乙型肝炎病毒感染和血吸虫感染对肝纤维化的影响  

The effects of infections with hepatitis B virus and Schistosome japonicum on human hepatic fibrosis

作　　者：侯循亚[1] 李岳生[1] 王媛圆[1] 陈四喜[1] 刘佳新[1] 杨周[1] 

机构地区：[1]湖南省血吸虫病防治所,血吸虫病免疫与传播控制湖南省重点实验室,血吸虫病国家重点专科,湖南岳阳414000

出　　处：《中国病原生物学杂志》2013年第10期937-940,共4页Journal of Pathogen Biology

基　　金：湖南省科技厅项目(No.S2010FJ3106;S2013FJ3123)

摘　　要：目的分析乙型肝炎病毒(HBV)感染和血吸虫感染对肝纤维化的影响。方法肝纤维化脾大脾亢患者59例,取肝组织进行肝纤维化病理分期并查肝组织血吸虫虫卵;采用酶联免疫吸附试验(ELISA)检测血清乙肝两对半,同时观察患者临床症状及实验室指标包括血常规、肝功能及血清胶原蛋白(HA),血小板转化生长因子BB(PDGF-BB)和金属蛋白酶组织抑制因子1(TIMP-1)水平。分析乙肝阳性与乙肝阴性肝纤维化患者之间,肝组织血吸虫虫卵阳性与虫卵阴性肝纤维化患者之间的肝纤维化程度、临床及实验室检查指标的差异,并分析影响肝纤维化程度的相关因素。结果乙肝肝纤维化患者肝功能显著异常,其血清HA和PDGF-BB分别为(1.03±0.35)ng/ml和(0.31±0.04)ng/ml,与单纯血吸虫病肝纤维化患者的(0.69±0.20)ng/ml和(0.11±0.03)ng/ml比较差异均有统计学意义(P<0.01)。肝组织虫卵阴、阳性患者间的肝纤维化程度差异无统计学意义(χ2=2.266,P>0.05);肝纤维化严重程度与乙肝感染相关(B=0.382,P<0.05),与肝脏血吸虫虫卵数无相关性(P>0.05)。结论乙肝比血吸虫病对肝纤维化的影响更严重,临床上应先确定肝纤维化的病因,以指导临床治疗。[Abstract] Objective To explore the effects of infections with hepatitis B virus （HBV） and with Schistosomejaponicum on human hepatic fibrosis. Methods Hepatic fibrosis in 59 patients with splenomegaly and hypersplenism was staged by liver histology on wedge liver biopsies. S. japonicum eggs from liver tissue were examined by microscope. Serology of HBV including HBsAg, HBsAb, HBeAg, HBeAb, and HBcAb was assessed by ELISA. Clinical symptoms and labora- tory （lab） parameters including routine blood test, liver function tests, and serum levels of HA, TIMP-1, PDGF-BB were also measured. The severity of hepatic fibrosis, clinical and lab parameters were compared between patients with HBV positive and HBV negative, and between patients with liver schistosome egg positive and egg negative. The factors affecting hepatic fibrosis were also analyzed. Results Hepatic fibrosis patients with HBV infection had anomalies of liv- er function. Serum levels of HA and PDGF-BB in patients with HBV infection were 1.03 （±0.35） ng/ml and 0. 3l（±0.04）ng/ml respectively, and significantly higher than those in patients infected with S. japonicum only, which were 0.69 （±0.20）ng/ml and 0.11 （χ2-0.03）ng/ml for HA and PDGF-BB respectively （P〈0.01）. The severity of hepatic fi- brosis with splenomegaly and hypersplenism showed no statistic significance between patients of schistosome egg positive and egg negative （χ2= 2. 266, P2〉0.05）. The severity of hepatic fibrosis with splenomegaly and hypersplenism was sig- nificantly associated with HBV infection （B= 0. 382, P〈0.05） but not associated with the intensity of liver schistosome egg （P〈0.05）. Conclusion HBV infection had more severe effect on human hepatic fibrosis than infection of S. ja- ponicum. Thus, the true etiology of hepatic fibrosis should be identified in order to provide relevant intervention thereaft- er.

关 键 词：肝纤维化 乙型病毒性肝炎 血吸虫病 临床特征 实验室检查指标 

分 类 号：R373.21[医药卫生—病原生物学]