重叠感染戊型肝炎患者的临床特征及预后分析

Analysis of clinical characteristics and prognosis of 35 patients with superinfection of hepatitis E

目的:探讨重叠感染戊型病毒性肝炎患者的临床特点及其对病情预后的影响。方法:比较分析35例重叠感染戊型肝炎患者(重叠组)和35例单纯戊型肝炎患者(单纯组)的临床特征及预后差异。结果:两组患者治疗前TBil、Alb、r-GT、AKP水平、ALT峰值、AST峰值、Alb谷值、r-GT峰值、AKP峰值、PT峰值、临床症状、并发症发生率、住院时间、病程等比较无统计学差异(P>0.05)。而重叠组患者治疗前ALT、AST、PT、INR水平、TBil峰值、肝衰竭发生率、并发症(尤其自发性腹膜炎)发生率均高于单纯组(P<0.05),而治愈好转率低于单纯组(P<0.05)。两组患者治疗后TBil、ALT、AST、r-GT、AKP均较治疗前显著降低(P<0.05),以单纯组患者TBil降低更为明显(P<0.05)。结论:重叠感染戊型肝炎患者,以慢性HBV重叠HEV感染多见,重叠组患者黄疸程度深,ALT及AST明显升高,凝血酶原时间延长,并发症多见,肝功能损害加重,肝衰竭发生率高,但大多数患者预后良好。

Objective:To investigate the clinical characteristics of superinfection with viral hepatitis E and its influence on the prognosis.Methods:The clinical characteristics and prognosis of 35 patients with superinfection of hepatitis E(superinfection group)and 35 patients with simple hepatitis E(simple group)were compared and analyzed.Results:There was no significant difference in the levels of TBiL,ALb,r-GT,AKP before treatment,ALT peak,AST peak,ALb valley,r-GT peak,AKP peak,PT peak,clinical symptoms,the incidence of complications,length of hospital stay and course of disease between the two groups(P>0.05).But the levels of ALT,AST,PT,INR,TBiL peak,the incidence of liver failure,and incidence of complications(especially spontaneous peritonitis)in the superinfection group before treatment were higher than those in the simple group(P<0.05),but the cure and improvement rate was lower than that in the simple group(P<0.05).After active treatment,TBiL,ALT,AST,r-GT,and AKP in the two groups were significantly lower than those before treatment(P<0.05),especially TBiL in the simple group(P<0.05).Conclusion:Chronic HBV superinfection of HEV is more common in patients with superinfection of hepatitis E.In the superinfection group,the degree of jaundice is deep,ALT and AST are obviously increased,the prothrombin time is prolonged,complications are more common,liver function damage is aggravated,and the incidence of liver failure is increased,but the prognosis of most patients is good.