Chen Chong, Zhang Shu-Ye, Zhang Dan-Dan, Li Xin-Yan, Zhang Yu-Ling, Li Wei-Xia, Yan Jing-Jing, Wang Min, Xun Jing-Na, Lu Chuan, Ling Yun, Huang Yu-Xian, Chen Liang
Chong Chen, Liang Chen, Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China.
World J Gastroenterol. 2016 Dec 21;22(47):10388-10397. doi: 10.3748/wjg.v22.i47.10388.
To examine the clinical features and risk factors for adverse outcomes in chronic hepatitis B (CHB) superimposed with hepatitis E virus (HEV).
This retrospective cohort study included 228 patients with acute HEV infection (showing clinical acute hepatitis symptomology and positivity for anti-HEV immunoglobulin M) with underlying CHB (confirmed by positivity for hepatitis B surface antigen and/or hepatitis B virus (HBV) DNA over 6 mo) who had been admitted to the Shanghai Public Health Clinical Center, which represents the regional tertiary hospital for infectious diseases in Shanghai city, China. Data for adverse outcomes were collected, and included severe liver diseases (defined as liver failure and/or acute liver decompensation) and liver-related mortality. Logistic regression modeling was performed to determine the risk factors for adverse outcomes.
The symptoms caused by superimposed acute hepatitis E (AHE) were much more severe in cirrhotic patients ( = 94) than in non-cirrhotic patients ( = 134), as evidenced by significantly higher liver complications (77.7% 28.4%, < 0.001) and mortality rate (21.3% 7.5%, = 0.002). Most of the cirrhotic patients ( = 85, 90.4%) had no prior decompensation. Among the non-cirrhotic patients, superimposed AHE caused progressively more severe diseases that corresponded with the CHB disease stages, from immune tolerant to immune reactivation phases. Few risk factors were identified in the cirrhotic patients, but risk factors for non-cirrhotic patients were found to be intermediate HBV DNA levels (OR: 5.1, = 0.012), alcohol consumption (OR: 6.4, = 0.020), and underlying diabetes (OR: 7.5, = 0.003) and kidney diseases (OR: 12.7, = 0.005). Only 28.7% of the cirrhotic patients and 9.0% of the non-cirrhotic patients had received anti-HBV therapy previously and, in all cases, the efficacy had been suboptimal.
CHB-related cirrhosis and intermediate HBV DNA level were associated with severe disease in superinfected patients, and successful antiviral treatment might counter this outcome.
探讨慢性乙型肝炎（CHB）合并戊型肝炎病毒（HEV）感染的临床特征及不良结局的危险因素。
本回顾性队列研究纳入了228例急性戊型肝炎病毒感染患者（表现出临床急性肝炎症状且抗-HEV免疫球蛋白M阳性），这些患者均合并慢性乙型肝炎（通过乙肝表面抗原和/或乙肝病毒（HBV）DNA持续6个月以上阳性确诊），均入住上海公共卫生临床中心，该中心是中国上海市区域性传染病三级医院。收集不良结局的数据，包括严重肝脏疾病（定义为肝衰竭和/或急性肝失代偿）及肝脏相关死亡率。采用逻辑回归模型确定不良结局的危险因素。
肝硬化患者（n = 94）中，合并急性戊型肝炎（AHE）导致的症状比非肝硬化患者（n = 134）严重得多，表现为肝脏并发症发生率显著更高（77.7% 对28.4%，P < 0.001）和死亡率更高（21.3% 对7.5%，P = 0.002）。大多数肝硬化患者（n = 85，90.4%）既往无失代偿。在非肝硬化患者中，合并AHE导致的疾病严重程度随CHB疾病阶段（从免疫耐受期到免疫激活期）逐渐加重。肝硬化患者中未发现明显危险因素，但非肝硬化患者的危险因素为HBV DNA水平处于中等水平（比值比：5.1，P = 0.012）、饮酒（比值比：6.4，P = 0.020）、合并糖尿病（比值比：7.5，P = 0.003）和肾脏疾病（比值比：12.7，P = 0.005）。仅28.7%的肝硬化患者和9.0%的非肝硬化患者既往接受过抗HBV治疗，且所有病例疗效均欠佳。
CHB相关肝硬化和中等水平的HBV DNA与重叠感染患者的严重疾病相关，成功的抗病毒治疗可能会改善这一结局。
