丁型肝炎病毒与乙型肝炎病毒感染关系的探讨
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摘要
目的探讨丁型肝炎病毒(HDV)与乙型肝炎病毒(HBV)感染的相关性,为其临床防治提供可参考依据。方法连续收集120例入住医院的乙型肝炎病毒感染患者,采用统一的调查表详细记录其病史及相关信息;采用酶联免疫吸附法检测HDV血清标记物HDAg、抗HD、抗HDIgM及HBV血清标记物HBsAg、抗HBs、HBeAg、抗HBe、HBcAg、抗HBc;同时检测所有患者的肝功能、HBV-DNA水平及肝硬化Child-Pugh评分。结果 120例HBV感染的患者中有20例患者同时存在HDV感染的影响,HDV感染的发生率为16.7%,8例为HDAg阳性,11例为抗HD阳性,1例为抗HDIgM阳性;HBV感染联合HDV感染的患者,其肝功能指标:谷丙转氨酶(ALT)为(178.9±8.6)U/L,总胆红素(TBil)为(61.9±9.2)μmol/L水平明显高于单独HBV感染组患者的(78.4±9.4)U/L、(41.4±9.1)μmol/L,而白蛋白(ALB)水平(26.7±7.6)g/L明显低于单独HBV感染组患者的(29.9±7.3)g/L,两组间比较差异均有统计学意义(P<0.05);HBV感染联合HDV感染的患者,其肝硬化Child-Pugh评分(10.7±1.6)分明显高于单独HBV感染组患者(8.9±1.3)分,而HBV-DNA拷贝数(4.1±0.4)log10拷贝/ml低于单独HBV感染组患者(5.2±0.7)log10拷贝/ml,两组间比较差异均有统计学意义(P<0.05)。结论 HBV感染患者易并发HDV感染,进一步加重肝功能的损伤,进而加重患者的病情,且HDV感染可以抑制HBV的复制,减低其水平,临床对于HBV联合HDV感染患者要积极给予相应的对症治疗措施。
OBJECTIVE To explore the correlation between the butyl hepatitis virus(HDV) and hepatitis B virus(HBV) infections so as to provide reliable basis for the clinical prevention.METHODS A total of 120 cases of patients with HBV infections were enrolled in the study,the unified questionnaires were employed to record the medical records and the relevant information in detail;enzyme-linked immunosorbent method was used to detect HDV serum marker HDAg,resisting HD,fight HDIgM and HBV serum marker HBsAg,resistance to HBs,HBeAg,resisting HBe,HBcAg,and HBc resistance,at the same time,the liver function(ALT,ALB,TBil),HBV-DNA level,and liver cirrhosis Child-Pugh score were determined for all the patients.RESULTS Of totally 120 cases of patients with HBV infections,there were 20 cases with concurrent HDV infections with the incidence of 16.7%,including 8 HDAg positive cases,11 anti-HD positive cases,and 1 anti-HDIgM positive case.For the HBV infections complicated with HDV infections,the liver function index ALT was(178.9±8.6) U/L,TBil(61.9±9.2) μmol/L,significantly higher than(78.4±9.4) U/L and(41.4±9.1) μmol/L of the patients with single HBV infection,however,the ALB level was(26.7±7.6) g/L,significantly lower than(29.9±7.3 g/L) of the patients with single HBV infections,the differences between the two groups were statistically significant(P<0.05);the liver cirrhosis Child-Pugh score of the HBV infection patients complicated with HDV infections was(10.7±1.6) points,significantly higher than(8.9±1.3) points of the patients with single HBV infection,however,the HBV-DNA copy number of the HBV infections patients complicated with HDV infections was(4.1±0.4) log10 /ml,significantly lower than(5.2±0.7) log10/ml of the patients with single HBV infections,the differences between the two groups were statistically significant(P<0.05).CONCLUSION The patients with HBV infections are prone to be complicated with HDV infections which wound aggravate the liver function and in turn the patients condition.the HDV infection can inhibit the replication of HBV and reduce its level,thus the symptomatic treatment should be carried out for the patients with HBV infections complicated with HDV infections.
OBJECTIVE To explore the correlation between the butyl hepatitis virus(HDV) and hepatitis B virus(HBV) infections so as to provide reliable basis for the clinical prevention.METHODS A total of 120 cases of patients with HBV infections were enrolled in the study,the unified questionnaires were employed to record the medical records and the relevant information in detail;enzyme-linked immunosorbent method was used to detect HDV serum marker HDAg,resisting HD,fight HDIgM and HBV serum marker HBsAg,resistance to HBs,HBeAg,resisting HBe,HBcAg,and HBc resistance,at the same time,the liver function(ALT,ALB,TBil),HBV-DNA level,and liver cirrhosis Child-Pugh score were determined for all the patients.RESULTS Of totally 120 cases of patients with HBV infections,there were 20 cases with concurrent HDV infections with the incidence of 16.7%,including 8 HDAg positive cases,11 anti-HD positive cases,and 1 anti-HDIgM positive case.For the HBV infections complicated with HDV infections,the liver function index ALT was(178.9±8.6) U/L,TBil(61.9±9.2) μmol/L,significantly higher than(78.4±9.4) U/L and(41.4±9.1) μmol/L of the patients with single HBV infection,however,the ALB level was(26.7±7.6) g/L,significantly lower than(29.9±7.3 g/L) of the patients with single HBV infections,the differences between the two groups were statistically significant(P<0.05);the liver cirrhosis Child-Pugh score of the HBV infection patients complicated with HDV infections was(10.7±1.6) points,significantly higher than(8.9±1.3) points of the patients with single HBV infection,however,the HBV-DNA copy number of the HBV infections patients complicated with HDV infections was(4.1±0.4) log10 /ml,significantly lower than(5.2±0.7) log10/ml of the patients with single HBV infections,the differences between the two groups were statistically significant(P<0.05).CONCLUSION The patients with HBV infections are prone to be complicated with HDV infections which wound aggravate the liver function and in turn the patients condition.the HDV infection can inhibit the replication of HBV and reduce its level,thus the symptomatic treatment should be carried out for the patients with HBV infections complicated with HDV infections.
引文
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[6]史桂兰,赵春.丁型肝炎病毒抗体强阳性而乙型肝炎病毒表面抗原阴性血清标本1例[J].检验医学与临床,2009,6(1):62-63.
[7]耿建章,范晓红,陆海英,等.乙型肝炎肝硬化失代偿期初始拉米夫定和阿德福韦酯联合抗病毒治疗的疗效观察[J].临床肝胆病杂志,2011,27(8):837-839.
[8]Pradeep Kumar S,Medhi S,Asim M,et al.Evaluation of ade-fovir&lamivudine in chronic hepatitis B:correlation withHBV viral kinetic,hepaticnecro inflammation fibrosis[J].In-dian J Med Res,2011,133:50-56.
[2]陈晓华,傅冬梅.乙肝患者血清中丁肝病毒标志物检测的临床意义[J].中国误诊学杂志,2011,11(25):6156-6157.
[3]Almeida AM,Ribeiro AQ,Pádua CA,et al.The efficacy ofadefovir dipivoxil,entecavir and telbivudine for chronic hepa-titis B treatment:a systematic review[J].Rev Soc Bras MedTrop,2010,43(4):440-451.
[4]杨松,邢卉春,成军.慢性丁型肝炎抗病毒治疗进展[J].中华实验和临床感染病杂志,2011,5(4):484-488.
[5]朱兵,朱江丽.新疆维吾尔族和汉族乙型与丁型肝炎重叠感染模式的研究[J].中国中西医结合消化杂志,2010,18(4):265-266.
[6]史桂兰,赵春.丁型肝炎病毒抗体强阳性而乙型肝炎病毒表面抗原阴性血清标本1例[J].检验医学与临床,2009,6(1):62-63.
[7]耿建章,范晓红,陆海英,等.乙型肝炎肝硬化失代偿期初始拉米夫定和阿德福韦酯联合抗病毒治疗的疗效观察[J].临床肝胆病杂志,2011,27(8):837-839.
[8]Pradeep Kumar S,Medhi S,Asim M,et al.Evaluation of ade-fovir&lamivudine in chronic hepatitis B:correlation withHBV viral kinetic,hepaticnecro inflammation fibrosis[J].In-dian J Med Res,2011,133:50-56.