慢性乙型肝炎或乙肝肝硬化重叠急性戊型肝炎临床特点分析

目的研究慢性乙型肝炎或乙肝肝硬化基础上重叠急性戊型肝炎（简称乙戊重叠）的临床特点及戊肝病毒（HEV）对乙肝病毒（HBV）的影响。方法将2002年12月至2006年12月解放军第三。二医院收治的所有625例戊肝患者分为急性戊肝组（AHE组，437例）和乙戊重叠组（S组，188例），并进一步将乙戊重叠组分为慢性乙肝重叠戊肝组（CHB＋AHE，130例）和乙肝肝硬化重叠戊肝组（LCB＋AHE，58例），回顾性分析其特点并对32例乙戊重叠患者急性期和恢复期的HBVDNA水平进行随访。结果与AHE组相比，s组的总胆红素水平、重型肝炎发生率、痊愈患者平均住院日和病死率均明显升高，而谷丙转氨酶、白蛋白和凝血酶原活动度均明显降低；而且LCB＋AHE组的TBil水平，并发症如腹水、腹膜炎、肝性脑病和糖代谢紊乱等的发生率要明显高于CHB＋AHE组。对32例s组患者随访发现，20例（62．5％）出现HBVDNA水平下降，平均下降值为2，1log10；6例（18．8％）HBVDNA始终阴性，4例（12，5％）HBVDNA无变化，2例（6，2％）HBVDNA轻度升高。结论乙戊重叠感染会导致患者病情加重，但HEV对于HBV的复制有一定的抑制作用。

An analysis of the clinical characteristics of patients with chronic hepatitis B superinfected with acute hepatitis E

OBJECTIVE: To investigate clinical features of the patients with hepatitis B superinfected with acute hepatitis E (AHE). METHODS: Totally 625 consecutive patients enrolled from Dec 2002 to Dec 2006 were studied retrospectively. All of the patients were subclassified into acute hepatitis E group (AHE=437 cases) and Superinfected Group (S=188 cases), and S group was further divided into the group of chronic hepatitis B superinfected with acute hepatitis E (CHB+AHE, 130 cases) and the group of liver cirrhosis and hepatitis B superinfected with acute hepatitis E (LCB+AHE, 58 cases). In 32 of the 188 superinfected patients the effects of HEV on HBV were observed by comparing the levels of HBV DNA in acute vs. convalescence stages. RESULTS: Compared with the patients with AHE, the superinfected patients had a higher level of total bilirubin (TBil), an elevated frequency of fulminate hepatitis, mortality and a longer period of the mean hospital stay for the cured patients but significantly lower levels of alanine aminotransferase (ALT), serum albumin and prothrombin activity (PA). Furthermore, the group of LCB+AHE had a higher level of TBil and higher incidences of complications such as ascites, peritonitis, hepatic encephalopathy and disturbance in glycometabolism than the group of CHB+AHE. The follow-up for the superinfected patients showed that 20 of 32 patients (62.5 percent) had decreased copies of HBV DNA during the recovery phase compared with the acute phase, and the mean decrease of HBV DNA was 2.1 log10. The HBV DNA was in a persistently undetectable level in 6 of 32 (18.8 percent) superinfected patients. However, 4 of 32 patients (12.5 percent) showed an unchanged levels of HBV DNA and 2 cases (6.2 percent) had a slightly increased HBV DNA levels. CONCLUSION: Superinfection with AHE in patients with chronic hepatitis B leads to a more severe hepatic damage and the replication of HBV DNA can be transiently inhibited.