HBV慢性感染者重叠HEV感染的临床特征探讨

目的了解慢性HBV感染重叠感染HEV患者的临床特征及疾病转归。方法慢性乙型肝炎患者重叠感染HEV(HBV+HEV组)患者62例;慢性乙型肝炎感染(HBV组)患者50例。ELISA检测两组患者的HBV标志物,实时荧光定量PCR法检测HBV DNA,同时检测其肝功能指标。结果HBV+HEV组TBil、ALT、AST和PT分别为(260.33±32.47)μmol/L、(373.92±105.84)U/L、(510.32±167.25)U/L和(20.08±3.69)s,HBV组分别为(216.22±42.67)μmol/L、(339.62±98.36)U/L、(429.13±112.44)U/L、(16.79±2.34)s,且均差异有统计学意义(P0.05),Alb两组间无差异;TBil恢复正常的时间HBV+HEV组患者为(45.6±8.4)d,HBV组患者为(24.3±5.8)d,重叠感染患者恢复时间延长(P0.05),HBV+HEV组的重型肝炎的发病率(30.6%)和病死率(12.9%)均显著高于HBV组的14.0%和0,且均差异有统计学意义(P0.05)。结论 HEV重叠感染慢性HBV对患者的肝功能及其疾病转归均有严重影响。     

戊型肝炎及重叠乙型肝炎感染患者丙氨酸转氨酶变化

目的　观察戊型肝炎及重叠乙型肝炎感染患者丙氨酸转氨酶 (ALT)变化。方法　将戊型肝炎抗体阳性及重叠乙型肝炎感染患者 2 73例分为 5组。A组 12 7例 ,为戊型肝炎病毒 (HEV) IgG阳性 ;B组 9例 ,为HEV IgM阳性 ;C组 64例 ,为HEV IgM和HEV IgG均阳性 ;D组 3 2例 ,为HEV IgM和HEV IgG均阳性并重叠乙型肝炎感染 ;E组 41例 ,为HEV IgG阳性并重叠乙型肝炎感染。另选戊型肝炎抗体阴性的非乙型肝炎患者 5 0 0例作为对照组。用速率法测定各组ALT值。结果　各组ALT异常增高百分率及异常增高者ALT值分别为 :A组 2 1例 ( 16.5 %) ,ALT( 183± 89)U /L ;B组 3例 ,ALT( 2 0 3± 112 )U /L ;C组 16例 ( 2 5 .8%) ,ALT( 2 17± 119)U/L ;D组 11例 ( 3 4.4%) ,ALT( 2 3 4± 12 8)U/L ;E组 13例 ( 3 1.7%) ,ALT( 2 10± 98)U/L ;对照组 5 1例 ( 10 .2 %) ,ALT( 112± 68)U/L。戊型肝炎抗体阳性各组ALT异常增高率与对照组间差异有显著性 (P <0 .0 5 ) ,戊型肝炎抗体阳性各组ALT异常增高者ALT值与对照组间差异有显著性 (P <0 .0 5 )。结论　戊型肝炎抗体阳性组ALT异常增高率和增高者ALT值均较对照组有明显增高 ,HEV IgM阳性或重叠乙型肝炎感染较单纯HEV IgG阳性者 ,ALT增高明显     

慢性HBV感染重叠HEV感染的临床研究

目的进一步了解慢性乙型肝炎病毒(HBV)感染重叠戊型肝炎病毒(HEV)感染的临床特点及转归。方法对慢性HBV感染重叠HEV感染与单纯戊型肝炎进行临床对照研究。结果167例戊型肝炎均为散发型,发病无明显季节性,以40岁以上成人发病为主,平均年龄为42.12±14.06岁,男女比例为2.71∶1。其中,慢性HBV感染重叠HEV感染(简称乙戊肝)79例(47.31%),单纯戊型肝炎88例(52.69%)。乙戊肝组重度黄疸(TB>280μmol/L)、严重凝血功能异常(PTA<40%)和低蛋白血症的发生率明显高于单纯戊型肝炎组(P<0.01)。结论重叠戊型肝炎病毒感染是导致慢性HBV感染者病情急性加重和重症化,甚至发展成致死性重型肝炎的重要原因之一。     

799例重型肝炎患者的临床病原学与实验室分析

目的探讨乙型重型肝炎患者乙型肝炎病毒(HBV)DNA定量、e抗原表达与病死率的相关性,为重型肝炎临床治疗提供参考。方法统计我院2000-2004年各型重型肝炎的发病率,进一步应用荧光定量多聚酶链反应方法检测乙型重型肝炎患者血清HBV DNA,应用微粒子方法检测乙型肝炎e抗原表达情况,并分析其与病死率及抗病毒治疗的临床疗效间的关系。结果(1)重型肝炎中乙型肝炎占83．50％,慢性重型肝炎中乙型肝炎占96．77％;(2)5年间慢性乙型重型肝炎患者HBV DNA定量大于1×10,拷贝／ml组,总病死率为53．25%,小于1×105拷贝／ml组,病死率为34．50％,差异有统计学意义(P<0．01);e抗原表达对病死率无影响;(3)2004年,慢性乙型重型肝炎患者HBV DNA定量大于1×105拷贝／ml病例加用拉米夫定抗病毒治疗,病死率由2000年的54．64%下降至2004年的30．38%,差异有统计学意义(P<0．01)。结论重型肝炎以慢性乙型重型肝炎为主,病毒载量高是高病死率关键因素之一,抗病毒治疗可以降低患者的病死率。     

戊型肝炎病毒与甲乙丙型肝炎病毒重叠感染的研究

本文对419例病毒性肝炎患者进行抗-HEV-IgM/IgG及其它病毒标志物检测。结果:HEV感染者112例(26.2％);其中单纯HEV感染者30例,两种以上肝炎病毒重叠感染占73.2％;43.75％为HBV和HEV重叠感染,HAV和HEV合并感染占急性肝炎的40.58％。在重型肝炎中HEV感染率占57.89％,均为HBV和HEV重叠感染,病死率达72.73％。16.67％的单纯HEV感染者为慢性肝炎和肝硬变。结果表明,本地区戊型肝炎以散发为主,重叠感染多见。HBV与HEV重叠感染和HAV与HEV重叠感染是较常见的感染模式。在HBV感染的基础上重叠HEV感染是肝炎重症化的重要原因。HEV感染有导致慢性化的可能性。     

慢性乙型肝炎重叠戊型肝炎病毒感染致重型肝炎的临床分析

为了探讨慢性乙型肝炎病毒(HBV)感染者重叠戊型肝炎病毒(HEV)感染发展为重型肝炎后的临床特征,我们对2005年1-7月住院的慢性乙型肝炎重叠HEV感染的48例重型肝炎患者和单纯慢性HBV重型肝炎50例进行分析.结果报告如下.     

慢性乙型肝炎患者HBV DNA自发性下降的流行病学特点

目的 了解HBV DNA水平自发性下降在慢性乙型肝炎(CHB)患者中的发生率、分布特征及其影响因素.方法 应用临床流行病学调查方法研究315例CHB或肝硬化(LC)患者HBVDNA自发性下降的发生率、人口学特点及诊断分布情况,并采用Logistic回归分析HBV DNA自发性下降的影响因素.结果 在12周内发生HBV DNA自发性下降的患者为171例,占54.3%,其中,HBV DNA降至3 lg拷贝/mL以下的患者为61例.占19.4%.分层研究显示青年组与少年组患者HBV DNA自发性下降率分别为58.6%(116/198例)和25.0%(2/8例),前者高于后者(X2=2.956,P=0.048);病情重的比病情轻的患者更易发生HBV DNA自发性下降,两两比较,有差异组的均X2＞3.84,P＜0.05,其中慢性重型肝炎的下降率最高,达78.7%(48/61例).重叠HEV感染与单纯HBV感染患者HBV DNA自发性下降率分别为75.0%(21/28例)和51.8%(146/282例),前者高于后者(X2=5.530,P=0.019).ALT＞400 U/L与ALT≤400 U/L的患者HBV DNA自发性下降率分别为61.8%(102/165例)和46.0%(69/150例),前者高于后者(X2=7.922,P=0.005);TBil＞200 μmol/L与TBil≤200 μmol/L的患者HBV DNA自发性下降率分别为68.7%(79/115例)和46.0%(92/200例),前者高于后者(X2=15.155,P:0.000).多因素Logistic回归分析显示,慢性重型肝炎、ALT＞400 U/L、TBil＞200 μmol/L 是CHB或LC患者发牛HBV DNA自发性下降的影响因素(均OR＞1,P＜0.05).结论 HBV DNA水平自发性下降足CHB或LC患者自然病程进展(免疫清除期)中的常见现象.患者病情严重、ALT高、TBil高,则易发生HBV DNA自发性下降.     

慢性乙型肝炎患者重叠戊型肝炎病毒感染的临床与病理学研究

目的：观察重叠戊型肝炎病毒（HEV）感染对慢性乙型肝炎（CHB）肝脏损害及HBV复制的影响。方法：应用ELISA法对122例CHB患者血清进行了抗－HEV IgkM,IgG检测,同时应用肝穿刺活检、荧光定量PCR及免疫组化等技术对重叠与未重叠HEV感染者分别进行了ALT、总胆红素（TBil)、凝血酶原活动度（PTA）、白蛋白／球蛋白（A／G）、电泳γ球蛋白（γ－EP）水平、肝脏病理学、血清HBeAg及肝组织HBcAg阳性率、血清及肝组织中HBV DNA含量对比。具有可比性的重叠（7例）与未重叠HEV感染者（14例）1年后做第2次肝穿活检并做病理学比较;HBeAg阴性重叠HEV感染者8例做HEV感染急性期、恢复期血清HBeAg定性、HBV DNA含量对比。结果：重叠HEV感染者21例（17．2％）。重叠HEV感染者较未重叠感染者ALT、TBil增高,PTA降低（P＜0．05）,但A／G、γ－EP水平未见显著差别（P＞0．05）;血清HBeAg及肝组织HBcAg阳性率、血清及肝组织HBV DNA含量低（P＜0．05）;肝组织炎症活动度重（P＜0．05）,但纤维化程度未见明显差别（P＞0．05）。两组患者1年前肝组织炎症活动度及纤维化程度无显著差别,1年后仍无显著差别（P＞0．05）。HEV感染恢复期血清HBeAg阳性率、HBV DNA含量高于急性期（P＜0．05）。结论：重叠HEV感染可加重CHB肝组织炎症活动度;对HBV复制具有短暂抑制作用。     

拉米夫定治疗慢性重型乙型肝炎疗效观察

观察拉米夫定治疗慢性重型乙型肝炎的疗效和安全性。98例慢性重型乙型肝炎患者随机分为2组。对照组36例,给予常规的综合治疗；治疗组62例,在常规综合治疗的基础上,加拉米夫定100mg,每日1次口服。分别观察2组治疗前后肝功能和凝血酶原活动度(PTA)、血清HBV DNA水平变化及疗效情况。结果表明,治疗组的总有效率为79．0%,对照组为52．8%,(P＜0．01)。治疗后4周,与对照组比较,治疗组存活患者的总胆红素(TBil)降低(P＜0．001)、凝血酶原活动度(PTA)升高(P＜0．001)、血清HBV DNA水平降低得更明显(P＜0．001)。拉米夫定治疗期间未发现明显的毒副作用,治疗安全性良好。拉米夫定治疗慢性重型乙型肝炎有较好的疗效和安全性。     

重型肝炎中HEV感染的临床意义

为探讨重型戊肝的临床表现及转归，对75例重型肝炎中的13例戊肝病毒（HEV）感染者进行临床分析。以单纯乙肝病毒（HBV）感染20例为对照组，比较其与单纯HEV，HEV合并HBV感染的重型肝炎在临床表现，实验室检查，预后等方面的差异。结果显示，重型肝炎的HEV感染率为17．3％（13／75），HEV与HBV重叠感染率为8．0％（6／75），在临床表现方面各组差异无显著性意义（P＞0．05）。HEV合并HBV感染组SB，PT及死亡率明显高于单纯HEV组及单纯HBV组，差异有显著性差异（P＜0．05）。肝炎病毒重叠感染是影响戊型重型肝炎预后的重要因素。     

戊型肝炎与慢性乙型肝炎重叠戊型肝炎病毒感染的临床特征比较

目的分析比较戊型肝炎与慢性乙型肝炎重叠戊型肝炎病毒感染患者的临床特征,并初步探索戊型肝炎慢性化问题。方法对66例戊型肝炎与37例慢性乙型肝炎重叠戊型肝炎病毒感染患者的临床资料进行回顾性分析比较及统计。结果慢性乙型肝炎重叠戊型肝炎病毒感染患者较戊型肝炎患者丙氨酸氨基转移酶(ALT)、天门冬酸氨基转移酶(AST)、总胆红素(TBIL)、直接胆红素(DBIL)升高水平及发生率无显著差异,而在白蛋白(A)、白蛋白/球蛋白(A/G)及凝血酶原活动度(PTA)降低与肝纤维化系列各项指标增高方面更突出,消化道症状更重。结论慢性乙型肝炎重叠戊型肝炎病毒感染后肝功能损害更严重,凝血酶原时间长,慢性肝病特征常见,但单纯戊型肝炎患者慢性化问题也值得重视。     

An Unusual Cause for a Hepatic Flare in a Chronic HBV Carrier

Introduction:

Hepatitis E is an emerging disease in developed countries with an increasing incidence. In developed countries, HEV genotype 3 prevails as a zoonotic disease carried by wild boars or pigs, which usually causes asymptomatic infection.

Case Presentation:

An asymptomatic HBsAg carrier was tested regularly at a German university hospital and showed no signs of chronic hepatitis B (CHB) activity. At a routine visit, elevated aminotransferases were detected while HBV DNA remained low and the patient was clinically asymptomatic. The laboratory signs of acute hepatitis resolved spontaneously. When aminotransferases returned to normal limits, the patient showed a flare of HBV-replication, which resolved spontaneously. In follow-up, further investigations revealed a resolved hepatitis E (HEV) superinfection causing an acute hepatitis before the HBV flare. No potential risk factors for HEV infection were identified.

Conclusions:

Elevated aminotransferases in CHB patients are most commonly caused by exacerbation of CHB. Nevertheless, when HBV DNA is not elevated, other reasons should be excluded. Amongst others, superinfection with another hepatotropic virus can be the reason for decompensation of chronic hepatitis B. This case report describes an asymptomatic HEV superinfection followed by a flare in HBV replication in an HBsAg carrier without signs of HBV replication for eight years. In CHB carriers with signs of acute hepatitis, rare causes should be considered as well. HEV should be a part of routine laboratory evaluation for hepatitis flares given the rising number of infections.     

慢性乙型肝炎患者肝细胞内乙型肝炎核心抗原阳性的临床意义

目的探讨CHB患者肝组织HBcAg阳性的意义。方法对200例CHB患者应用荧光聚合酶链反应（FQ-PCR）法精确定量检测血清HBV DNA含量。患者均检测血清中HBeAg含量,同时进行肝活组织检查,应用免疫组织化学技术检测HBcAg情况,并进行相关性分析。结果按测定血清HBV DNA水平,分为A组（＜3 log10拷贝/ml）20例,B组（≥3 log10拷贝/ml-＜5 log10拷贝/ml）13例,C组（≥5 log10拷贝/ml～＜6 log10拷贝/ml）24例,D组（≥6 log10拷贝/ml～＜8 log10拷贝/ml）116例,E组（≥8 log10拷贝/ml）27例。肝组织HBcAg阳性者175例,占87．5％,A组HBcAg阳性率55．0％（11/20）,B组53．8％（7/13）,C组75．0％（18/24）,D组96．6％（112/116）,E组100．0％（27/27）,HBcAg阳性率与血清HBV DNA水平之间呈显著正相关（r=0．80,P＜0．01）。血清HBV DNA水平高低与HBeAg阳性率之间呈显著正相关（r=0．47,P＜0．01）。其中20例HBV DNA阴性者中（A组）,HBeAg阳性者5例（25％）,HBcAg阳性者11例（55％）；15例HBV DNA阴性且HBeAg阴性者中有7例HBcAg阳性,占46．7％。结论CHB患者肝组织HBcAg阳性能更可靠地反映肝细胞内HBV复制状态。检测肝组织内HBcAg对CHB患者疗效评价和对治疗反应性的预测更具有临床意义。     

Influence of chronic HBV infection on superimposed acute hepatitis E

AIM:To investigate the influence of chronic hepatitis B virus(HBV)infection[based on the status of hepatitis B e antigen(HBeAg),HBV DNA,and cirrhosis]on superimposed acute hepatitis E.METHODS:A total of 294 patients were recruited from the Department of Infectious Diseases of the Third Affiliated Hospital,Sun Yat-sen University,from January 2003 to January 2012.The patients were classified into two groups:an HBV+hepatitis E virus(HEV)group(a group with chronic HBV infection that was superinfected with acute hepatitis E,n=118)and an HEV group(a group with acute hepatitis E,n=176).We retrospectively analyzed and compared the clinical features of the two groups.Statistical analyses were performed using theχ2test or Fisher’s exact test for categorical variables and the Student’s t test forcontinuous variables.A P value<0.05 was considered statistically significant.RESULTS:The peak values of prothrombin time,serum total bilirubin,and Model for End-Stage Liver Disease scores were significantly higher in the HBV+HEV group.More patients in the HBV+HEV group had complications(39.8%vs 16.5%,P=0.000)and developed liver failure(35.6%vs 8.5%,P=0.000).Additionally,the mortality of the HBV+HEV group was significantly higher(20.3%vs 7.4%,P=0.002).Further analysis of the HBV+HEV group showed that there were no significant differences in complication occurrence,liver failure incidence,or mortality between patients with different HBeAg and HBV DNA statuses.However,in patients with underlying cirrhosis,complication occurrence and liver failure incidence significantly increased.In total,12.7%of the patients in the HBV+HEV group received anti-HBV treatment,but this therapy failed to reduce mortality in patients who developed liver failure.CONCLUSION:The presence of underlying cirrhosis in chronic HBV infection results in more severe clinical outcomes with superimposed acute hepatitis E.AntiHBV treatment cannot improve the prognosis of liver failure caused by HBV-HEV superinfection.     

1686例慢性乙型肝炎中HBeAg阴性与阳性患者临床和病毒学特点比较分析

目的通过大样本横断面回顾性调查,了解HBeAg(-)和HBeAg( )两类慢性乙型肝炎(CHB)患者临床相关因素的异同。方法对1686例CHB患者的住院病历进行回顾性调查,分析HBeAg(-)和HBeAg( )CHB患者ALT、HBV DNA定量、肝组织病理(炎症及纤维化)等指标的组内和组间差异。结果HBeAg(-)CHB628例,占37·3%;HBeAg( )CHB1058例,占62·7%。HBeAg( )组ALT、HBV DNA总体上均高于HBeAg(-)组。HBeAg( )组肝组织炎症及纤维化程度总体上均轻于HBeAg(-)组。结论目前我国CHB病例以HBeAg( )者占多数。无论HBeAg(-)或HBeAg( )CHB,肝炎活动在病毒复制活跃时均重于病毒复制水平较低时。HBeAg(-)CHB肝组织学损害重于HBeAg( )CHB。     

Impact of acute hepatitis C virus superinfection in patients with chronic hepatitis B virus infection

BACKGROUND & AIMS: Superinfection in patients with chronic hepatitis B virus (HBV) infection is not uncommon. Acute hepatitis delta virus (HDV) superinfection is associated with severe and/or progressive liver disease. The natural course following acute hepatitis C virus (HCV) superinfection has not been well studied. The aim of this study was to investigate the impact of acute HCV superinfection. METHODS: The clinical features during acute phase and long-term outcomes of acute HCV superinfection were studied and compared with a cohort of acute HDV superinfection and a matched control group of active chronic hepatitis B. RESULTS: Acute HCV superinfection typically occurs as acute icteric hepatitis. The severity is similar to acute HDV superinfection in that hepatic decompensation developed in 34% of patients, hepatitis failure occurred in 11%, and 10% died. During a follow-up period of 1-21 years, patients with acute HCV superinfection had a significantly higher cumulated incidence of cirrhosis (48% at 10 years) and hepatocellular carcinoma (14% at 10 years, 21% at 15 years, and 32% at 20 years) than acute HDV superinfection or active chronic hepatitis B. Hepatitis B surface antigen (HBsAg) seroclearance occurred earlier in HCV superinfected patients. Continuing hepatitis after HBsAg seroclearance was observed only in HCV superinfected patients. CONCLUSIONS: Acute HCV superinfection in patients with chronic HBV infection is clinically severe during its acute phase. The long-term prognosis following acute HCV superinfection is much worse than that following HDV superinfection or active hepatitis B in terms of continuing hepatitis activity after HBsAg loss and the development of cirrhosis or hepatocellular carcinoma.     

天津地区家族聚集性慢性乙型肝炎病毒感染者病毒载量及组织病变与基因型的关系

目的探讨天津地区家族聚集性HBV感染患者基因型特征与病毒载量及肝组织病理的关系。方法随机采集临床确诊家族聚集性的慢性HBV表面抗原携带者(ASC)35例和轻型CHB患者65例。分别进行HBV基因分型、HBV DNA载量、肝组织病理学检测。结果HBV基因型显示:B型7例,HBV DNA主要为低载量(57.14%),病理损害程度较轻。BC混合型11例,HBV DNA以低、中载量为主(45.45%、36.36%),病理损害多为轻至中度≤G2 10例(90.91%),≤S2 9例(81.82%)。C型82例,其中ASC 29例,HBV DNA以高载量为主(72.41%),均有不同程度的病理损伤(100%);CHB 53例,HBV DNA主要为中、高载量(39.62%,49.06%),病理损害≥G2者38例(71.70%),≥S2者25例(47.17%)。结论天津地区家族聚集性ASC和CHB以基因C型为主、病毒载量高、肝组织病理损伤较严重,为乙型肝炎预后不良的主要因素;家族聚集性ASC不仅存在HBV病毒高载量,而且均有不同程度的肝脏病理损伤,临床可视肝组织病理结果酌情抗病毒治疗;肝组织病理学检查作为ASC和CHB患者治疗前的常规检测手段,为规范CHB的抗病毒治疗提供可靠依据。     

Hepatitis E virus superinfection impairs long-term outcome in hospitalized patients with hepatitis B virus-related decompensated liver cirrhosis

Introduction and objectivesHepatitis E virus (HEV) superinfection is a common excerbating event in patients with chronic hepatitis B, but the impact on the long-term prognosis is not clear. This study investigates the specific role of HEV superinfection in the long-term outcome of hepatitis B virus (HBV) patients with liver cirrhosis.Patients and methodsA retrospective, observational cohort study was conducted using clinical, laboratory, and survival data collected from patients suffering from hepatitis B cirrhosis with or without HEV superinfection. Disease progression and mortality rates were analyzed.ResultsAfter a two-year follow-up, HEV superinfection was identified in 27 of 811 patients. The transplantation-free mortality was significantly increased (51.9% vs. 14.3%, p< 0.001) in HEV superinfection compared to that in hepatitis B cirrhosis patients without HEV superinfection. Logistic regression analysis demonstrated that elderly people were independent host risk factors for hepatitis B cirrhosis patients with HEV superinfection before and after propensity score matching (PSM). Moreover, HEV superinfection was a risk factor for patients with hepatitis B cirrhosis with new acute decompensation (AD) and acute-on-chronic liver failure (ACLF) during hospitalization. A multivariate Cox proportional hazards regression model demonstrated that acute HEV co-infection is associated with two-year mortality (hazard ratio [HR]: 2.49; 95% CI: 1.40–4.43; p= 0.002; and HR: 5.79; 95% CI: 1.87–17.87; p= 0.002) in patients with hepatitis B cirrhosis before and after PSM.ConclusionsElder patients with hepatitis B cirrhosis are susceptible to HEV superinfection, accelerating disease progression and increasing long-term mortality in hospitalized patients with HBV-related decompensated liver cirrhosis.     

慢性乙型肝炎重叠急性戊型肝炎3种血清细胞因子表达及意义

目的分析慢性乙型肝炎重叠急性戊型肝炎患者血清γ-干扰素（IFN-γ）、白细胞介素-2（IL-2）、白细胞介素-10（IL-10）的表达及临床意义。方法采用酶联免疫吸附试验（ELISA）测定慢性乙型肝炎重叠急性戊型肝炎患者（重叠组）、急性戊型肝炎患者（AHE组）、慢性乙型肝炎患者（CHB组）和健康体检者（对照组）的血清IFN-γ、IL-2、IL-10水平;分别采用实时荧光PCR和ELISA方法测定重叠组和CHB组的乙肝病毒（HBV）基因定量（HBV DNA）和HBV血清标记物;同时检测重叠组、AHE组和CHB组的主要肝功能指标。结果 重叠组IFN-γ高于CHB组和对照组,IL-10低于CHB组和对照组,IL-2高于CHB组（P〈0.05）;CHB组IL-10高于其他3组（P〈0.05）。重叠组丙氨酸氨基转移酶（ALT）、门冬氨酸氨基转移酶（AST）、血清总胆红素（TBIL）高于CHB组,胆碱酯酶（CHE）、白蛋白（ALB）、凝血酶原活动度（PTA）低于CHB组（P〈0.05）。重叠组乙型肝炎e抗原（HBeAg）和HBV DNA阴性率高于CHB组（P=0.00）。重叠组组中HBV-DNA阴性者IFN-γ、IL-2水平高于HBV-DNA阳性者,IL-10水平低于HBV DNA阳性者（P〈0.01）。结论 IFN-γ、IL-2、IL-10参与慢性乙型肝炎重叠急性戊型肝炎肝细胞免疫损伤过程;IFN-γ、IL-2、IL-10可作为判断重叠感染后肝细胞损伤程度的指标;重叠感染后IFN-γ、IL-2可能影响HBV的复制。