507例HDV感染肝炎患者临床研究

Analysis of clinical characteristics of 507 cases of Hepatitis with HDV infection

目的 :分析丁型肝炎病毒(HDV)感染患者临床特点 ,探讨丁型肝炎发病机制。方法 :对507例HDV( +)肝炎患者各临床类型肝炎的发病率、疾病转归、临床表现、肝功能、肝炎病毒标志物等进行统计分析 ,以213例HDV( -)乙型肝炎患者作对照。结果 :HDV感染后重型肝炎和肝硬化的发生率及病死率均较HDV( -)者高(P<0.01)。HDV( +)患者出血、腹水、肝性脑病、并发症的发生率及ALT反复增高和增高幅度均较HDV( -)者高 (P<0.01或0.05) ,且慢性肝炎重度和重型肝炎患者主要肝功能改变也较对照组明显 (P<0.01) ,而血清HBeAg检出率降低 (P<0.01)。HDV( +)的HBVDNA( -)组的HBeAg( -)表达高于HBVDNA( +)组 (P<0.01)。急性肝炎、重型肝炎和肝硬化HDAg( +)HBeAg( -)表达高于HDAg( +)HBeAg( +)表达 (P<0.01或P<0.05)。结论 :HDV感染与慢性肝炎重度、重型肝炎和肝硬化的发生及预后密切相关。HDV感染可抑制HBVDNA复制或HBcAg表达。HDV的直接细胞毒性作用在急性肝炎中可能起主要致病作用。HDV重叠感染的乙肝患者其病情加重、病死率增高和慢性化过程中 ,HDV可能起了主要促进作用。

Objective:To analyze the clinical characteristics of the patients with HDV infection and to investigate the pathogenesis of hepatitis D. Methods: The morbidity, prognosis, clinical features, liver function tests and hepatitis virus markers of 507 patients with HDV(+) hepatitis were statistically analysed and compared with 213 patients with HDV(-) hepatitis B as control. Results: The morbidity of serious chronic hepatitis (serious CH), severe hepatitis(SH), and liver cirrhosis(LC) and the mortality of the HDV(+) patients was higher than that of the HDV(-) HB patients. The prognosis was obviously worse than that of HDV(-) HB patients (P<0.01). The morbidity of complications, bleeding, ascites, hepatic coma (encephalopathy) and the ALT intermittently increased level was higher than those in HDV(-) patients (P<0.01 or 0.05). The liver function test in serious CH and SH patients showed more severely damaged than those in HDV(-)HB patients of the same types (P<0.01) but the detection rate for serum HBeAg in HDV(+) patients was obviously lower than that in HDV(-) patients. In acute hepatitis (AH), SH and LC patients expression of serum HDAg(+) HBeAg(-) in HBV DNA(-) patients was higher than that in HBV DNA(+) patients (P<0.01). Conclusion: There was a close relationship between the morbidity of serious CH, SH, LC and the prognosis and HDV infection, HDV infection may inhibit the replication of HBV DNA or expression of HBeAg. The direct cytoxic effect of HDV on hepatocytes may play an important role in the pathogenesis of AH and in aggrevating the illness states to severe type.