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目的 探讨病毒性肝炎病原学与慢性肝炎重症化及其预后的关系。方法 对 43 2例重型病毒性肝炎 (重肝 )的病原学资料进行回顾性分析。结果 在引起重肝的肝炎病毒中以HBV单一或重叠感染率最高 95 8% (4 14 / 43 2 ) ,未发现单一HAV、HDV和HGV感染引起者。 10例 (2 3 % )未能确定病原。乙型慢性重肝的HBV前C区变异率为5 9 8% (5 5 / 92 ) ,显著高于乙型急性或亚急性重肝 0 % (P <0 0 5和P <0 0 1)。HBV重叠HEV感染者病死率为 73 4%(69/ 94) ,HEV重叠其他肝炎病毒感染者的病死率为 68 6% (72 / 10 5 ) ,均比单一HBV或单一HEV感染者高 (P <0 0 1和P <0 0 5 )。结论 HBV感染仍是广东地区重肝的主要病因。乙型慢性重肝与HBV前C区变异相关。HBV与HEV重叠感染可加重病情 ,病死率高。
Objective To investigate the relationship between viral hepatitis etiology and the severity of chronic hepatitis and its prognosis. Methods A total of 432 cases of severe viral hepatitis (severe liver) etiological data were retrospectively analyzed. As a result, the single or overlapping HBV infection rates in hepatitis C virus causing severe hepatitis were 95.8% (4 14/43 2). No single HAV, HDV or HGV infection was found. Ten patients (23%) failed to identify the pathogen. The rate of HBV pre-C mutation was 58.8% (5/92) in patients with chronic severe hepatitis B, which was significantly higher than 0% (P <0.05 or P <0.01) in patients with acute or subacute type B acute hepatitis B . The case fatality rate was 73 4% (69/94) in patients with overlapping HEV and 68 6% (72/10 5) in patients with HEV overlap other hepatitis viruses, both of which were higher than that of single HBV or single HEV <0 0 1 and P <0 0 5). Conclusion HBV infection is still the major cause of severe hepatitis in Guangdong. Chronic severe hepatitis B is associated with HBV pre-C mutation. HBV and HEV overlap infection can aggravate the disease, high mortality.