慢性肝炎交叉感染的临床对比分析

Clinical Study of Hepatitis A and Hepatitis B Virus Superinfection in Chronic Hepatitis

目的研究慢性乙型肝炎重叠甲型肝炎与乙型肝炎重叠戊型肝炎患者在临床表现、预后及病毒之间相互干扰方面的异同。方法慢性乙型肝炎重叠甲型肝炎组50例,慢性乙型肝炎重叠戊型肝炎组50例和单纯乙型肝炎组50例,其中每组各含4例肝硬化患者;对3组患者的临床表现实验室检查等进行对比分析。结果在症状、转氨酶及胆红素方面,重叠感染组均重于单纯慢性乙型肝炎组(P<0.05或P<0.01)。但与预后有关的一些指标,如白蛋白、凝血酶原活动度及病死率,两种重叠感染对慢性乙型肝炎的影响有所不同:甲型肝炎重叠感染似对慢性乙型肝炎影响不大,但戊型肝炎重叠感染似对慢性乙型肝炎有比较严重的不良影响。在病毒干扰方面,两种重叠感染似对乙型肝炎病毒复制均有一定抑制作用,戊型肝炎重叠感染更明显。结论甲型肝炎重叠感染对慢性乙型肝炎的症状、转氨酶、胆红素虽有一定影响,但对其预后无太大影响,对乙型肝炎病毒复制似有一定的抑制,但不如戊型肝炎明显;戊型肝炎重叠感染对慢性乙型肝炎的临床表现及其预后均有明显的影响,对乙型肝炎病毒的抑制也较强。

Objective To investigate the clinical manifestation, prognosis and the virus loading in chronic hepatitis B patients with superinfection with hepatitis A or hepatitis E. Method Chronic hepatitis B patients without （50 cases） or with superinfection with hepatitis A （50 cases） or with hepatitis E （50 cases） were included in this study. Each of these study groups had 4 cases of liver cirrhosis, Result The levels of alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, bilirubin, and also the symptoms in the two superinfection groups were higher or severe than those in the non-superinfection group. Chronic hepatitis B patients with hepatitis E superinfection had a greater impact on the biomarkers related to the prognosis such as serum albumin, prothrombine activity, and the mortality than the patients with hepatitis A superinfection. Levels of hepatitis B virus in patients with hepatitis A or hepatitis E superinfection were significantly lower than the patients without superinfection. The effect was more apparent with hepatitis E superinfection. Conclusion Hepatitis E superinfection significantly affects the clinical manifestation and prognosis of chronic hepatitis B.