV-RNA persistently positive patients in mean follow-up time, age and sex, the long-term progression of hepatic inflammatory activity grade and fibrosis stage in persistently positive patients were more speedy (P<0.01). Conclusion HCV superinfection worsens the hepatic pathological changes of patients with CHB and speeds up its progression.

关 键 词：患者 HCV-RNA 肝脏病变 CHB 阴性 阳性 血清 分布 持续 RT-PCR 

分 类 号：R512.62[医药卫生—内科学]