巨脾型晚期血吸虫病与HBV及HCV感染的研究

A STUDY ON ADVANCED SCHISTOSOMIASIS HBV AND HCV INFECTIONS

本文作者对１２４例临床诊断为巨脾型晚期血吸虫病（晚血）的患者作了肝组织病理、ＨＢＶ和ＨＣＶ标志检测及随访观察。病理诊断为血吸虫病性肝纤维化７８例（６２．９％），血吸虫病性肝纤维化合并肝炎３１例（２５％），门脉性肝硬化１５例（１２．１％），三组患者ＨＢｓＡｇ及ＨＣＶ标志检出率分别为３５．９％、６４．５％及９３．３％，提示肝细胞病变及其严重程度与肝炎病毒感染有密切关系。以血吸虫病性肝纤维化为基本病变的１０９例中，ＨＢｓＡｇ或ＨＣＶ标志阳性组病死率为２２．９％（１１／４８），显著高于阴性组１．６％（１／６１）。１８例死亡患者中，ＨＢｓＡｇ和／或ＨＣＶ标志阳性１７例，占９４．４％。最常见的死亡原因是肝功能衰竭，第二位是原发性肝癌（ＨＣＣ）。ＨＢＶ及ＨＣＶ感染是发生肝衰竭及ＨＣＣ的关键因素，与晚血患者的死亡密切相关。

Liver biopsy and serological test for the HBV and HCV markers were done on onehundred and twenty-four patients with clinical diagnosis of huge splenomegalic ad-vanced schistosomiasos(AS).the clinical outcome of the patients was followed upfor 1 to 6 years. According to the histological finding s,78(62.9%)were diagnosed as schisto-somiasis with liver fibrosis (SLF),31(5%)were SLF accompanied with chronic hepa-titis, and l5(12.1%)were portal cirrhosis.The prevalence of HBsAg and HCV mar-kers among the three groups mentioned above were 35.9%, 64.5%and 93.3%, respe-ctively. The results suggest that the hepatocellular lesion may be closely related to HBV and HCV infections. The mortality of the patients with portal cirrhosis(40%)was significantly higherthan that of the patients with SLF (11%).Among the l8 patients who died, 17(94.4%)were positive for HBsAg and HCV markers.The most common cause of deathwas hepatic failure(38.9).The second cause was hepatocellular carcinoma (HCC).HBV and HCV infections may play a crucial role in occurrence of hepatic failure, HCCand death of the patients with clinical diagnosis of AS.