慢性乙型肝炎重叠EB病毒感染的临床观察  

A clinical study of chronic hepatitis B patients with Epstein-Barr virus infection

作　　者：黄姜伟 韩方正 HUANG Jiangwei;HAN Fangzheng(Department of Infectious Diseases,The Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002,China)

机构地区：[1]徐州医科大学附属医院感染性疾病科,江苏徐州221002

出　　处：《临床肝胆病杂志》2018年第8期1659-1663,共5页Journal of Clinical Hepatology

摘　　要：目的探讨重叠EB病毒(EBV)感染对慢性乙型肝炎(CHB)患者肝功能及HBV复制的影响。方法选取徐州医科大学附属医院2015年1月-2017年8月收治的CHB患者119例,依据CHB临床分度标准,分为轻度(60例)、中度(38例)和重度(21例)。其中60例为CHB重叠EBV感染患者(重叠感染组),59例为单纯CHB患者(单纯CHB组)。收集2组患者性别、年龄、住院天数、肝功能指标、HBV DNA载量、血常规、凝血功能等临床资料进行对比分析。计量资料2组间比较采用t检验或Mann-Whitney U检验,计数资料组间比较采用χ~2检验或Fisher精确检验。结果 CHB重度患者EBV DNA检出率(76.19%,16例)较轻度(43.33%,26例)和中度(47.37%,18例)患者均明显升高(χ~2值分别为6.727、4.601,P值均<0.05);与单纯CHB组比较,重叠感染组患者住院天数、ALT、AST、TBil、DBil、GGT水平均显著升高(t值分别为3.523、4.085、3.755、10.976、8.380;Z=-3.474,P值均<0.05),PTA和HBV DNA定量下降(t值分别为-2.501、-6.140,P值均<0.05);重叠感染组HBeAg阳性率、HBV DNA阳性率均低于单纯CHB组(P值均<0.05);2组间淋巴细胞百分比、Alb、WBC、Hb、PLT比较,差异均无统计学意义(P值均>0.05)。结论 CHB患者病情越重越易重叠感染EBV或机体内潜伏的EBV越易重新激活,EBV感染后又可加重病情,延长病程,但血清HBV DNA水平下降,可能与EBV抑制了HBV复制有关。Objective To investigate the influence of Epstein-Barr virus（ EBV） infection on liver function and hepatitis B virus（ HBV）replication in chronic hepatitis B（ CHB） patients. Methods A total of 119 CHB patients who were admitted to The Affiliated Hospital of Xuzhou Medical University from January 2015 to August 2017 were enrolled,and according to the criteria for clinical grading of CHB,they were divided into mild group with 60 patients,moderate group with 38 patients,and severe group with 21 patients. Of all patients,60 had CHB and EBV superinfection（ superinfection group） and 59 had CHB alone（ CHB group）. The two groups were compared in terms of the clinical data including sex,age,length of hospital stay,liver function parameters,HBV DNA quantification,routine blood test results,and coagulation function. The t-test and the Mann-Whitney U test were used for comparison of continuous data between two groups,and the chi-square test and the Fisher＇s exact test were used for comparison of categorical data between groups. Results The severe group had a significantly higher EBV DNA detection rate than the mild and moderate groups [76. 19%（ 16/21） vs 43. 33%（ 26/60） and 47. 37%（ 18/38）,χ~2= 6. 727 and 4. 601,both P 〈0. 05]. Compared with the CHB group,the superinfection group had significant increases in the length of hospital stay and the levels of alanine aminotransferase,aspartate aminotransferase,total bilirubin,direct bilirubin,and gamma-glutamyl transpeptidase（ t = 3. 523,4. 085,3. 755,10. 976,and 8. 380,Z =-3. 474,all P〈 0. 05） and significant reductions in prothrombin time activity and HBV DNA quantification（ t =-2. 501 and-6. 140,both P〈 0. 05）. The superinfection group had significantly lower positive rates of HBeAg and HBV DNA than the CHB group（ both P 〈0. 05）,and there were no significant differences between these two groups in lymphocyte percentage,albumin,white blood cell count,hemoglobin,and platelet count（ all P 〉0. 05）. Conclusion In CHB patien

关 键 词：肝炎 乙型 慢性 爱泼斯坦巴尔病毒感染 重叠感染 

分 类 号：R512.62[医药卫生—内科学]