Weltman M D, Brotodihardjo A, Crewe E B, Farrell G C, Bilous M, Grierson J M, Liddle C
Department of Gastroenterology and Hepatology, University of Sydney, Westmead Hospital, NSW, Australia.
J Viral Hepat. 1995;2(1):39-45. doi: 10.1111/j.1365-2893.1995.tb00070.x.
Chronic coinfection with the hepatitis B (HBV) and hepatitis delta (HDV) viruses is known to cause severe liver disease, but the importance of coinfection with hepatitis C virus (HCV) and HBV has not been well documented. In the present study, the clinical and pathological severity of liver disease among patients with hepatitis resulting from multiple viruses was examined and an open trial of the efficacy of interferon-alpha 2b (IFN-alpha) treatment was conducted. Nineteen patients with chronic HBV and HCV infection and 17 with HBV, HCV and HDV infection were studied; 12 in each group underwent liver biopsy. For each coinfected patient, two patients infected with HCV alone were selected as controls, and these were matched for age and risk factor and were estimated to have been infected for a similar duration. Coinfection with HBV and HCV or HBV, HCV and HDV was associated with more severe liver disease than HCV alone (P < 0.01); total Scheuer score, portal and lobular inflammation and fibrosis were all worse in coinfected subjects. Eight patients with chronic HBV and HCV were treated with recombinant IFN-alpha 2b [3 million units (MU), thrice weekly for 6 months]. Liver function tests normalized in two patients and one lost hepatitis B surface antigen (HBsAg). Seven patients with hepatitis B, C and delta coinfection were treated with the same regimen and only one normalized serum alanine aminotransferase (ALT) during (and after) treatment. It is concluded that coinfection with multiple hepatitis viruses is associated with histologically more severe liver disease than HCV alone.(ABSTRACT TRUNCATED AT 250 WORDS)
已知乙型肝炎病毒（HBV）和丁型肝炎病毒（HDV）的慢性合并感染会导致严重的肝脏疾病，但丙型肝炎病毒（HCV）与HBV合并感染的重要性尚未得到充分记录。在本研究中，对多种病毒所致肝炎患者肝脏疾病的临床和病理严重程度进行了检查，并对α-2b干扰素（IFN-α）治疗的疗效进行了开放试验。研究了19例慢性HBV和HCV感染患者以及17例HBV、HCV和HDV感染患者；每组12例接受肝脏活检。对于每例合并感染患者，选择2例单独感染HCV的患者作为对照，这些对照在年龄和危险因素方面相匹配，且估计感染持续时间相似。与单独感染HCV相比，HBV与HCV或HBV、HCV和HDV合并感染与更严重的肝脏疾病相关（P<0.01）；合并感染患者的总Scheuer评分、门脉和小叶炎症及纤维化均更严重。8例慢性HBV和HCV患者接受重组IFN-α 2b治疗[300万单位（MU），每周3次，共6个月]。2例患者肝功能检查恢复正常，1例失去乙肝表面抗原（HBsAg）。7例HBV、HCV和HDV合并感染患者接受相同治疗方案，治疗期间（及治疗后）仅1例血清丙氨酸氨基转移酶（ALT）恢复正常。结论是，与单独感染HCV相比，多种肝炎病毒合并感染与组织学上更严重的肝脏疾病相关。（摘要截短于250字）
