慢性HBV和HCV合并感染患者肝损害的血清学改变

目的了解乙型肝炎病毒(HBV)和丙型肝炎病毒(HCV)合并感染的患者肝损害的血清学改变特点。方法收集225例慢性肝病(包括慢性乙型肝炎,慢性丙型肝炎,乙、丙肝病毒合并感染引起慢性肝炎或肝硬化,肝炎后肝硬化)患者的肝穿病理标本;所有病例均常规检测肝功能、血清HBVDNA、HBV血清标志物、血清HCVRNA,抗-HCV。所有肝活检标本均用10%中性福尔马林固定,石蜡包埋,做苏木素-伊红染色,进行肝炎分级分期,HBsAg、HBcAg免疫组化,HBVDNA、HCVRNA原位杂交检测。结果①重度慢性肝炎患者:HBV/HCV合并感染的患者(B加C组)谷-丙转氨酶(ALT)、谷-草转氨酶(AST)、总胆红素(TB)、直接胆红素(DB)水平与HCV单独感染(C组)患者相比差异无显著性(P>0.05),而比HBV单独感染的患者(B组)低(P<0.05)。②非重度慢性肝炎患者:三组的血清学改变差异无显著性(P>0.05)。③C组与B加C组患者的发病年龄相似(P>0.05),但明显大于B组患者(P<0.01)。④单独感染组发病的病程长短差异无显著性(P>0.05),但比合并感染组长,与单纯感染组相比,合并感染组发展为重肝的时间要短(P<0.01)。结论在重度慢性肝炎的患者中,肝功能损害的血清学指标(AST、ALT、TB、DB)不能很好地反映肝内损害严重度。与单纯感染组相比,HBV与HCV合并感染组发展为重度肝炎的时间要短。

The serological characteristics of damaged livers in patients with chronic HBV and HCV coinfection

Objective To investigate the serological characteristics of damaged liver in patients with chronic liver diseases caused by hepatitis B virus(HBV) and hepatitis C virus(HCV) coinfection.Methods 225 samples of liver biopsy in patients with chronic liver diseases(including chronic hepatitis B,chronic hepatitis C,chronic hepatitis or cirrhosis induced by HBV and HCV coinfection,post-hepatitis cirrhosis) were collected through needle aspiration in our hospital.The liver function,sera HBVDNA,HBV sera markers,sera HCVRNA and anti-HCV in all cases were detected routinely.All liver specimens were fixed in a 10% neutral formalin,embedded in paraffin and stained with hematoxylin-eosin.The hepatitis was staged and graded.HBSAg and HBCAg in livers were detected by immunohistochemical technique,HBVDNA and HCVRNA in liver were detected by in situ hybridizationliver. Results ① In patients with severe chronic hepatitis:those coinfected with HBV and HCV(B plus C group) had similar or lower levels of glutamate pyruvate transaminase(ALT),glutamate oxalo-acetate transaminase(AST),total bilirubin(TB) and direct bilirubin(DB) as compared with those infected with HCV(group C)(P>0.05) or HBV(group B)(P<0.05) alone, respectively.② In patients suffered from non-severe chronic hepatitis:the serological changes of damaged liver did not differ significantly among the three groups.③The age of patients in group C and B plus C group were similar(P>0.05),but patients in these two groups were older than those in group B(P<0.01).④ The clinical duration of disease in those infected with either HBV or HCV were similar(P>0.05),but they have longer duration of disease than those coinfected with HBV and HCV,and the latter have shorter disease duration to develop to severe hepatitis(P<0.01). Conclusion In patients with severe chronic hepatitis,the serological changes of indexes(ALT,AST,TB and DB) can not used as markers to evaluate the severity of liver damage.As compared with those infected with HCV or HBV alone,respectively,patients coinfected with HBV and HCV have shorter duration to develop to severe hepatitis.