Rosina F, Saracco G, Rizzetto M
N Engl J Med. 1985 Jun 6;312(23):1488-91. doi: 10.1056/NEJM198506063122305.
Hepatitis delta virus is a defective virus that can replicate only in the presence of hepatitis B virus. To determine the prevalence, circumstances of transmission, and clinical importance of infection with hepatitis delta virus, we obtained data on 262 patients with post-transfusion hepatitis who were positive for the hepatitis B surface antigen (HBsAg) even though they had received blood screened for it. We also studied 94 HBsAg carriers who were receiving repeated blood transfusions for other diseases, and 103 HBsAg carriers with hemophilia who were receiving various forms of coagulation factors. Antibody to hepatitis delta virus was found in 9 of 262 patients (3.5 per cent) with post-transfusion hepatitis, 5 of 234 (2 per cent) with self-limited disease, and 4 of 28 (14.5 per cent) with fulminant disease (P less than 0.05). The absence of IgM antibodies to the hepatitis B core antigen indicated that three of the nine patients with both HBsAg and antibodies to hepatitis delta virus had been carriers of HBsAg at the time of transfusion, and the acute disease represented the combined effects of the two viruses. Antibody to hepatitis delta virus was found in 3 of 94 Italian carriers of HBsAg who were receiving repeated blood transfusions, in none of 24 Brazilian, East German, or Australian hemophiliac carriers infused with clotting factors prepared from single or mini-pool volunteer plasma, and in 27 to 100 per cent of 79 hemophiliac carriers from European and U.S. series who received coagulation factors manufactured from large pools of plasma. We conclude that infection with hepatitis delta virus is likely to be more severe than infection with hepatitis B virus alone and that screening for HBsAg provides a high degree of safety in preventing infection with hepatitis delta virus, but that the risk is considerably greater in patients who are already carriers of HBsAg. We recommend that HBsAg carriers be given only blood derivatives prepared from a single donor or mini-pool donors.
丁型肝炎病毒是一种缺陷病毒，仅在乙型肝炎病毒存在的情况下才能复制。为了确定丁型肝炎病毒感染的患病率、传播情况及临床重要性，我们收集了262例输血后肝炎患者的数据，这些患者尽管接受了乙肝表面抗原（HBsAg）筛查但仍为阳性。我们还研究了94例因其他疾病接受反复输血的HBsAg携带者，以及103例接受各种凝血因子的血友病HBsAg携带者。在262例输血后肝炎患者中有9例（3.5%）、234例自限性疾病患者中有5例（2%）、28例暴发性疾病患者中有4例（14.5%）检测到丁型肝炎病毒抗体（P<0.05）。乙肝核心抗原IgM抗体阴性表明，9例同时感染HBsAg和丁型肝炎病毒抗体的患者中有3例在输血时已是HBsAg携带者，急性疾病代表了两种病毒的联合作用。在94例接受反复输血的意大利HBsAg携带者中有3例检测到丁型肝炎病毒抗体，在24例接受由单个或小批量志愿供血者血浆制备的凝血因子的巴西、东德或澳大利亚血友病携带者中均未检测到，而在79例接受由大量血浆制备的凝血因子的欧美血友病携带者中有27%至100%检测到。我们得出结论，丁型肝炎病毒感染可能比单独的乙型肝炎病毒感染更严重，筛查HBsAg在预防丁型肝炎病毒感染方面提供了高度安全性，但对于已为HBsAg携带者的患者，风险要大得多。我们建议仅给予HBsAg携带者由单个供血者或小批量供血者制备的血液制品。
