西罗莫司替代钙调磷酸酶抑制剂治疗肾毒性和慢性移植肾肾病

背景：西罗莫司替代钙调磷酸酶抑制剂治疗肾移植后钙调磷酸酶抑制剂肾毒性和慢性移植肾肾病,转换对象的选择和时机至关重要。 目的：观察不同血肌酐水平下应用西罗莫司替代钙调磷酸酶抑制剂治疗肾移植患者钙调磷酸酶抑制剂肾毒性和慢性移植肾肾病的临床效果。 方法：选择肾移植后确诊钙调磷酸酶抑制剂慢性肾毒性和慢性移植肾肾病患者,根据转换前血肌酐≤220 μmol/L和血肌酐> 220 μmol/L,各分为钙调磷酸酶抑制剂肾毒性组、慢性移植肾肾病组和钙调磷酸酶抑制剂维持组;前两组将原有免疫抑制方案中钙调磷酸酶抑制剂转换为西罗莫司,转换组共53例,钙调磷酸酶抑制剂维持患者为对照组共28例,随访3年。动态观察各组在不同随访时间点的血肌酐水平及不良事件发生率,并在随访终点共行移植肾穿刺活检9例。 结果与结论：转换前血肌酐≤ 220 μmol/L钙调磷酸酶抑制剂肾毒性组、慢性移植肾肾病组血肌酐值,在随访第24、36个月血肌酐较转换前明显降低(P < 0.05),钙调磷酸酶抑制剂维持组血肌酐呈缓慢爬行上升高于前两组(P < 0.05)。血肌酐> 220 μmol/L钙调磷酸酶抑制剂肾毒性组血肌酐转换后显著下降(P < 0.05);后两组转换后血肌酐呈爬行上升(P < 0.05)。转换后主要不良事件有轻度贫血(30.2%)、高脂血症(35.8%)、白细胞低下(22.6%)等。肾移植后血肌酐爬行升高转换西罗莫司方案疗效显著,转换前穿刺活检确诊钙调磷酸酶抑制剂肾中毒还是慢性移植肾肾病,并结合血肌酐水平综合判断是否行西罗莫司转换治疗,注意监测血脂水平;转换应在移植肾功能发生严重损害前进行,早期转换,患者将获益更大。 中国组织工程研究杂志出版内容重点：肾移植;肝移植;移植;心脏移植;组织移植;皮肤移植;皮瓣移植;血管移植;器官移植;组织工程全文链接：     

慢性乙型肝炎患者肝组织中HBV抗原表达特征及其临床意义

目的探讨慢性乙型病毒性肝炎肝活检组织中检测乙肝表面抗原(HBsAg)和乙肝核心抗原(HBcAg)表达强度及表达方式的必要性。方法采用EnVision免疫组织化学法检测196例慢性乙型肝炎患者肝穿组织中HBsAg和HBcAg的表达水平,并用荧光定量PCR检测其血清中的HBV DNA的含量。对肝组织进行炎症活动度分级和纤维化分期。结果肝组织中的HBsAg表达强度和表达方式与炎症分级、纤维化分期和血清乙肝病毒载量均无相关性(P>0.05)。HBcAg表达强度与炎症分级无相关性(r=-0.02,P>0.05);与纤维化分期呈负相关(r=-0.28,P<0.01);与血清乙肝病毒载量呈正相关(r=0.53,P<0.01)。HBcAg表达方式与炎症分级为负相关(r=-0.27,P<0.01),其中浆型组炎症活动度分级高于核型组和混合型组(P<0.01),混合型组高于核型组(P<0.01)。HBcAg表达方式与纤维化分期亦呈较弱的负相关(r=-0.23,P<0.01),其中浆型组纤维化分期高于核型组和混合型组(P<0.05)。HBcAg表达方式与血清乙肝病毒载量呈正相关(r=0.22,P<0.01)。结论区分肝组织中的HBsAg表达强度和表达方式无益于了解慢性乙型肝炎患者肝损害的程度,而检测肝组织中的HBcAg则有助于临床抗病毒治疗。     

移植肾穿刺活组织检查：72例的病理及临床分析

背景：肾移植后慢性排斥反应及各种移植肾病变是移植肾失功能的常见原因,但对移植肾予以准确评估往往非常困难,活检仍是目前的主要手段。 目的：分析肾移植后出现合并症时移植肾穿刺活检的病理结果。 方法：对72例移植肾进行肾穿刺活组织检查,并进行病理诊断及分类,结合移植后情况进行分析。 结果与结论：72例中发生急性细胞介导性排斥反应35例,急性抗体介导性排斥反应12例,移植肾急性药物毒性损伤10例,慢性T细胞介导性排斥反应6例,慢性抗体介导性排斥反应2例,急性肾小管坏死4例,慢性移植肾肾病3例。移植肾组织活检的病理报告与穿刺前临床诊断的符合率在75%以上。移植肾穿刺活检未发生明显的不良反应。提示移植肾活检安全可靠,对肾移植后难以根据临床化验资料作出准确判断肾脏损害的并发症及治疗方案的选择有极为重要的指导意义。     

小儿慢性乙型肝炎临床分度与病理分级、分期关系研究

《95方案》对病毒性肝炎进行了临床分度、病理分级 (Ｇ)、分期 (Ｓ) ,为我们临床研究提供了一个量化标准。根据此方案 ,我们对小儿慢性乙型肝炎临床分度与病理分级、分期以及与外周血乙肝病毒抗原、肝组织病毒抗原表达关系进行了研究。1　材料和方法1 1　研究对象　 46例小儿慢性乙型肝炎均为解放军 30 2医院 1995年 7月至1997年 12月住院患者 ,经过肝组织活检者 ,其中男性 45例 ,女性 1例 ;年龄 3～ 14岁 ,平均年龄 8 87岁 ,按 1995年(北京 )全国传染病与寄生虫病学术会议修订的病毒性肝炎防治方案 ,临床诊断为病毒性肝炎、乙型慢性轻度 2 …     

间α胰蛋白酶抑制剂水平反映肾移植慢性排斥反应

背景：目前,肾移植病理学检查仍为移植肾慢性排斥反应的“金标准”,但肾移植程序性活检在中国尚难以普及,且存在一定的风险;由于诸多原因,使患者慢性排斥反应早期因未及时发现而错失治疗时机。 目的：观察肾移植慢性排斥反应大鼠血浆中间α胰蛋白酶抑制剂的水平。 方法：实验以正常雄性Wistar大鼠为供体,正常雄性SD大鼠为受体进行肾移植。移植后分为慢性排斥反应组和正常肾移植组。慢性排斥反应组受体于移植前3 d起,每日给予腹腔注射环孢素A微乳化剂2 mg/kg,正常肾移植组则每日给予环孢素A微乳化剂腹腔注射5 mg/kg。 结果与结论：移植后4,6,8,10,12周,Western blot检测结果显示,与移植前1周相比,正常肾移植组和慢性排斥反应组间α胰蛋白酶抑制剂蛋白表达量明显降低(P < 0.01)。移植后第4,6周,慢性排斥反应组间α胰蛋白酶抑制剂蛋白表达高于正常肾移植组(P < 0.01),而在8,10,12周低于正常肾移植组(P < 0.01)。慢性排斥反应组血浆间α胰蛋白酶抑制剂呈时间依赖性下降(P < 0.01)。结果证实,大鼠肾移植后出现慢性排斥反应时,血浆α胰蛋白酶抑制剂水平显著下调。间α胰蛋白酶抑制剂水平变化与肾移植慢性排斥反应关系密切,可为肾移植后慢性排异反应的预测提供参考依据。     

甘利欣联合苦参素治疗慢性乙型病毒性肝炎肝纤维化指标的变化

目的观察联合应用甘利欣和苦参素治疗慢性乙型病毒性肝炎患者血清肝纤维化指标的变化。方法选择39例慢性乙型病毒性肝炎中度患者,随机分成：治疗组19例,联合应用甘利欣和苦参素治疗;甘利欣组20例,给予甘利欣治疗。分别于治疗前后一周内检测血清肝纤维化指标HA、LN、ⅣP。结果两组治疗前血清HA、LN、ⅣP均明显高于正常对照组（P〈0.05）。两组患者治疗后的血清HA、LN、ⅣP水平较治疗前降低,治疗组血清HA、LN、ⅣP水平治疗前后存在统计学差异,且明显低于甘利欣组治疗后水平（P〈0.05）。结论苦参素和甘利欣合用较与单纯应用甘利欣治疗慢性乙型肝炎可明显改善肝纤维化指标,说明苦参素有较强的抗肝纤维化作用。     

156例轻度慢性乙型肝炎患者肝组织病理学研究

目的 探讨临床诊断为轻度慢性乙型肝炎患者的肝组织病理学特点及其肝穿刺活检的重要意义.方法 选择156例轻度慢性乙型肝炎患者进行肝穿刺活检及肝组织病理学检查,对临床诊断与病理诊断的结果进行对比分析.结果 经病理诊断为轻度慢性乙型肝炎者为105例,临床诊断与之的符合率为67.3%(105/156),中度28例(18.0%)、重度3例(1.9%)、肝硬化20例(12.8%);另外,肝组织炎症分级为G3～4者共48例(30.8%),纤维化分期为S3～4者共39例(25.0%);病理诊断为轻度慢性乙型肝炎与非轻度者之间的ALT、AST、Tbil和ALB水平差异无统计学意义.结论 对于临床诊断轻度慢性乙型肝炎患者最好行肝脏穿刺活检,以便更好指导诊断和抗病毒治疗.     

恩替卡韦在乙肝e抗原阳性慢性乙型病毒性肝炎中的应用价值

目的:研究恩替卡韦治疗乙肝e抗原(Hepatitis B virus e antigen,HBeAg)阳性慢性乙型病毒性肝炎(Chronic Viral Hepatitis type B,CHB)患者的近期临床效果.方法:选取2018年9月至2020年5月期间我科收治的97例HBeAg阳性慢性乙型病毒性肝炎患者作为研究对象,按照随机数字表法分为对照组(n=48)和观察者(n=49).对照组采用替诺福韦治疗,观察组采用恩替卡韦治疗,12个月后对比两组患者临床疗效、乙肝病毒DNA定量(DNA quantification of hepatitis B virus,HBV DNA)水平和人软骨糖蛋白-39(Human chondroglycoprotein-39,YKL-40)和癌胚抗原(Carcinoembryonic antigen,CEA)水平.结果:观察组的总有效明显高于对照组(P<0.05);观察组HBV DNA水平低于对照组(P<0.05);观察组血清YKL-40和CEA水平低于对照组(P<0.05).结论:恩替卡韦治疗HBeAg阳性CHB患者疗效确切,能够促进HBeAg的转阴率,改善近期疗效,降低HBV DNA水平及血清YKL-40和CEA水平.     

乙肝病毒相关肝病患者肝移植后外周血单个核细胞及肝组织中乙型肝炎病毒cccDNA的检测

背景：肝移植后受者体内绝大部分病毒负荷被清除,植入新肝后其复发性肝炎病原体从肝外进入肝内的途径及其复制规律目前尚无定论。 目的：检测肝移植前后外周血单个核细胞和肝组织中乙型肝炎病毒cccDNA及血清中乙型肝炎病毒DNA的表达。 方法：采用淋巴细胞分离液从乙肝病毒相关终末期肝病37例患者外周血中分离出单个核细胞,采用荧光定量PCR检测肝移植前后及移植后乙肝复发3个时期外周血单个核细胞和肝组织中cccDNA及血清乙型肝炎病毒DNA表达。 结果与结论：肝移植前,单个核细胞cccDNA阳性12例,肝组织cccDNA阳性6例,检出率分别为32%和16%,单个核细胞、肝组织中cccDNA拷贝范围分别为(3.028~6.508)×10⁴,(4.158~6.234)×10⁴ 拷贝/mL。肝移植后,单个核细胞cccDNA阳性1例,无血清乙型肝炎病毒DNA检测阳性病例。6例肝移植后乙肝复发病例中外周血单个核细胞cccDNA阳性4例,肝组织活检cccDNA阳性1例,6例血清乙型肝炎病毒 DNA均为阳性。提示乙肝病毒相关终末期肝病患者肝移植后乙肝复发途径可能是残留乙肝病毒在外周单个核细胞中以cccDNA为模板复制,然后再迁移到肝脏。     

经肝动脉及经门静脉异种胰岛移植治疗1型糖尿病恒河猴

背景：经门静脉及经肝动脉是胰岛移植治疗1型糖尿病的2种途径,经门静脉途径并发症较多,经肝动脉移植创伤小,并发症少,但缺乏深入研究。 目的：对经肝动脉及经门静脉异种胰岛移植治疗糖尿病恒河猴模型的疗效进行比较。 方法：将18只恒河猴糖尿病模型分成经肝动脉组(n=6)、经门静脉组(n=9)及对照组(n=3)。经肝动脉组采用Seidinger技术肝动脉插管经导管植入处理好的新生猪胰岛(50 000胰岛当量/kg);经门静脉组在超声引导下门静脉穿刺经导管植入处理好的新生猪胰岛(50 000胰岛当量/kg);对照组2只经门静脉穿刺注入门静脉组等量生理盐水,1只经肝动脉注入肝动脉组等量生理盐水。各组均使用相同免疫抑制方案。 结果与结论：肝动脉组及门静脉组外源性胰岛素的用量较移植前分别平均减少约59.53%,48.39%,2组间外源性胰岛素减少的百分比差异无显著性意义(P > 0.05);肝动脉组及门静脉组血清猴C-肽一直保持在较低的水平,而血清猪C-肽的水平逐渐升高,2组之间血清猪C-肽浓度差异无显著性意义(P > 0.05),但门静脉组因移植后不同并发症出现4/9只糖尿病猴死亡,而肝动脉组仅因穿刺点渗血死亡1只,提示经肝动脉肝内移植途径操作较经门静脉途径更安全、简便,并发症及不良反应小,移植物均能长期成活并发挥生理功能。      

Lamivudine in the treatment of HBV-related liver disease after renal transplantation: an update

Diminished survival due to hepatitis B has been observed after renal transplantation (RT). Lamivudine, a second-generation nucleoside analogue, has been approved for the treatment of chronic hepatitis B virus (HBV) infection in patients with normal renal function. Numerous clinical experiences with lamivudine after RT have been recently published. Despite numerous shortcomings, all of these reports have shown encouraging results. The rate of clearance of HBV viremia ranged between 67% and 100%, and the frequency of ALT normalization was between 50% and 100% with lamivudine use. Even patients with fibrosing cholestatic hepatitis, a serious form of HBV-related liver disease with ominous course, have been successfully treated with lamivudine. Lamivudine therapy significantly improved the survival of HBsAg positive renal allograft recipients. However, numerous issues concerning the treatment of hepatitis B after RT remain unclear: the optimal time to initiate lamivudine, the appropriate duration of antiviral therapy after RT, and the role for pre-transplantation liver biopsy. Also, the management of lamivudine resistance remains a concern for physicians. Clinical trials are under way.     

Recurrent hepatitis B in liver allograft recipients. Differentiation between viral hepatitis B and rejection.

The histologic findings in the original liver obtained from 9 liver allograft patients with active B virus hepatitis were compared with 28 posttransplant pathology specimens. All specimens were studied with the use of light and immunohistochemical microscopy in conjunction with pertinent clinical data. Eight of the 9 patients had chronic active hepatitis B (HB) with cirrhosis, prior to transplant, one of which had coexistent hepatocellular carcinoma. The ninth patient had fulminant hepatic necrosis secondary to acute HB prior to transplantation. In all of the patients with chronic HB prior to transplantation who survived more than 2 months after transplantation recurrent infection of the graft developed despite perioperative HB immunoglobulin therapy. The patient with acute fulminant hepatitis B pretransplant has done well postoperatively and has evidence of HB virus immunity (positive anti-HBs) 15 months after transplantation. Examination of tissue specimens obtained during episodes of allograft dysfunction in these 9 patients indicate that pathologic alterations of active HB infection of the allograft are associated with a preferential lobular insult, whereas those occurring in rejection preferentially involve portal tract structures. Serologic data combined with biopsy histopathologic data are essential in distinguishing between the two quite different events.     

庚型肝炎病毒致病性的初步研究

目的 探讨庚型肝炎病毒（ＨＧＶ）的致病性。方法 应用ＲＴ－ｎＰＣＲ检测３６８例肝炎患者血清ＨＧＶ ＲＮＡ和血清酶的变化,并对其中１例单独庚型肝炎肝硬化病例进行肝脏活组织是检测。结果 在７１例急性黄疸型肝炎中检出单纯性ＨＧＶ ＲＮＡ阳性７例,１５５例慢性肝炎中检出单纯性ＨＧＶ ＲＮＡ阳性２２例,５１例肝硬化中检出单纯ＨＧＶ ＲＮＡ阳性３例。其中１例肝穿组织免疫组化证实为ＨＧＶ ＮＳ ５Ａｇ阳性。结论 争性黄疸型肝炎及乙、丙型肝炎病毒携带者,其慢性肝炎、肝硬化和肝癌中均可检出ＨＧＶ ＲＮＡ,ＨＧＶ感染可为单独感中与乙／丙型肝炎病毒混合或重叠感染,肝脏病理和免疫组化检查证实庚型肝炎病毒是一种嗜肝病毒,其定位主要存在于细胞浆内,可引起慢性病毒性肝炎甚至肝硬化。庚型肝炎病毒很可能具有致病性。     

血清谷氨酰转肽酶含量测定在慢性乙型肝炎中的临床意义

目的探讨血清谷氨酰转肽酶（GGT）含量变化在慢性乙型肝炎（CHB）不同程度肝脏病理损害中的变化规律及临床意义。方法测定70例CHB患者血清ALT、AST、GGT水平，同时行肝活体组织检查，对肝脏进行炎症分级和纤维分期。分析ALT、AST、GGT与CHB之间的关系。结果（1）ALT、AST、GGT随炎症程度和纤维化程度的上升而上升，但到G4和s4后则下降。GGT随ALT、AST的升高而升高，ALT、AST和GGT的相关系数分别为：0．322、0．328（P〈0．05）。在保肝治疗后，ALT较快降至正常且GGT保持在一个较低水平的为轻度CHB，而随着ALT下降，GGT仍持续在一个较高水平的为中度及重度CHB，其中重度CHB的GGT水平有所波动。结论血清GGT比ALT、AST更准确的反映肝脏的炎症程度，GGT的活动度给临床判断慢乙肝的炎症提供了重要的判断依据。     

阿德福韦酯治疗e抗原阴性慢性乙型肝炎病毒老年感染者的临床观察

目的 目的 观察e抗原阴性的慢性乙型肝炎病毒感染的老年患者,在阿德福韦酯(ADV)初始抗病毒治疗3年的疗效及其不良反应.方法 对初治的老年慢性乙型肝炎病毒感染者31例应用ADV治疗3年,治疗前及治疗后查生化指标:总胆红素、白蛋白、丙氨酸转移酶、天冬氨酸转移酶、肌酸激酶、尿氮、肌酐、尿酸、钾、钠、氯、钙;外周血:白细胞、血红蛋白、血小板及HBV DNA等病毒学指标.结果 治疗后血清总胆红素、血清直接胆红素、丙氨酸转移酶、天冬氨酸氨基转移酶、HBV DNA载量与治疗前比较,差异有统计学意义(P ＜0.001),其他指标差异均无统计学意义(P＞0.05).结论 ADV治疗老年慢性乙型肝炎是安全、有效的.     

Clinical and histological features of delta infection in chronic hepatitis B virus carriers.

One hundred and six consecutive chronic hepatitis B virus (HBV) carriers were studied for the prevalence of delta markers in serum and tissue, and the clinical and histological features of those with and without delta infection were compared. Twenty (18.9%) patients were positive for anti-delta in serum or delta antigen in the liver or both. They presented at a younger age (30.3 v 38 years). All of them were symptomatic at the time of biopsy, in contrast to 35% of patients without delta infection who were not symptomatic. Those with delta infection had higher serum transaminase values and showed more severe liver damage on biopsy: chronic active hepatitis in 45% and cirrhosis in 55%. There was more pronounced disease activity both within the parenchyma and in the portal and periportal zones. The histological diagnosis of the 86 patients without delta infection included minimal disease (10%), chronic persistent hepatitis (9%), chronic active hepatitis (62%), and cirrhosis (19%). Delta infection in chronic HBV carriers is associated with a more active and progressive liver disease.     

Kidney transplantation in hepatitis B surface antigen carriers

Chronic hepatitis B surface antigen (HBsAg) carriers run a high risk of developing chronic liver disease after renal transplantation. To determine the impact of liver disease on long-term morbidity and mortality of HBsAg carriers following kidney transplantation we analyzed 1977 patients, including 76 HBsAg carriers, who underwent renal transplantation during the period 1968–1992. Although the HBsAg carriers had a better 5-year patient and graft survival rate (94% and 83%) than HBsAg-negative patients (87% and 61%), the prognosis was poor after the tenth year of transplantation. Transplant loss is more frequently caused by death of the HBsAg carriers, in contrast to the total population (34% vs 17% for HBsAg-negative patients). Death occurs in 73% of cases due to complications of hepatitis B. In the HBsAg-negative patients, the predominant cause of death is cardiovascular failure (51% vs 11% in HBsAg carriers), whereas only 2% died of liver disease. Kidney transplantation in HBsAg carriers with normal liver function appears to be justified because of rare graft loss due to acute rejection, low early morbidity and mortality, and late onset of fatal hepatic deterioration.Abbreviations HBsAg hepatitis B surface antigen - HBV hepatitis B virus - HBeAg hepatitis B e antigen - GOT glutamic oxaloacetic transaminase - GPT glutamic pyruvate transaminase - GLDH glutamate dehydrogenase - AP alkaline phosphatase - GGT gamma-glutamyl transferase - CHE buturyl cholinesterase - LDH lactate dehydrogenase - HBc hepatitis B core - HDV hepatitis delta virus - HCV hepatitis C virus - CsA cyclosporine A - Aza azathioprine - RIA radioimmunoassay - HD haemodialysis - KTx kidney transplantation - LTx liver transplantation - CMV cytomegalovirus Correspondence to: V Kliem     

肾移植后重症肝炎19例分析

背景：研究认为肾移植后感染肝炎病毒,比术前感染有更为严重的肝损害表现,且有观点认为术前肝炎病毒感染对肾移植术后5年内肾功能影响不大。 目的：分析肾移植后的重症肝炎发病情况和治疗方法。 方法：对19例肾移植后重症肝炎病例进行回顾性分析。治疗包括一般治疗、抗病毒治疗、免疫抑制剂方案调整和人工肝治疗。主要观察患者综合治疗后一般情况、肝功能、血常规及死亡率。 结果与结论：19例重症肝炎患者经过常规治疗和抗病毒治疗,部分应用胆红素吸附治疗,12例应用人工肝治疗患者,精神和神智均有不同程度的好转,胆红素和转氨酶均有一定程度的下降。死亡13例,其中术后感染肝炎病毒的4例全部死亡,3例单纯药物性肝损害患者全部痊愈。结果提示肾移植后重症肝炎死亡率高,对于诊断为重症肝炎患者常规治疗基础上,进行一定的抗病毒治疗和/或人工肝治疗,可使部分患者病情逆转,可能降低死亡率。     

Serum hepatitis C virus RNA levels and histologic findings in liver allografts with early recurrent hepatitis C

BACKGROUND: Histopathologic features of early recurrent hepatitis C after orthotopic liver transplantation (OLTx) may be modified by immunosuppressive therapy or complicated by other conditions. Hepatitis C virus (HCV) RNA level usually increases after OLTx, but its correlation to histologic findings is not clear. OBJECTIVE: To evaluate the histologic findings of early recurrent hepatitis C in liver allografts and its correlation to serum HCV RNA level. METHODS: We studied 14 patients who underwent OLTx for chronic HCV infection. Thirty liver biopsy specimens and HCV RNA levels of 22 corresponding plasma samples obtained during the first 6 months following OLTx were analyzed. The control group (9 patients, 25 biopsy specimens) was chosen at random from patients with chronic liver disease other than HCV who were undergoing OLTx, and all tested negative for HCV RNA by polymerase chain reaction after OLTx. RESULTS: Statistically significant pathological features of early recurrent HCV infection were the number of acidophilic bodies, piecemeal necrosis, lymphocyte predominance in the portal tracts, and fibrous septum. These findings and histologic activity index scores increased with time after OLTx. The HCV RNA levels determined by branched DNA assay showed no significant correlation with histologic features. However, patients with higher histologic activity index scores tended to have higher RNA levels. CONCLUSIONS: Liver biopsy specimens are helpful for the diagnosis or confirmation of early recurrent hepatitis C in liver allografts, but serial biopsy specimens are sometimes required for definite diagnosis. The HCV RNA levels are usually higher in patients who display signs of more severe liver damage.     

Delta agent superinfection. Rapidly progressive liver disease in a hepatitis B virus carrier

We report a case of rapidly progressive chronic active hepatitis (CAH) following acute delta infection in a previously asymptomatic hepatitis B virus carrier. Serologic evidence of delta superinfection coincided with an acute icteric hepatitis, and was followed by the development of clinically evident chronic liver disease. The liver biopsy specimens documented the acute hepatitis and subsequent progression of severe CAH. This case illustrates the clinical and pathologic changes that may follow acute delta infection in chronic hepatitis B carriers.