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中国东南部慢性乙型肝炎病程中致命性肝衰竭的病因学调查

Etiological investigation of fatal liver failure during the course of chronic hepatitis B in southeast China.

作者信息

Ke Wei-Min, Li Xue-Jun, Yu Li-Na, Lai Jing, Li Xiao-He, Gao Zhi-Liang, Chen Pei-Jia

机构信息

Department of Infectious Diseases, The Third Affiliated Hospital, Sun Yat-Sen University, Shipai, Guangzhou 510630, P. R. China.

出版信息

J Gastroenterol. 2006 Apr;41(4):347-51. doi: 10.1007/s00535-005-1781-y.

Abstract

BACKGROUND

The purpose of this study was to clarify the relationships between patients who had fatal liver failure during the course of chronic hepatitis B and those who were also superinfected with hepatitis A, C, D, or E virus, as well as their hepatitis B virus e system status, so that suitable measures could be adopted to decrease the mortality of patients with chronic hepatitis B.

METHODS

This study detected superinfections of hepatitis A, C, D, or E virus and the hepatitis B virus e system status in cases of fatal liver failure during the course of chronic hepatitis B by enzyme-lined immunosorbent assay.

RESULTS

The frequency of superinfections of hepatitis A, C, D, and E virus was 1.4% (4/282), 6.4% (18/282), 1.8% (5/282), and 28.4% (80/282), respectively, overall, 37.9% (107/282). Hepatitis E was prominent and steady in superinfection rates during the past 12 years. In 62.1% (175/282) of patients, the causes of fatal liver failure were not clear. The serological status frequency of HBeAg(+) and anti-HBe(-), HBeAg(-) and anti-HBe(-), and HBeAg(-) and anti-HBe(+) was 20.6% (22/107), 23.4% (25/107), and 56.1% (60/107), respectively, in the group with superinfections of hepatitis A, C, D, or E virus and 31.4% (55/175), 21.1% (37/175), and 47.4% (83/175), respectively, in the group in which causes were not clear. The serological status HBeAg(+) and anti-HBe(-) was more frequent in the group in which causes were not clear than in the group with superinfections of hepatitis A, C, D, or E virus (P < 0.05). Statistically, there were no differences (P > 0.05) between the serological status HBeAg(-), anti-HBe(-) and HBeAg(-), anti-HBe(+) between the two groups.

CONCLUSIONS

These results suggest that superinfection (107/282) is an important factor in fatal liver failure. The mortality of chronic hepatitis B can be decreased by strict food sanitation and the use of safe blood products. There were no significant relationships between hepatitis B e antigen seroconversion and fatal liver failure during the course of chronic hepatitis B.

摘要

背景

本研究旨在阐明慢性乙型肝炎病程中发生致命性肝衰竭的患者与同时重叠感染甲型、丙型、丁型或戊型肝炎病毒的患者之间的关系,以及他们的乙肝病毒e系统状态,以便采取适当措施降低慢性乙型肝炎患者的死亡率。

方法

本研究采用酶联免疫吸附试验检测慢性乙型肝炎病程中发生致命性肝衰竭病例的甲型、丙型、丁型或戊型肝炎病毒重叠感染情况及乙肝病毒e系统状态。

结果

甲型、丙型、丁型和戊型肝炎病毒重叠感染率分别为1.4%(4/282)、6.4%(18/282)、1.8%(5/282)和28.4%(80/282),总体重叠感染率为37.9%(107/282)。在过去12年中,戊型肝炎在重叠感染率方面较为突出且稳定。62.1%(175/282)的患者致命性肝衰竭病因不明。在甲型、丙型、丁型或戊型肝炎病毒重叠感染组中,HBeAg(+)和抗-HBe(-)、HBeAg(-)和抗-HBe(-)、HBeAg(-)和抗-HBe(+)的血清学状态频率分别为20.6%(22/107)、23.4%(25/107)和56.1%(60/107);在病因不明组中,上述血清学状态频率分别为31.4%(55/175)、21.1%(37/175)和47.4%(83/175)。病因不明组中HBeAg(+)和抗-HBe(-)的血清学状态比甲型、丙型、丁型或戊型肝炎病毒重叠感染组更常见(P<0.05)。统计学上,两组之间HBeAg(-)、抗-HBe(-)和HBeAg(-)、抗-HBe(+)的血清学状态无差异(P>0.05)。

结论

这些结果表明重叠感染(107/282)是致命性肝衰竭的一个重要因素。通过严格的食品卫生和使用安全的血液制品可降低慢性乙型肝炎的死亡率。在慢性乙型肝炎病程中,乙肝e抗原血清学转换与致命性肝衰竭之间无显著关系。

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