Troisi C L, Hollinger F B, Hoots W K, Contant C, Gill J, Ragni M, Parmley R, Sexauer C, Gomperts E, Buchanan G
Baylor College of Medicine, Houston, TX 77030.
Blood. 1993 Jan 15;81(2):412-8.
Hemophilia A and B patients seen at nine US regional treatment centers were tested for serologic markers of hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis delta virus (HDV) during 1987 and 1988. Because human immunodeficiency virus (HIV) infection, a potentially confounding variable, was present in 53% of the group, the population was divided by HIV status for analysis purposes. In the HIV-positive group (N = 382), less than 1% had not been infected with HBV, HCV, or HDV, whereas 75% had evidence of infection with HBV and 98% with HCV. HBsAg, a marker of active HBV infection, was present in 12% of subjects; 96% of these were HCV positive. Anti-HDV was detected in 35 subjects (9.1%); all were anti-HBc positive. Ten of the 35 (29%) also were positive for IgM anti-HDV, indicating current infection. All 10 were HBsAg positive and 7 of the 9 tested were HDV RNA positive. Severe/moderate hemophilia B patients were more likely to have experienced an HBV infection and to be anti-HDV positive than were similar hemophilia A patients (22% v 8%, P < .05). In the HIV-negative group (N = 345), the subjects were younger and had less severe hemophilia than the HIV-positive patients. No evidence of HBV, HCV, or HDV infection was found in 18%, whereas 33% had experienced HBV infection and 79% were anti-HCV positive. Within this group, 4% were HBsAg positive. All 13 subjects with anti-HDV (4% of the HIV-negative group) also possessed anti-HBc. One (7.7%) was IgM anti-HDV positive and the serum from another contained HDV RNA. Both of these individuals were HBsAg positive. As in the HIV-positive group, severe/moderate hemophilia B patients were more likely to be HBV and HDV positive than were hemophilia A patients (9% v 3%, P < .05). A prevalence study of viral hepatitis in a large US hemophilic population showed that active infection with HCV is common, occurring in 89% of all study patients regardless of HIV status. Evidence of active HBV infection was found in 8%; 19% of these were actively infected with HDV. HDV was more common in hemophilia B patients after controlling for disease severity.
1987年至1988年期间，对在美国9个地区治疗中心就诊的甲型和乙型血友病患者进行了乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）和丁型肝炎病毒（HDV）血清学标志物检测。由于该组中有53%的患者存在人类免疫缺陷病毒（HIV）感染这一潜在混杂变量，为便于分析，将人群按HIV感染状态进行了划分。在HIV阳性组（N = 382）中，不到1%的患者未感染HBV、HCV或HDV，而75%的患者有HBV感染证据，98%的患者有HCV感染证据。12%的受试者存在活跃HBV感染的标志物HBsAg；其中96%的患者HCV呈阳性。35名受试者（9.1%）检测出抗HDV；所有受试者抗HBc均为阳性。35名受试者中有10名（29%）IgM抗HDV也呈阳性，表明存在现症感染。所有10名患者HBsAg均为阳性，9名接受检测的患者中有7名HDV RNA呈阳性。与甲型血友病患者相比，中重度乙型血友病患者更易发生HBV感染且抗HDV呈阳性（22%对8%，P < 0.05）。在HIV阴性组（N = 345）中，受试者比HIV阳性患者更年轻，血友病病情也较轻。18%的患者未发现HBV、HCV或HDV感染证据，而33%的患者曾有HBV感染，79%的患者抗HCV呈阳性。该组中4%的患者HBsAg呈阳性。所有13名抗HDV的受试者（占HIV阴性组的4%）抗HBc也均为阳性。1名受试者（7.7%）IgM抗HDV呈阳性，另1名受试者的血清含有HDV RNA。这两名患者HBsAg均为阳性。与HIV阳性组一样，中重度乙型血友病患者比甲型血友病患者更易出现HBV和HDV阳性（9%对3%，P < 0.05）。一项针对美国大量血友病患者群体的病毒性肝炎患病率研究表明，HCV现症感染很常见，所有研究患者中89%的患者无论HIV感染状态如何均有感染。8%的患者有活跃HBV感染证据；其中19%的患者同时活跃感染HDV。在控制疾病严重程度后，HDV在乙型血友病患者中更为常见。
