重型病毒性肝炎病原学与预后的关系探讨

The etiological feature and outcome of patients with severe hepatitis

目的探讨重型病毒性肝炎的病原学特点。方法收集各型重型病毒性肝炎418例,分析其病原学分型及乙型肝炎病毒不同病原学模式与重型肝炎预后的关系。结果急性重型肝炎以甲型和戊型病毒性肝炎为主,乙型肝炎病毒感染治愈后病毒阴转率较高。亚急性及慢性重型肝炎以乙型肝炎病毒感染居首位,占92.8％。在乙型肝炎病毒感染的病原学模式中,以HBsAg、HBeAb、HBcAb阳性的重型肝炎发病及死亡率最高。乙型肝炎病毒与其他肝炎病毒重叠感染与单纯感染比较死亡率无显著差异。单纯TTV感染可导致重型肝炎。重型肝炎发病后HBV DNA可自然阴转,阴转率可达53.6％。结论重型肝炎仍以乙型肝炎病毒感染为主。乙型肝炎病毒前C区发生基因突变可能较易发生重型肝炎。

Objective To study the etiologial feature of severe hepatitis. Methods 418 cases of severe hepatitis were collected. The relationship between etiologic type and prognosis of severe hepatitis, and between etiologic models of HBV and prognosis of severe hepatitis were analysed.Results Most of acute severe hepatitis were hepatitis A and hepatitis E. Infection of HBV leads to 92.8% sub - acute severe hepatitis and chronic severe hepatitis. The incidence rate and fatality rate of patients with HbsAg, HbeAb and HbcAb positive were higher in severe hepatitis B patients. There was no significant difference between the fatality rate of patients with single infection of HBV and that of patients with multiple infection of HBV and other type hepatitis virus. Single infection of TTV led to some severe hepatitis. In addtion, 53.6% of patients with HBV DNA positive turned negative naturally after severe hepatitis.Conclusion Severe hepatitis is mainly caused by the infection of HBV, and HBV precore mutant infection is more likely to result in severe hepatitis.