慢性乙型肝炎肝病急性加重的原因探讨

目的 为了弄清慢性乙型肝炎病程中肝病急性加重的原因。方法 用酶联免疫吸附试验检测慢性乙型肝炎病程中肝病急性加重时甲、丙、丁或戊型肝炎病毒的重叠感染以及HBeAg和抗-HBe的血清学状态。结果 在83例慢性乙型肝炎的92次肝病急性加重中,甲、丙、丁或戊型肝炎病毒重叠感染分别为3.3％(3/92)、5.4％(5/92)、3.3％(3/92)和5.4％(5/92),共为17.4％(16/92);使用肝损害药物为1.1％(1/92);HBeAg至抗-HBe的自发血清转换为9.8％(9/92);HBeAg至抗-HBe的不稳定自发血清转换状态为12.0％(12/92);保持HBeAg至抗-HBe血清学状态不变为59.8％(55/92)。重叠其它嗜肝病毒感染、HBeAg至抗-HBe的不稳定自发血清转换以及保持HBeAg和抗-HBe的状态不变均可出现致死性肝衰竭。结论 重叠其它嗜肝病毒感染、使用肝损害药物和HBeAg至抗-HBe的自发血清转换与慢性乙型肝炎病程中40％左右的肝病急性加重有关,大约60％的肝病急性加重与HBeAg和抗-HBe血清学状态无关。促使致死性肝衰竭发生的原因更为复杂。

RESEARCHES ON THE CAUSES OF ACUTE EXACERBATION IN CHRONIC HEPATITIS B

Objective In order to clarify the causes of acute exacerbation in chronic hepatitis B. Methods This study detected the superinfections of heaptits A,C,D or E virus and serological status of HBeAg and anti-HBe in the acute exacerbation occurring in the course of chronic hepatits B by enzyme linked immunosorbent assay. Results The superinfections of hepatitis A,C,D or E virus were 3.396(3/92),5.4%(5/92) ,3.3%(3/92)or 5.4%(5/92), respectively,altogether 17.4% (16/92) ; tuberculocidas was 1. 1 % ( 1 /92) ; the spontaneous seroconversion of HBeAg to anti-HBe was 12.0%(11/92)and no change in serological status of HBeAg and anti-HBe was 59. 8%(55/92)a-mong 83 chronic hepatits B with 92 acute exacerbations. The fatal liver failure may occur in the superinfection of other hepatophilus virus, unstable spontaneous seroconversion of HBeAg to anti-HBe and no change kept in serological status of HBeAg to anti-HBe. Conclusion These results suggeste that the superinfections of other hepatophilus virus, tuberculocides and the spontaneous seroconversion of HBeAg to anti-HBe are responsible for about 40 % of acute exacerbations. About 60% of acute exacerbations is not related to serological status of HBeAg and anti-HBe. The causes of fatal liver failure occurring in chronic hepatitis B could be more complex.