重叠乙型和丙型肝炎病毒感染的临床与病理分析

目的 观察HBV和HCV重叠感染的临床与病理,探讨HBV和HCV相互作用的特点.方法 收集226例慢性肝病患者的血清学指标,实时荧光定量PCR法测定HBV DNA和HCVRNA,ELISA检测HBV血清标志物、抗-HCV抗体.行肝穿刺活组织病理检查、免疫组织化学HBsAg、HBcAg和原位杂交HBV DNA、HCV RNA检测.计数资料比较采用X2检验或Fisher确切率检验.结果 HBV和HCV重叠感染的重度慢性肝炎患者比例为62.50%,高于HBV或HCV单独感染者的27.05%和30.56%(X2=14.70,P＜0.01).HBV感染组的血ALT、AST、TBil、DBil和Alb高于HBV和HCV重叠感染组和HCV感染组,差异均有统计学意义(X2=8.52,P＜0.05).重叠感染组和HBV感染组的血HBsAg与肝内HBsAg一致率比较,差异均有统计学意义(X2=15.60,P＜0.01).HBV和HCV重叠感染组血清HBV DNA阳性率为12.5%,低于HBV单独感染组的87.7%(X2=17.66,P＜0.01);而HBV和HCV重叠感染组HCV RNA阳性率为75.0%,低于HCV单独感染组的80.6%,差异无统计学意义(P＞0.05).结论 HBV和HCV重叠感染导致的肝损伤更明显.

Clinical and histopathological analysis of patients with chronic hepatitis B virus and hepatitis C virus co-infection

Objective To investigate the clinical and pathological features of patients co-infected with hepatitis B virus(HBV)and hepatitis C virus(HCV)and to study the underlying interaction between HBV and HCV in these patients.Methods The liver biopsy and sera samples of 226 patients with chronic hepatitis were collected.Real-time fluorescent quantitative polymerase chain reaction were used tO measure HBV DNA and HCV RNA,respectively.Enzyme-linked immunosorbent assay (ELISA)was utilized to detect HBV serological marker and anti-HCV antibody.Liver biopsy examination was performed through needle aspiration.HBsAg and HBcAg in liver tissue were detected by immunohistochemistry,while HBV DNA and HCV RNA were detected by in situ hybridization.Results Sixty two point five percent patients co-infected with HBV and HCV suffered from severe hepatitis,while the rates of those infected with HBV or HCV alone were 27.1%and 30.6%,respectively(X2=14.70,P＜0.01).The serum alanine aminotransferase,aspartate aminotransferase,total bilirubin.direct bilirubin and albumin levels of patients infected with HBV alone were higher than those of patients co-infected with HBV and HCV or those infected with HCV alone,which showed statistically significant difference(X2=8.52.P＜0.05).The HBsAg titers in serum samples and in liver tissue samples were inconsistent in both co-infected patients and HCV mono infected patients (X2=15.60,P＜0.01).The HBV DNA positive rate of co-infected patients was 12.5%,which was lower than that of patients infected with HBV alone(87.7%,X2=17.66,P＜0.01).Meanwhile,the HCV RNA positive rate of patients co-infected with HBV and HCV was 75.0%,which was lower than that of patients infected with HCV alone(80.6%).However,the difference was not statistically significant(P＞0.05).Conclusion Co-infection with HBV and HCV may induce severer liver injury than HBV infection or HCV infection alone.