慢性乙型肝炎患者重叠戊型肝炎病毒感染的临床与病理学研究  

The effects of hepatitis E virus superinfection on patients with chronic hepatitis B :a clinico-pathological study

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

机构地区：[1]解放军第88医院济南军区肝病研究所,山东泰安271000 [2]山东省泰安市中心医院

出　　处：《中华内科杂志》2002年第10期656-659,共4页Chinese Journal of Internal Medicine

摘　　要：目的　观察重叠戊型肝炎病毒 (HEV)感染对慢性乙型肝炎 (CHB)肝脏损害及HBV复制的影响。方法　应用ELISA法对 12 2例CHB患者血清进行了抗 HEVIgM、IgG检测 ,同时应用肝穿刺活检、荧光定量PCR及免疫组化等技术对重叠与未重叠HEV感染者分别进行了ALT、总胆红素(TBil)、凝血酶原活动度 (PTA)、白蛋白 /球蛋白 (A/G)、电泳γ球蛋白 (γ EP)水平、肝脏病理学、血清HBeAg及肝组织HBcAg阳性率、血清及肝组织中HBVDNA含量对比。具有可比性的重叠 (7例 )与未重叠HEV感染者 (14例 ) 1年后做第 2次肝穿活检并做病理学比较 ;HBeAg阴性重叠HEV感染者 8例做HEV感染急性期、恢复期血清HBeAg定性、HBVDNA含量对比。结果　重叠HEV感染者 2 1例(17 2 %)。重叠HEV感染者较未重叠感染者ALT、TBil增高 ,PTA降低 (P <0 0 5 ) ,但A/G、γ EP水平未见显著差别 (P >0 0 5 ) ;血清HBeAg及肝组织HBcAg阳性率、血清及肝组织HBVDNA含量低 (P <0 0 5 ) ;肝组织炎症活动度重 (P <0 0 5 ) ,但纤维化程度未见明显差别 (P >0 0 5 )。两组患者 1年前肝组织炎症活动度及纤维化程度无显著差别 ,1年后仍无显著差别 (P >0 0 5 )。HEV感染恢复期血清HBeAg阳性率、HBVDNA含量高于急性期 (P <0 0 5 )。Objective To observe the effect of hepatitis E virus (HEV) superinfection on hepatic lesion and hepatitis B virus (HBV) replication in patients with chronic hepatitis B (CHB) Methods Totally 122 patients with CHB were enrolled in this study They were tested for anti HEV IgM and IgG in serum,amount of HBV DNA in serum and liver tissue obtained by liver biopsy and HBcAg expression in liver tissue Other parameters such as ALT,total bilirubin(TBil),albumin(A) and globulin(G),γ electrophoretic protein(γ EP),prothromin activity(PTA)were also measured 21 of the 122 patients(17 2%) were found to have HEV superinfection and the remaining 101 were not Repeat liver biopsy was performed after 1 year in 7 patients with HEV superinfection and 14 patients without Moreover, HBV DNA amount in serum from 8 HBeAg negatived patients with HEV superinfection were tested dynamically in acute and recovery stage of HEV infection Results Comparison of the data from the 21 patients with HEV superinfection and 101without showed that there was no significant difference in the level of A/G ratio (1 74±0 50 vs 1 83±0 37)and γ EP [(24 18±6 36)% vs (22 27±4 59)%, P >0 05] However, the level of ALT [(244 61±81 07 )U/L vs (143 87±47 69) U/L] and TBil [(88 24±28 54) μmol/L vs (46 16±17 13) μmol/L]was significantly higher( P <0 05),but that of PTA lower in the group with HEV superinfection than in the group without superinfection[(58 57±17 44)% vs (72 52±12 25)%, P <0 05]. So were the amount of HBV DNA in serum[(5 45±1 86) copies/ml vs (6 59±1 28) copies/ml, P <0 05] and liver tissue[(6 96±2 52)copies/g vs (8 47±1 79) copies/g, P <0 05] as well as HBeAg and HBcAg positive rates(8/21 vs 64/101;9/21 vs 67/101, P <0 05) Pathologically, the hepatic inflammatory activity was more severer in patients with HEV superinfection, but the severity of fibrosis was not significantly different There was no difference in the severity of inflammatory

关 键 词：戊型肝炎病毒 乙型肝炎 重叠感染 病理学 

分 类 号：R512.6[医药卫生—内科学]