慢性乙型肝炎患者的HCV重叠感染

THE SUPERINFECTION OF HEPATITIS C VIRUS IN CHRONIC HEPATITIS B: A STUDY BY REVERSE TRANSCRIPTION AND POLYMERASE CHAIN REACTION

研究45例慢性乙型肝炎患者的HCV重叠感染。病例均为后发抗HCV阳性的慢性HBsAg携带者,无先抗HCV阳性而后HBsAg阳性的个案,这可能反映HBV和HCV两种病毒感染的先后次序、不同传播方式及HBV对HCV易感性的增进作用。用RT-PCR检出30/45例血浆HCV RNA阳性,不仅确证HCV重叠感染诊断,还证实HCV复制及传染性。23/30例HCVRNA阳性者有输血史,提示输血是其获得HCV重叠感染的主要途迳。用PCR检出25/45例血清HBV DNA阳性,其中抗HBe阳性者的HBV DNA检出率为42.9％(12/18),明显低于(P<0.001)我们前文报道,提示重叠HCV感染对HBV复制有抑制作用。此外有9例抗HBe阳性者,其HBV DNA阴性但HCV RNA阳性,反映HCV可能已取代HBV成为致肝损害的主要病因。

The superinfection of HCV in chronic hepatitis B was studied. Fourty-five chronic HBsAg carriers were found to be anti-HCV positive. No initially anti-HCV positive then HBsAg positive observed reflecting the time order of HBV and HCV infection, the difference of the transmission, possibly the promotion HBV exerts to HCV. By RT-PCR to detect plasma HCV RNA, 30/45 were positive that verified the HCV superinfection, replication and infectivity. Among the RNA positive, 23 have history of blood or plasma transfusion indicating the transfusion is the course aquiring HCV superinfection. By PCR to detect serum HBV DNA, 25/45 were positive, among them 6 were HBeAg positive, 12 anti-HBe positive and 7 HBeAg and anti-HBe negative. The positivity of HBV DNA in the anti-HBe positive was significantly less than that previously reported, which suggests that HCV superinfection possibly inhibits HBV replication. There were 9 anti-HBe carriers who were HBV DNA negative but HCV RNA positive, in them HCV possibly replaced HBV to be the main pathogen responsible for the liver damage.