Zhang Y Y, Wang Y K, Sheng H Q, Li L, Hao L J, Zhang Y D, Hou G Z
Clinical Immunology Research Unit, Tongji Medical University, Wuhan.
J Tongji Med Univ. 1990;10(1):5-9. doi: 10.1007/BF02909113.
To explore etiology of acute exacerbation in severe chronic active hepatitis, in situ HBVDNA hybridization was carried out combined with detection of HBV markers in the serum and the liver as well as intrahepatic HDAg in 15 cases. Four subgroups were identified based on the etiological evidence: 1) 9 cases were still undergoing HBV active replication or reactivation with cytoplasmic and membraneous HBcAg expression, often associated with the hepatic necrosis foci; 2) 3 cases showed HBsAg or/and HBVDNA positivity despite absence of HBcAg expression, the membranous and homogeneous HBsAg expression being closely related with hepatic necrosis; 3) 2 cases were HDAg positive; 4) the remaining case exhibited no HBV infection evidence. All findings suggested that HBV active replication or reactivation was the major cause of the exacerbation in severe chronic active hepatitis. In addition, HBV superinfection accounted for over 10% of cases with acute exacerbation. Hepatitis A or C may contribute to some episodes of exacerbation.
为探讨重度慢性活动性肝炎急性加重的病因，对15例患者进行了原位HBVDNA杂交，并结合血清、肝脏中HBV标志物及肝内HDAg的检测。根据病因学证据将患者分为4个亚组：1）9例仍处于HBV活跃复制或再激活状态，伴有细胞质和膜性HBcAg表达，常与肝坏死灶相关；2）3例尽管无HBcAg表达，但HBsAg或/和HBVDNA呈阳性，膜性且均匀的HBsAg表达与肝坏死密切相关；3）2例HDAg阳性；4）其余1例未显示HBV感染证据。所有结果表明，HBV活跃复制或再激活是重度慢性活动性肝炎急性加重的主要原因。此外，HBV重叠感染占急性加重病例的10%以上。甲型或丙型肝炎可能导致部分加重发作。
