慢性乙型肝炎重叠甲型肝炎与重叠戊型肝炎的异同

目的 研究慢性乙型肝炎重叠甲型肝炎与慢性乙型肝炎重叠戊型肝炎患者在临床表现、预后及病毒之间相互干扰方面的异同。方法慢性乙型肝炎重叠甲型肝炎组50例，慢性乙型肝炎重叠戊型肝炎组50例和单纯慢性乙型肝炎组50例，其中每组各含4例肝硬化患者；对3组患者的临床表现、实验室检查结果等进行对比分析。结果在症状、转氨酶及胆红素方面，重叠感染组均重于单纯慢性乙型肝炎组（P〈0．05或P〈0．01），但在与预后有关的一些指标，如白蛋白、凝血酶原活动度及病死率，两种重叠感染对慢性乙型肝炎的影响则有所不同：甲型肝炎重叠感染似对慢性乙型肝炎影响不大，但戊型肝炎重叠感染似对慢性乙型肝炎有比较严重的不良影响。在病毒干扰方面，两种重叠感染似对乙型肝炎病毒复制均有一定抑制作用，戊型肝炎重叠感染更明显。结论甲型肝炎重叠感染对慢性乙型肝炎的症状、转氨酶、胆红素虽有一定影响，但对其预后无太大影响，对乙型肝炎病毒复制似有一定的抑制，但不如戊型肝炎明显；戊型肝炎重叠感染对慢性乙型肝炎的临床表现及其预后均有明显的影响，对乙型肝炎病毒的抑制也较强。

Differences and similarities between superinfection of hepatitis A and E in chronic hepatitis B

Objective To investigate the differences and similarities of clinical manifestation,prognosis and the interference of viruses between superinfection of hepatitis A and superinfection of hepatitis E in chronic hepatitis B.Methods There were 4 cases of liver cirrhosis in patients with chronic hepatitis B superinfected by hepatitis A (n=50),by hepatitis E (n=50),and without superinfection (n=50),respectively.The clinical manifestation and laboratory results in the three groups were compared.Results The symptoms,alanine aminotransferase(ALT),aspartate aminotransferase(AST),and bilirubin in superinfection groups were more severe than those in the non-superinfection group but the markers related to the prognosis such as serum albumin,prothrombine activity,and the mortality in both superinfection groups presented differences in on chronic hepatitis B,indicating that superinfection of hepatitis A had no distinct influence on chronic hepatitis B but superinfection of hepatitis E had obvious adverse influence on chronic hepatitis B.Conclusion The superinfection of hepatitis A has certain effects on symptoms,ALT,AST and bilirubin but not on prognosis of chronic hepatitis B,which also seems to inhibit the replication of hepatitis B virus,but not so prominent as superinfection of hepatitis E does.The superinfection of hepatitis E has effects both on clinical manifestation and prognosis of chronic hepatitis B as well as stronger inhibition to hepatitis B virus replication.