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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HBV DNA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HBV DNA水平下降,平均下降值为2.1log10;6例(18.8%)HBV DNA始终阴性,4例(12.5%)HBV DNA无变化,2例(6.2%)HBV DNA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。
Objective To investigate the clinical characteristics of hepatitis A or hepatitis B virus (HBV) overlapping hepatitis B virus (HBV) and the influence of hepatitis E virus (HEV) on hepatitis B virus (HBV). Methods All 625 cases of hepatitis E patients admitted to the 302 Hospital of PLA from December 2002 to December 2006 were divided into acute hepatitis E group (AHE group, 437 cases) and Yi-Pei overlapping group (S group, 188 cases) (CHB + AHE, 130 cases) and hepatitis E cirrhosis overlapping group (LCB + AHE, 58 cases) were retrospectively analyzed, and 32 cases HBV DNA levels in acute and convalescent patients were followed up. Results Compared with AHE group, total bilirubin level, incidence of severe hepatitis, average length of hospital stay and mortality in patients with S were significantly increased, but activities of alanine aminotransferase, albumin and prothrombin were significantly decreased In addition, the incidence of TBil and complications such as ascites, peritonitis, hepatic encephalopathy and glucose metabolism in LCB + AHE group were significantly higher than those in CHB + AHE group. The follow-up of 32 patients in group S showed that the HBV DNA level decreased in 20 patients (62.5%) with an average value of 2.1log10. HBV DNA was always negative in 6 patients (12.5%), HBV DNA in 4 patients (12.5% Two patients (6.2%) had mild HBV DNA. Conclusions Over-exposure to diethylvalerate can lead to aggravating of the disease, but HEV can inhibit the replication of HBV.