Department of Gastroenterology, Molinette, University of Torino, Torino, Italy.
Dig Dis. 2010;28(1):139-43. doi: 10.1159/000282077. Epub 2010 May 7.
Surveys in the 1980s showed that the hepatitis D virus (HDV) is endemic worldwide, though with prevalences and patterns of infection varying in different areas. Medical scrutiny confirmed that chronic hepatitis D usually runs a severe and progressive course, the prototype patient having HBsAg in blood, elevated ALT, a liver biopsy exhibiting aggressive hepatitis and markers of HDV (but no marker of HBV replication in serum). Although the circulation of HDV has declined significantly following the control of HBV achieved over the last 20 years, depriving HDV of the HBV network necessary to propagate its infection, there is still a consistent reservoir of the virus in Europe, sustained by two different pools of HDV-infected patients: the residual ageing domestic pool that survived the brunt of the hepatitis D epidemic in the 1970s and 1980s and the population of young patients with recent HDV infections migrating to Europe. Therapy of hepatitis D remains an unsolved business. The therapy available today is not different from the limited interferon treatment attempted more than 20 years ago. The problem is formidable as HDV has no enzymatic protein to be targeted by conventional antiviral therapy. A potential target of therapy is offered by the process of hepatitis D virion assembly.
20 世纪 80 年代的调查显示，乙型肝炎病毒（HDV）在全球流行，但其感染率和流行模式在不同地区有所不同。医学检查证实，慢性乙型肝炎通常呈严重且进行性病程，典型患者血液中 HBsAg 阳性，ALT 升高，肝活检显示为侵袭性肝炎和 HDV 标志物（但血清中无 HBV 复制标志物）。尽管过去 20 年 HBV 得到控制后，HDV 的传播明显减少，剥夺了 HDV 传播其感染所需的 HBV 网络，但在欧洲仍存在着病毒的持续储存库，这是由两类不同的 HDV 感染患者池维持的：一类是在 20 世纪 70 年代和 80 年代乙型肝炎 D 流行中幸存下来的年龄较大的残留家庭池，另一类是新近感染 HDV 的年轻患者人群迁移到欧洲。乙型肝炎 D 的治疗仍然是一个悬而未决的问题。目前的治疗方法与 20 多年前尝试的有限的干扰素治疗没有什么不同。由于 HDV 没有酶蛋白可供常规抗病毒治疗靶向，因此问题十分严峻。治疗的一个潜在靶点是乙型肝炎 D 病毒衣壳组装的过程。
