急性乙型肝炎与慢性乙型肝炎急性发作的临床特征比较

Clinical features of acute hepatitis B and acute exacerbation of chronic hepatitis B: a comparative study

目的探讨鉴别急性乙型肝炎(AHB)和慢性乙型肝炎(CHB)急性发作的临床特征。方法回顾性分析2014年6月^(-1)2月在复旦大学附属公共卫生临床中心就诊的96例AHB和124例CHB急性发作患者的临床资料。计量资料组间比较采用MannWhitney U检验,计数资料组间比较采用χ~2检验。结果 AHB和CHB急性发作在发病年龄和性别方面差异无统计学意义,男性发病率高于女性。AHB以性接触和医源性传播为主,而CHB急性发作以母婴垂直传播为主。基线ALT水平≥1072 U/L诊断AHB的敏感性和特异性分别为78.6%和79.2%;抗-HBc-Ig M滴度≥13.6 S/CO诊断AHB的敏感性和特异性分别为94.5%和89.3%。入院2周时AHB组HBs Ag、HBe Ag和HBV DNA较基线的下降值均显著高于CHB急性发作组且差异有统计学意义(P值均<0.05)。入院第8周时AHB患者HBs Ag阴转率、抗-HBs阳转率、HBe Ag阴转率、抗-HBe阳转率和HBV DNA阴转率均显著高于CHB急性发作患者(P值均<0.05)。结论明确传播途径、基线高ALT水平和抗-HBc-Ig M水平、快速HBV DNA阴转和HBV血清学标志物转换均有助于AHB和CHB急性发作的鉴别诊断。

Objective To investigate the clinical features of acute hepatitis B（ AHB） and acute exacerbation of chronic hepatitis B（ CHB）for differential diagnosis. Methods A retrospective analysis was performed on the clinical data of 96 AHB patients and 124 patients with acute exacerbation of CHB,who were admitted to the Public Health Clinical Center Affiliated to Fudan University from June to December,2014. Comparison of continuous data between the two groups was made by Mann Whitney U test,while comparison of categorical data was made by chi- square test. Results There were no significant differences in the age of onset and sex between the AHB group and the acute exacerbation of CHB group; the incidence was higher in males than in females. Sexual transmission and iatrogenic transmission were the main routes of transmission for AHB,while mother- to- child transmission was the main route of transmission for acute exacerbation of CHB. The sensitivity and specificity of alanine aminotransferase（ ALT） level ≥1072 U / L for diagnosing AHB were 78. 6% and 79. 2%,respectively. The sensitivity and specificity of S / CO ≥13. 6 in the anti- HBc- Ig M test for diagnosing AHB were 94. 5% and 89. 3%,respectively. At week 2 after admission,the AHB group showed significantly greater decreases in levels of HBs Ag,HBe Ag,and hepatitis B virus（ HBV） DNA than the acute exacerbation of CHB group（ P〈0. 05）. At week 8 after admission,the AHB group had significantly higher HBs Ag clearance rate,anti- HBs seroconversion rate,HBe Ag clearance rate,anti- HBe seroconversion rate,and HBV DNA clearance rate than the acute exacerbation of CHB group（ P〈0. 05）. Conclusion It is helpful for making the differential diagnosis between AHB and acute exacerbation of CHB to know the route of transmission,ALT level,anti- HBc- Ig M test result（ S / CO value）,HBV DNA clearance rate,and the seroconversion rates of HBV markers.