Keeffe Emmet B
Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Trans Am Clin Climatol Assoc. 2006;117:227-37; discussion 237-8.
A number of studies have demonstrated that the acquisition of hepatitis A or hepatitis B in patients with chronic liver disease is associated with high rates of morbidity and mortality. Superimposition of acute hepatitis A in patients with chronic hepatitis C has been associated with a particularly high mortality rate, and chronic hepatitis B virus coinfection with hepatitis C virus is associated with an accelerated progression of chronic liver disease to cirrhosis, decompensated liver disease and hepatocellular carcinoma. With the availability of vaccines against hepatitis B and hepatitis A since 1981 and 1995, respectively, these are vaccine-preventable diseases. Studies have confirmed that hepatitis A and hepatitis B vaccines are safe and immunogenic in patients with mild to moderate chronic liver disease. However, hepatitis A and B vaccination is less effective in patients with advanced liver disease and after liver transplantation. These observations have led to the recommendation that patients undergo hepatitis A and B vaccination early in the natural history of their chronic liver disease. Vaccination rates are low in clinical practice, and public health and educational programs are needed to overcome barriers to facilitate timely implementation of these recommendations.
多项研究表明，慢性肝病患者感染甲型肝炎或乙型肝炎与高发病率和死亡率相关。慢性丙型肝炎患者叠加急性甲型肝炎与特别高的死亡率相关，而乙型肝炎病毒与丙型肝炎病毒合并感染与慢性肝病加速进展为肝硬化、失代偿性肝病和肝细胞癌相关。自1981年和1995年分别有了乙型肝炎和甲型肝炎疫苗以来，这些都是可通过疫苗预防的疾病。研究证实，甲型肝炎和乙型肝炎疫苗在轻至中度慢性肝病患者中是安全且具有免疫原性的。然而，甲型和乙型肝炎疫苗在晚期肝病患者和肝移植后效果较差。这些观察结果导致建议患者在慢性肝病自然史的早期接受甲型和乙型肝炎疫苗接种。在临床实践中，疫苗接种率较低，需要公共卫生和教育项目来克服障碍，以促进及时实施这些建议。
