Hepatic Pathogenesis Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
Semin Liver Dis. 2012 Aug;32(3):228-36. doi: 10.1055/s-0032-1323628. Epub 2012 Aug 29.
Hepatitis D is caused by infection with hepatitis D virus (HDV), a defective RNA virus that requires the obligatory helper function of hepatitis B virus (HBV) for its in vivo transmission. Thus, HDV is acquired only by coinfection with HBV or by superinfection of an HBV carrier. The clinical outcome of hepatitis D differs according to the modality of infection. Whereas coinfection evolves to chronicity in only 2% of the cases, superinfection results in chronic infection in over 90% of the cases. HDV is a highly pathogenic virus that causes acute, often fulminant hepatitis, as well as a rapidly progressive form of chronic viral hepatitis, leading to cirrhosis in 70 to 80% of the cases. The clinical picture of HDV disease is evolving as a consequence of a significant change in the epidemiology of HDV infection, which has led to a significant decline in incidence in Western countries, mainly as a result of universal HBV vaccination programs. However, in the face of a declining prevalence in areas of old endemicity like Europe, immigration poses a threat of HDV resurgence. The interaction of HDV with other hepatitis viruses or human immunodeficiency virus is complex and may lead to different patterns in terms of virologic expression and immunologic responses. Multiple viral infections are associated with rapid progression of liver fibrosis and eventually with the development of hepatocellular carcinoma. Hepatitis D is not a vanishing disease, and continuous efforts should be made to improve its prevention and treatment.
丁型肝炎由丁型肝炎病毒（HDV）感染引起，HDV 是一种缺陷 RNA 病毒，其体内传播需要乙型肝炎病毒（HBV）的必需辅助功能。因此，HDV 仅通过与 HBV 的合并感染或 HBV 携带者的重叠感染获得。丁型肝炎的临床结局因感染方式而异。虽然合并感染仅导致 2%的病例慢性化，但重叠感染导致 90%以上的病例慢性感染。HDV 是一种高致病性病毒，可引起急性、常为暴发性肝炎，以及快速进展型慢性病毒性肝炎，导致 70%至 80%的病例发生肝硬化。HDV 疾病的临床特征因 HDV 感染的流行病学发生显著变化而不断演变，这导致西方国家的发病率显著下降，主要是由于普遍的 HBV 疫苗接种计划。然而，在像欧洲这样的旧流行地区，患病率下降的情况下，移民构成了 HDV 死灰复燃的威胁。HDV 与其他肝炎病毒或人类免疫缺陷病毒的相互作用很复杂，可能导致在病毒学表达和免疫反应方面出现不同的模式。多种病毒感染与肝纤维化的快速进展以及最终发展为肝细胞癌相关。丁型肝炎不是一种正在消失的疾病，应继续努力改善其预防和治疗。
