慢性乙型肝炎重叠感染戊型肝炎病毒患者临床指标及转归分析
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摘要
目的探讨慢性乙型肝炎重叠感染戊型肝炎病毒患者的临床指标变化及转归。方法回顾性选取2012年6月至2017年9月四川省人民医院接受治疗慢性乙型肝炎重叠感染戊型肝炎病毒患者45例,为重叠感染组,回顾性选取同一时期在本院治疗的单纯慢性乙型肝炎患者45例,为对照组;检测患者血清中生化指标、嗜肝性病毒标记物及肝功能球蛋白(GLB)、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、总胆红素(TB)、凝血酶原时间(PT)和白蛋白(ALB)等各项指标,对两组患者临床表现进行分析比较。结果两组患者中GLB(对照组34.5±7.0 g/L、重叠感染组36.3±6.5g/L)与AST(对照组460±100 IU/L、重叠感染组470±115 IU/L)比较,差异无统计学意义(P>0.05),重叠感染组患者的ALT(1210±360)IU/L、TB(281±95)μmol/L、PT(20.0±3.0)s、HBe Ag阳性率(22.22%)、ALB(26.8±4.8)g/L,对照组患者ALT(693±288)IU/L、TB(105±41)μmol/L、PT(14.3±2.2)s、HBe Ag阳性率(40.0%)、ALB(49.5±5.0)g/L,重叠感染组患者ALT、TB、PT显著高于对照组,ALB低于对照组,差异均有统计学意义(P<0.05)。结论 HBe Ag呈阳性慢性乙型肝炎重叠感染戊型肝炎病毒患者比率较小,单纯慢性乙型肝炎患者重叠感染戊型肝炎病毒病情明显加重。
Objective To analyze the influence of the indicators and clinical outcomes of overlapping hepatitis B patients with other hepatotropic viral infection. Methods Retrospectively selected 45 patients with hepatitis B virus infection in this hospital during June 2012 to September 2017 for tthis study. For the overlapping infection group,retrospectively selected patients with chronic hepatitis B treated in this hospital during the same period. 45 cases were listed as control group; serum biochemical indicators,heptoavirus markers and liver function as globulin( GLB),alanine aminotransferase( ALT),prothrombin time( PT) and albumin( Alb) were detected,total bilirubin( TB),aspartate aminotransferase( AST)) indicators,the clinical manifestations of these two groups of patients were analyzed and compared. Results Serum level of GLB in patients of these two groups( control group 34. 5 ± 7. 0 g/L,coinfection group 36. 3 ± 6. 5 g/L) and AST( control group 460 ± 100 IU/L,coinfection group 470 ± 115 IU/L),and the difference had no statistical significance( P > 0. 05). ALT( 1210 ± 360) IU/L,TB( 281 ± 95) μmol/L,PT( 20. 0 ± 3. 0) s,and HBe Ag positive rate( 22. 22%) in patients with overlapping infection. ALB( 36. 8 ± 4. 8) g/L and control group ALT( 693 ± 288) IU/L,TB( 105 ± 41) μmol/L,PT( 14. 3 ± 2. 2) s,HBe Ag positive rate( 40. 0%). The levels of ALT,TB and PT in overlapping infection group were significantly higher than those in control group,and the level of ALB was lower than that of control group. The difference was statistically significant( P < 0. 05). Conclusion Patients with HBe Ag-positive chronic hepatitis B overlapping with viral hepatitis E is smaller than that in patients with chronic hepatitis B,. Hepatitis E virus( HEV) can significantly aggravate the condition of these patients..
Objective To analyze the influence of the indicators and clinical outcomes of overlapping hepatitis B patients with other hepatotropic viral infection. Methods Retrospectively selected 45 patients with hepatitis B virus infection in this hospital during June 2012 to September 2017 for tthis study. For the overlapping infection group,retrospectively selected patients with chronic hepatitis B treated in this hospital during the same period. 45 cases were listed as control group; serum biochemical indicators,heptoavirus markers and liver function as globulin( GLB),alanine aminotransferase( ALT),prothrombin time( PT) and albumin( Alb) were detected,total bilirubin( TB),aspartate aminotransferase( AST)) indicators,the clinical manifestations of these two groups of patients were analyzed and compared. Results Serum level of GLB in patients of these two groups( control group 34. 5 ± 7. 0 g/L,coinfection group 36. 3 ± 6. 5 g/L) and AST( control group 460 ± 100 IU/L,coinfection group 470 ± 115 IU/L),and the difference had no statistical significance( P > 0. 05). ALT( 1210 ± 360) IU/L,TB( 281 ± 95) μmol/L,PT( 20. 0 ± 3. 0) s,and HBe Ag positive rate( 22. 22%) in patients with overlapping infection. ALB( 36. 8 ± 4. 8) g/L and control group ALT( 693 ± 288) IU/L,TB( 105 ± 41) μmol/L,PT( 14. 3 ± 2. 2) s,HBe Ag positive rate( 40. 0%). The levels of ALT,TB and PT in overlapping infection group were significantly higher than those in control group,and the level of ALB was lower than that of control group. The difference was statistically significant( P < 0. 05). Conclusion Patients with HBe Ag-positive chronic hepatitis B overlapping with viral hepatitis E is smaller than that in patients with chronic hepatitis B,. Hepatitis E virus( HEV) can significantly aggravate the condition of these patients..
引文
[1]中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2015年版)[J/CD].中华实验和临床感染病杂志(电子版),2015,19(5):1-20.
[2]Yan YJ,Zhang W,Shen Q,et al.Prevalence of four different subgenotypes of genotype 4 hepatitis E virus among swine in the Shanghai area of China[J].Acta Vet Scand,2008,50:12.
[3]姜永亮,彭雁忠.特异性细胞毒性T细胞在乙型肝炎病毒感染中的作用机制及其影响因素[J].国际免疫学杂志,2015,38(6):586-591.
[4]王贵强,王福生,成军,等.慢性乙型肝炎防治指南(2015年版)[J].中国肝脏病杂志:电子版,2015,19(3):1-18.
[5]李兰娟,段钟平.肝衰竭诊治指南(2012年版)[J].实用器官移植电子杂志,2013,21(4):210-216.
[6]陈光武.老年戊型病毒性肝炎及其重叠感染的临床分析[J].世界临床医学,2015,9(6):15,10.
[7]胡家定,方婉珍.慢性乙型肝炎重叠戊型肝炎病毒感染与肝炎重症化关系的临床观察[J].浙江临床医学,2001,3(4):245-246.
[8]严延生,杨秀惠.戊型肝炎病毒传播的研究进展[J].中国人兽共患病学报,2017,33(8):669-673.
[9]曲晶.病毒性肝炎合并糖尿病预后与病毒因素的研究[J].糖尿病新世界,2015,4:77.
[10]杨宁,李妍,申艳,等.丙型病毒性肝炎肝损害患者血小板减少机制的探讨[J].中国病毒病杂志,2017,8(1):38-42.
[11]杜敬佩,赵巍峰.急性散发性戊型病毒性肝炎及乙戊重叠感染的研究[J].中国现代药物应用,2015,9(13):67-68.
[12]Guidotti LG,Isogawa M,Chisari FV.Host-virus interactions in hepatitis B virus infection[J].Curr Opin Immunol,2015,36:61-66.
[13]付佳.慢性乙型病毒性肝炎重叠感染其它嗜肝性病毒性肝炎的临床分析[D].重庆:重庆医科大学,2016.
[14]张宁,薛红元,赵彩彦.HBV/HCV重叠感染患者临床特点分析[J].实用肝脏病杂志,2017,20(6):697-700.
[15]Shiota G,Itaba N.Progress in stem cell‐based therapy for liver disease[J].Hepatology Research,2017,47(2):138-156.
[2]Yan YJ,Zhang W,Shen Q,et al.Prevalence of four different subgenotypes of genotype 4 hepatitis E virus among swine in the Shanghai area of China[J].Acta Vet Scand,2008,50:12.
[3]姜永亮,彭雁忠.特异性细胞毒性T细胞在乙型肝炎病毒感染中的作用机制及其影响因素[J].国际免疫学杂志,2015,38(6):586-591.
[4]王贵强,王福生,成军,等.慢性乙型肝炎防治指南(2015年版)[J].中国肝脏病杂志:电子版,2015,19(3):1-18.
[5]李兰娟,段钟平.肝衰竭诊治指南(2012年版)[J].实用器官移植电子杂志,2013,21(4):210-216.
[6]陈光武.老年戊型病毒性肝炎及其重叠感染的临床分析[J].世界临床医学,2015,9(6):15,10.
[7]胡家定,方婉珍.慢性乙型肝炎重叠戊型肝炎病毒感染与肝炎重症化关系的临床观察[J].浙江临床医学,2001,3(4):245-246.
[8]严延生,杨秀惠.戊型肝炎病毒传播的研究进展[J].中国人兽共患病学报,2017,33(8):669-673.
[9]曲晶.病毒性肝炎合并糖尿病预后与病毒因素的研究[J].糖尿病新世界,2015,4:77.
[10]杨宁,李妍,申艳,等.丙型病毒性肝炎肝损害患者血小板减少机制的探讨[J].中国病毒病杂志,2017,8(1):38-42.
[11]杜敬佩,赵巍峰.急性散发性戊型病毒性肝炎及乙戊重叠感染的研究[J].中国现代药物应用,2015,9(13):67-68.
[12]Guidotti LG,Isogawa M,Chisari FV.Host-virus interactions in hepatitis B virus infection[J].Curr Opin Immunol,2015,36:61-66.
[13]付佳.慢性乙型病毒性肝炎重叠感染其它嗜肝性病毒性肝炎的临床分析[D].重庆:重庆医科大学,2016.
[14]张宁,薛红元,赵彩彦.HBV/HCV重叠感染患者临床特点分析[J].实用肝脏病杂志,2017,20(6):697-700.
[15]Shiota G,Itaba N.Progress in stem cell‐based therapy for liver disease[J].Hepatology Research,2017,47(2):138-156.