Liaw Y F, Tsai S L, Sheen I S, Chao M, Yeh C T, Hsieh S Y, Chu C M
Liver Research Unit, Chang Gung Memorial Hospital and University, Taipei, Taiwan.
Am J Gastroenterol. 1998 Mar;93(3):354-9. doi: 10.1111/j.1572-0241.1998.00354.x.
Hepatitis B, C, and delta virus (HBV, HCV, HDV) share similar transmission routes; thus, dual or triple infections may occur and even persist in the same patient. However, little is known about the presentations and course of chronic HBV infection with HCV and HDV markers, which this study examined.
Antibodies against HCV (anti-HCV) and HDV (anti-HDV) were assayed as appropriate in patients with HBV infection. The clinical, pathological, and virological presentations as well as the course of the disease in patients with HBV/HDV/HCV triple infection markers were then reviewed.
A total of 60 patients, 51 men and nine women, age 19-67 yr (mean 45.9+/-1.6 yr) were identified. Of these 60 patients, five (8.3%) were HBeAg positive and 10 (16.7%) cirrhotic at entry, 30 (50%) presented with acute superinfection (HCV or HDV, or both) and the remaining 30 presented with chronic liver disease. On presentation, 16 (53.3%) of the 30 patients with acute superinfection showed hepatic decompensation and eight (26.7%) died. In contrast, only one of the patients with "chronic liver disease" presented with hepatic decompensation. Of the 42 patients followed up for 1-15 (mean, 4.7+/-0.6) yr, 45.2% showed remission and 19% showed HBsAg seroclearance, whereas 12.5% of the 32 noncirrhotics developed cirrhosis and three of the nine cirrhotics became decompensated. At the end of follow-up, 29 patients (69.9%) were still seropositive for HCV-RNA but only nine (22.5%) were seropositive for HDV-RNA and five (12.5%) were seropositive for HBV-DNA.
These results suggest that infection with HBV, HCV, and HDV triple markers is a severe disease in acute superinfection stage but that the course is relatively benign, slowly progressive, and usually dominated by HCV.
乙型肝炎病毒、丙型肝炎病毒和丁型肝炎病毒（HBV、HCV、HDV）具有相似的传播途径；因此，双重或三重感染可能发生，甚至在同一患者体内持续存在。然而，对于伴有HCV和HDV标志物的慢性HBV感染的表现和病程知之甚少，本研究对此进行了探讨。
对HBV感染患者酌情检测抗HCV（抗-HCV）和抗HDV（抗-HDV）抗体。然后回顾了具有HBV/HDV/HCV三重感染标志物患者的临床、病理和病毒学表现以及疾病病程。
共确定60例患者，其中男性51例，女性9例，年龄19 - 67岁（平均45.9±1.6岁）。在这60例患者中，5例（8.3%）入院时HBeAg阳性，10例（16.7%）为肝硬化，30例（50%）表现为急性重叠感染（HCV或HDV，或两者兼有），其余30例表现为慢性肝病。就诊时，30例急性重叠感染患者中有16例（53.3%）出现肝失代偿，8例（26.7%）死亡。相比之下，“慢性肝病”患者中只有1例出现肝失代偿。在42例随访1 - 15年（平均4.7±0.6年）的患者中，45.2%病情缓解，19% HBsAg血清学清除，而32例非肝硬化患者中有12.5%发展为肝硬化，9例肝硬化患者中有3例出现失代偿。随访结束时，29例患者（69.9%）HCV-RNA仍为血清阳性，但只有9例（22.5%）HDV-RNA为血清阳性，5例（12.5%）HBV-DNA为血清阳性。
这些结果表明，HBV、HCV和HDV三重标志物感染在急性重叠感染阶段是一种严重疾病，但病程相对良性且进展缓慢，通常以HCV为主导。
