重型病毒性肝炎不同病因与预后的关系

Preliminary study on relationship between different viral pathogenesis and disease prognosis in patients with severe viral hepatitis.

目的 研究重型病毒性肝炎的不同病毒病因与预后的关系。方法 用回顾性研究方法,比较1994～1998年间87例重型肝炎不同病毒感染类型的发生率与病死率的关系。结果 87例重型肝炎患者总病死率7471%(6587),其中单独HBV感染占4138%(3687)。68例慢性重型肝炎患者中,单独HBV感染28例(4118%);2种以上病毒混合感染40例(5882%),即HBV+HEV或HAV19例(2794%),HBV+巨细胞病毒(CMV)7例(1029%),HBV+HCV4例(588%)等,病死率最高为HBV与CMV混合感染(8571%),其次为单独HBV感染(7778%)。急性或亚急性重型肝炎19例,单独HBV感染率为4211%(819)、病死率均较高,而单独HAV或HEV感染率占3685%(719),但病死率较低。结论 单独HBV、HAV或HEV是引起重型肝炎的主要病毒病因,2种以上病毒混合感染是慢性重型肝炎最常见的病毒感染类型,HBV与CMV混合感染预后较差。慢性乙型肝炎患者避免重叠感染HAV或HEV,可能有助于降低重肝发病率。

Objective To study the relationship between different viral pathogenesis and disease prognosis in severe viral hepatitis.Methods Different viral pathogenesis of 87 dead and live cases with severe viral hepatitis were compared. Results Total mortality of 87 patients with severe hepatitis was 74.71% (65/87), total prevalence of HBV infection alone in these patients was 41.38%(36/87). The detection rates of HBV infection alone and superinfection of different hepatitis viruses in 68 patients with chronic severe hepatitis (CSH) were 41.18%(28/68) and 58.82%(40/68) respectively. The prevalences of superinfection of HBV and HEV or HAV and superinfection of HBV and CMV in patients with CSH were 27.94%(19/68) and 10.29(7/68) respectively. The mortality of superinfection of HBV and CMV(85.71%) was the highest, followed by HBV infection alone( 77.78% ). In addition, the prevalence and mortality of HBV infection alone in 19 patients with acute or subacute severe hepatitis was the highest. Conclusion HBV, HEV or HAV infection alone was the main viral pathogenesis of severe hepatitis. Superinfection of different viruses in patients with CSH was the most common viral infection type. An unpromising prognosis of superinfection of HBV and CMV in CSH is noted.