Anand A C, Nagpal A K, Seth A K, Dhot P S
Army Hospital R and R and Armed Forces Transfusion Unit, New Delhi-l 10 010.
J Assoc Physicians India. 2004 Oct;52:785-7.
Hepatitis A virus (HAV) vaccination is recommended worldwide for patients with chronic liver disease to prevent decompensation due to superinfection with HAV. India being endemic for HAV, the prevalence of pre-existing antibodies against HAV due to subclinical exposure to the virus in childhood among patients with chronic liver disease may be high and, therefore, vaccination may not be needed. However, little data are available on the prevalence of HAV antibody among patients with chronic liver disease in India.
All patients with chronic liver disease seen at Gastroenterology Center, Army Hospital R and R, New Delhi during the year 2002 and diagnosed to have either chronic liver disease were tested for the presence of IgG anti-HAV antibody in their sera (using a commercial ELISA kit). All patients with acute exacerbation or rapid deterioration of a preexisting chronic liver disease were separately studied for presence of IgM anti-HAV. In addition, a matched number of patients who attended the center due to diseases other than liver disease were also studied as controls.
One hundred and eighty seven patients of chronic liver disease and 89 controls were studied. Mean age of these two groups was 38.6 and 42.1 years and 153 (81.8%) and 78 (87.6%) of them were males respectively. Etiology of chronic liver disease was HBV infection in 91(48.7%), HCV infection in 62 (33.2%), autoimmune chronic hepatitis in 3 (1.6%), PBC in seven (3.7%) and cryptogenic 24 (12.8%). Of these 179 (95.7%) patients tested positive for IgG anti-HAV. A total of 37 hospitalisations in 29 patients were noted during the study period due to acute exacerbation of pre-existing chronic liver disease. None of these were positive for IgM anti-HAV, while 28 were positive for IgG anti-HAV. Among the controls, 87 controls (94.6%) were positive IgG anti-HAV. The prevalence of anti-HAV positivity was similar among patients with various etiologies.
Vaccination against HAV is not routinely required among patients with chronic liver disease in India as there is a very high prevalence of pre-existing antibodies in these patients. HAV superinfection as a cause of acute exacerbation of chronic liver disease was not seen in this.
全世界都建议慢性肝病患者接种甲型肝炎病毒（HAV）疫苗，以预防因HAV重叠感染导致的失代偿。印度是HAV的地方性流行区，慢性肝病患者由于童年时期亚临床接触该病毒而预先存在抗HAV抗体的比例可能很高，因此可能不需要接种疫苗。然而，关于印度慢性肝病患者中HAV抗体流行率的数据很少。
2002年期间，在新德里陆军医院R&R胃肠病中心就诊并被诊断为患有慢性肝病的所有患者，均检测其血清中IgG抗HAV抗体的存在情况（使用商用ELISA试剂盒）。所有先前存在的慢性肝病急性加重或快速恶化的患者，均单独研究其IgM抗HAV的存在情况。此外，还对因非肝病疾病到该中心就诊的数量匹配的患者作为对照进行了研究。
研究了187例慢性肝病患者和89例对照。这两组的平均年龄分别为38.6岁和42.1岁，其中男性分别为153例（81.8%）和78例（87.6%）。慢性肝病的病因包括91例（48.7%）HBV感染、62例（33.2%）HCV感染、3例（1.6%）自身免疫性慢性肝炎、7例（3.7%）原发性胆汁性胆管炎和24例（12.8%）隐源性肝病。其中179例（95.7%）患者IgG抗HAV检测呈阳性。在研究期间，共记录到29例患者因先前存在的慢性肝病急性加重而住院37次。这些患者中没有一例IgM抗HAV呈阳性，而28例IgG抗HAV呈阳性。在对照组中，87例（94.6%）IgG抗HAV呈阳性。不同病因患者中抗HAV阳性率相似。
由于印度慢性肝病患者中预先存在抗体的比例非常高，因此在这些患者中通常不需要常规接种HAV疫苗。在本研究中未发现HAV重叠感染是慢性肝病急性加重的原因。
