Scevola D, Zambelli A, Albiero D, Gambino R, Rondanelli E G
Istituto di Clinica delle Malattie Infettive, Università di Pavia, Italy.
Boll Ist Sieroter Milan. 1989;68(3):258-70.
During the last eighteen years (1970-1987) at the Infectious Diseases Clinic of the University of Pavia, Ospedale Policlinico S. Matteo, IRCCS, Pavia (referral Center for hepatitis in our district: 502534 inhabitants) we observed 4238 patients (2706 M = 63.8%; 1532 F = 36.2%) admitted with presumptive diagnosis of hepatitis. The male to female sex ratio was 1.78 and average age was 38 (1-90) years. Acute viral hepatitis was diagnosed in 3238 patients (76.4%), 1960 of which were males (60.5%) and 1278 (39.5%) females, with an average age of 35 (1-88) years. The possible route of transmission was: drug addition in 487 patients (15%), blood transfusion in 464 (14.3%), other (sexual, professional, familiar) in 332 (10.3%), unknown in 1955 (60.4%). Chronic hepatitis (CH) was diagnosed according to the European Association for the Study of the Liver (EASL) and to the International Association for the Study of the Liver (IASL) in 848 patients (20%), 704 M(83%) and 144 F (17%) with an average age of 48 (2-90) years. 463 patients (54.5%) were biopsied during admission, 385 (45.5%) received definitive diagnosis by clinical and previous histologic records. CAH was found in 268 (57.9%), CPH in 161 (34.8%) and CLH in 20 (4.3%) patients. Other liver diseases (steatosis, cirrhosis, HCC) were identified in 152 subjects (3%). The prevalence of A, B, NANB and Delta hepatitis virus and HI virus in the acute disease was respectively of 5.4%, 54.8%, 33.9%, 0.28% and 0.77%. In CH the HBV aetiology accounted for 49.1%, NANB virus for 44.5%, co/super infection with HDV for 15%. Among factors involved in pathogenesis of chronic hepatitis we focused attention on drug addition which was found in 129 (28.7%) patients, blood transfusion in 70 (15.6%), HIV infection in 35 of 166 (21.1%). The data still demonstrate the high prevalence of HBV aetiology of CH and existence of co-factors in the pathogenesis of chronicity. The lack of markers for NANB infection persists as the main problem in the diagnosis of liver disease. This work was supported by grant 40% from M.P.I.: "Epatiti virali acute e croniche"....
在过去18年（1970 - 1987年）里，于帕维亚大学圣马泰奥综合医院传染病诊所（IRCCS，帕维亚，我们所在地区的肝炎转诊中心：502534名居民），我们观察了4238例以肝炎初步诊断入院的患者（男性2706例，占63.8%；女性1532例，占36.2%）。男女比例为1.78，平均年龄为38岁（1 - 90岁）。3238例患者（76.4%）被诊断为急性病毒性肝炎，其中男性1960例（60.5%），女性1278例（39.5%），平均年龄为35岁（1 - 88岁）。可能的传播途径为：487例患者（15%）因药物成瘾，464例（14.3%）因输血，332例（10.3%）因其他（性传播、职业接触、家庭接触），1955例（60.4%）传播途径不明。根据欧洲肝脏研究协会（EASL）和国际肝脏研究协会（IASL）的标准，848例患者（20%）被诊断为慢性肝炎（CH），其中男性704例（83%），女性144例（17%），平均年龄为48岁（2 - 90岁）。463例患者（54.5%）在入院期间接受了活检，385例（45.5%）通过临床及既往组织学记录获得明确诊断。在患者中发现268例（57.9%）为慢性活动性肝炎（CAH），161例（34.8%）为慢性迁延性肝炎（CPH），20例（4.3%）为慢性小叶性肝炎（CLH）。152名受试者（3%）被诊断为其他肝脏疾病（脂肪变性、肝硬化、肝癌）。急性疾病中甲型、乙型、非甲非乙型和丁型肝炎病毒及艾滋病毒的感染率分别为5.4%、54.8%、33.9%、0.28%和0.77%。在慢性肝炎中，乙肝病因占49.1%，非甲非乙病毒占44.5%，丁型肝炎病毒合并/重叠感染占15%。在慢性肝炎发病机制相关因素中，我们重点关注了药物成瘾，在129例（28.7%）患者中发现有此情况，70例（15.6%）有输血史，166例中有35例（21.1%）感染艾滋病毒。数据仍显示慢性肝炎中乙肝病因的高感染率以及慢性化发病机制中存在协同因素。非甲非乙感染标志物的缺乏仍是肝病诊断中的主要问题。本研究得到了意大利教育、大学与科研部40%的资助：“急性和慢性病毒性肝炎”……
