Koff R S, Pannuti C S, Pereira M L, Hansson B G, Dienstag J L, Neto V A, Wong D C, Purcell R H
Hepatology. 1982 Jul-Aug;2(4):445-8. doi: 10.1002/hep.1840020409.
During a 33-month period, 295 patients with acute viral hepatitis were admitted to a state hospital for civil servants and their dependents in São Paulo, Brazil. Seventy-nine per cent (232) were HBsAg negative. To define the contribution of non-A, non-B viral hepatitis to hepatitis morbidity in this population, further serological studies were performed in 147 confirmed HBsAg-negative patients. One hundred and twelve (76%) were serologically classified as hepatitis A based on identification of IgM antibody to hepatitis A virus. Thirty patients (20%) without IgM antibody to hepatitis A virus, HBsAg, or anti-HBc were categorized as the non-A, non-B hepatitis group. The remaining five patients had probable hepatitis B (IgM antibody to hepatitis A virus negative, HBsAg negative, anti-HBs negative but anti-HBc positive). These data suggest that all three etiological forms of viral hepatitis are endemic in São Paulo. Epidemiological, clinical, and laboratory features were compared to the hepatitis A and non-A, non-B hepatitis groups. Patients with non-A, non-B hepatitis were significantly older than patients with hepatitis A (mean age +/- S.D.: 30 +/- 22 years vs. 9 +/- 9 years, p less than 0.001). Contact with hepatitis or jaundice was recognized in 26 (23%) of 112 hepatitis A patients and 3 (10%) of 30 non-A, non-B patients, a difference which was not statistically significant. Parenteral exposures were identified in 13 (43%) of 30 patients with non-A, non-B hepatitis and 23 (21%) of the 112 hepatitis A patients. Blood transfusion in the 2 months preceding onset of illness was reported in 5 (17%) of the 30 non-A, non-B patients and in none of the hepatitis A group (p less than 0.001). Although prodromal symptoms and fever were more common in patients with hepatitis A, neither these nor other clinical features appeared to be distinguishing characteristics. Similarly, mean peak SGPT levels, peak SGPT levels of greater than or equal to 1,000 IU/per liter, and the mean duration of SGPT elevations for each group were not significantly different. Mean peak serum bilirubin levels were slightly higher in the non-A, non-B group than in the hepatitis A group (7.6 +/- 8.0 mg per dl vs. 5.1 +/- 2.7, p less than 0.01) and peak bilirubin levels greater than or equal to 10 mg per dl were found in 27% of the non-A, non-B group and 5% of the hepatitis A group (p less than 0.001). Whether the higher bilirubin levels reflect an agent-related phenomenon or an older population of affected patients is uncertain.
在33个月的时间里，295例急性病毒性肝炎患者住进了巴西圣保罗一家为公务员及其家属服务的国立医院。其中79%（232例）乙肝表面抗原（HBsAg）呈阴性。为确定非甲非乙型病毒性肝炎对该人群肝炎发病率的影响，对147例确诊为HBsAg阴性的患者进行了进一步的血清学研究。112例（76%）根据甲型肝炎病毒IgM抗体的检测结果被血清学分类为甲型肝炎。30例（20%）既无甲型肝炎病毒IgM抗体、HBsAg，也无抗-HBc抗体的患者被归类为非甲非乙型肝炎组。其余5例患者可能患有乙型肝炎（甲型肝炎病毒IgM抗体阴性，HBsAg阴性，抗-HBs阴性但抗-HBc阳性）。这些数据表明，圣保罗存在所有三种病毒性肝炎的地方流行情况。对甲型肝炎组和非甲非乙型肝炎组的流行病学、临床和实验室特征进行了比较。非甲非乙型肝炎患者的年龄显著大于甲型肝炎患者（平均年龄±标准差：30±22岁对9±9岁，p<0.001）。112例甲型肝炎患者中有26例（23%）以及30例非甲非乙型肝炎患者中有3例（10%）曾接触过肝炎患者或黄疸患者，差异无统计学意义。30例非甲非乙型肝炎患者中有13例（43%）以及112例甲型肝炎患者中有23例（21%）有过非肠道接触史。30例非甲非乙型肝炎患者中有5例（17%）报告在发病前2个月内曾接受过输血，而甲型肝炎组无一例输血（p<0.001）。虽然前驱症状和发热在甲型肝炎患者中更为常见，但这些症状以及其他临床特征似乎都不是鉴别特征。同样，每组的平均谷丙转氨酶（SGPT）峰值水平、SGPT峰值水平≥1000国际单位/升以及SGPT升高的平均持续时间均无显著差异。非甲非乙型肝炎组的平均血清胆红素峰值水平略高于甲型肝炎组（7.6±8.0毫克/分升对5.1±2.7，p<0.01），非甲非乙型肝炎组27%的患者胆红素峰值水平≥10毫克/分升，而甲型肝炎组为5%（p<0.001）。胆红素水平较高是反映与病原体相关的现象还是受影响患者年龄较大尚不确定。
