伴HDV感染的乙型肝炎患者的临床特征

目的　通过对丁型肝炎病毒（HDV）感染的乙型肝炎患者临床特点分析,了解HDV感染特征和HDV致病机理。方法　对合并HDV感染的507例乙型肝炎患者各临床类型肝炎的发生、预后、临床表现、生物化学指标、肝炎病毒标志物等作统计分析,以213例单纯HBV感染的乙型肝炎患者作对照。结果　HDV感染后重型肝炎、肝硬化的发生率和病死率、及发生出血、腹水、并发症和ALT反复增高及增高幅度均较HDV阴性者高（P＜0.01或P＜0.05）,重度慢性肝炎和重型肝炎患者的生物化学指标异常也较对照组明显（P＜0.01）。血清HBeAg检出率降低（P＜0.01）。急性肝炎、重型肝炎和肝硬化HDAg（+）、HBeAg（-）表达高于HDAg。HBeAg均阳性者（P＜0.01或P＜0.05）。结论　HDV感染后重度慢性肝炎、重型肝炎和肝硬化的发生率高,预后差;HDV感染可抑制HBV复制或HBeAg表达;HDV的直接细胞毒性作用在急性肝炎中可能起主要致病作用,在合并有HDV感染的乙型肝炎患者病情加重、病死率增高和慢性化过程中,HDV可能起主要促进作用。

Clinical characteristics of the patients with hepatitis B combining hepatitis D infection

Objective To explore the pathogenesis of hepatitis D virus by analyzing the clinic characteristics of 507 cases of hepatitis B (HB) with hepatitis D virus (HDV) infection. Methods The occurrence of different types of hepatitis, the prognosis, clinical features, major biochemistry results, and hepatitis virus marks were analyzed in 507 cases of HB with positive HDV and compared with 213 cases of HB with negative HDV. Results The incidence and the mortality of serious chronic hepatitis, severe hepatitis, and liver cirrhosis were all higher in the HB patients with positive HDV than negative one. The incidence of bleeding, ascites, hepat-coma complication, and the level of ALT were higher in HDV- positive patients than in HDV-negative patients (P < 0.01 or P < 0.05), and the changes of the major biochemistry results were more obvious than the same types of hepatitis B with negative HDV (P < 0.01). The detection rate for HBeAg in serum of the patients positive for HDV was obviously lower than that of the patients negative for HDV(P < 0.01). In patients with acute hepatitis, severe hepatitis, and liver cirrhosis, the expression of positive HDAg and negative HBeAg was obviously higher than that of positive HDAg and HBeAg (P < 0.01 or P < 0.05). Conclusions After HDV infection, the incidence and poor prognosis of serious chronic hepatitis, severe hepatitis, and live7ci,rhosis increase. HDV infection can inhibit the replication of HBV DNA or HBeAg expression. The effects of direct cytotoxicity of HDV on hepatocytes may play a major pathogenic role in acute hepatitis and in aggravating illness status to severe type.