Si-Hong Cheng, Li Mai, Feng-Qin Zhu, Xing-Fei Pan, Hai-Xia Sun, Hong Cao, Xin Shu, Wei-Min Ke, Gang Li, Qi-Huan Xu, Department of Infectious Diseases, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China.
World J Gastroenterol. 2013 Sep 21;19(35):5904-9. doi: 10.3748/wjg.v19.i35.5904.
To investigate the influence of chronic hepatitis B virus (HBV) infection [based on the status of hepatitis B e antigen (HBeAg), HBV DNA, and cirrhosis] on superimposed acute hepatitis E.
A total of 294 patients were recruited from the Department of Infectious Diseases of the Third Affiliated Hospital, Sun Yat-sen University, from January 2003 to January 2012. The patients were classified into two groups: an HBV + hepatitis E virus (HEV) group (a group with chronic HBV infection that was superinfected with acute hepatitis E, n = 118) and an HEV group (a group with acute hepatitis E, n = 176). We retrospectively analyzed and compared the clinical features of the two groups. Statistical analyses were performed using the χ(2) test or Fisher's exact test for categorical variables and the Student's t test for continuous variables. A P value < 0.05 was considered statistically significant.
The peak values of prothrombin time, serum total bilirubin, and Model for End-Stage Liver Disease scores were significantly higher in the HBV + HEV group. More patients in the HBV + HEV group had complications (39.8% vs 16.5%, P = 0.000) and developed liver failure (35.6% vs 8.5%, P = 0.000). Additionally, the mortality of the HBV + HEV group was significantly higher (20.3% vs 7.4%, P = 0.002). Further analysis of the HBV + HEV group showed that there were no significant differences in complication occurrence, liver failure incidence, or mortality between patients with different HBeAg and HBV DNA statuses. However, in patients with underlying cirrhosis, complication occurrence and liver failure incidence significantly increased. In total, 12.7% of the patients in the HBV + HEV group received anti-HBV treatment, but this therapy failed to reduce mortality in patients who developed liver failure.
The presence of underlying cirrhosis in chronic HBV infection results in more severe clinical outcomes with superimposed acute hepatitis E. Anti-HBV treatment cannot improve the prognosis of liver failure caused by HBV-HEV superinfection.
探讨慢性乙型肝炎病毒（HBV）感染[基于乙型肝炎 e 抗原（HBeAg）、HBV DNA 和肝硬化状态]对重叠性急性戊型肝炎的影响。
2003 年 1 月至 2012 年 1 月，中山大学附属第三医院感染科共招募 294 例患者。患者分为两组：HBV+HEV 组（慢性 HBV 感染者重叠急性戊型肝炎，n=118）和 HEV 组（急性戊型肝炎，n=176）。回顾性分析比较两组临床特征。计数资料比较采用卡方检验或 Fisher 确切概率法，计量资料比较采用 t 检验。P<0.05 为差异有统计学意义。
HBV+HEV 组凝血酶原时间、血清总胆红素、终末期肝病模型评分峰值显著更高，并发症更多（39.8%比 16.5%，P=0.000），发生肝衰竭更多（35.6%比 8.5%，P=0.000），病死率更高（20.3%比 7.4%，P=0.002）。HBV+HEV 组进一步分析显示，不同 HBeAg 和 HBV DNA 状态患者并发症发生、肝衰竭发生率、病死率差异均无统计学意义，但合并肝硬化患者并发症发生、肝衰竭发生率显著增高。HBV+HEV 组共 12.7%患者接受抗 HBV 治疗，但该治疗未能降低发生肝衰竭患者的病死率。
慢性 HBV 感染合并肝硬化导致重叠性急性戊型肝炎患者临床结局更差。抗 HBV 治疗不能改善 HBV-HEV 重叠感染所致肝衰竭的预后。
