重叠甲型肝炎病毒感染对慢性乙型肝炎影响的对比研究

EFFECTS OF HEPATITIS A VIRUS SUPERINFECTION ON PATIENTS WITH CHRONIC HEPATITIS B(CHB) :A COMPARATIVE STUDY

应用ELISA法对 12 6例CHB患者检测血清抗 HAV IgM ,同时应用肝穿刺活检、荧光定量PCR及免疫组化技术对重叠与未重叠HAV感染者进行了临床与病理学对比。具有可比性的重叠与未重叠感染者 8例、16例 1年后做第 2次肝穿活检 ;HBeAg阴性重叠感染者 9例做HAV感染急性期、恢复期血清HBeAg定性、HBV DNA含量对比。结果发现重叠HAV感染者 2 2例。重叠感染者较未重叠感染者ALT、TBIL增高、PTA降低 ,但A/G、γ EP无显著差别 ;血清HBeAg、肝组织HBcAg阳性率及血清、肝组织HBV DNA含量低 ;肝组织炎症活动度重 ,但纤维化程度无明显差别。重叠与未重叠感染者 1年前肝脏病变无显著差别、1年后仍无显著差别。HAV感染恢复期血清HBeAg阳性率、HBV DNA含量高于急性期。提示重叠HAV感染加重CHB肝脏炎症活动度 ,但并不加重纤维化程度及加速进展 ;抑制HBV复制 ,但并不持久。

Anti HAV IgM,HBVM in serum,amount of HBV DNA in serum and liver tissue obtained by liver biopsy and HBcAg expression in liver tissue as well as the level of ALT,TBIL,ALB,GLB,γ EP,PTA in serum were detected in 126 patients with CHB by ELISA,fluorescence quantitative PCR,SP immunohistochemical staining assay and the routine method,respectively. Liver biopsy was reperformed on 8 and 16 patients with and without HAV superinfection after 1 year and they were comparable. Meanwhile ,HBVM and amount of HBV DNA in serum from 9 HBeAg negative patients with HAV superinfection were detected dynamically in acute, recovery stage of HAV infection. The results showed 22 patients were found to have HAV superinfection. No significant difference was found in the level of A/G ratio,γ EP between patients with and without HAV superinfection( P >0 05),but the level of ALT,TBIL,PTA in the former was significantly lower( P <0 05)and so were the amount of HBV DNA in serum and liver tissue,serum HBeAg and liver tissue HBcAg positive rate( P <0 05).Compared with the patients without HAV superinfection,the hepatic inflammatory activity of the patients with HAV superinfection was higher( P <0 05),but the severity of fibrosis was not significantly different( P >0 05). No significant difference was found in the severity of inflammatory activity grade and fibrosis stage( P >0 05)before and after 1 year in patients with and without HAV superinfection. The amount of HBV DNA and HBeAg positive rate in serum from HAV infection recovery stage of patients with CHB were higher than those in acute stage( P <0 05).The results indicate HAV superinfection weakens the inflammatory activity,but not the fibrosis, and speeds up the progression of fibrosis of patients with CHB. HAV superinfction inhibits HBV replication,but won′t last.