急性散发性戊型病毒性肝炎及乙戊重叠感染的研究

发布时间：2018-03-04 18:21

本文选题：HBV　切入点：HEV　出处：《吉林大学》2013年硕士论文　论文类型：学位论文

【摘要】：HEV是引起我国成年人急性散发性肝炎的主要病原体，在多数地区的急性散发性肝炎病因中已占首位，尤其在老年人中占有更高的比例。我国亦是乙型肝炎的高发区，有大量的慢性乙型病毒性肝炎和乙肝肝硬化的患者，因此，HBV与HEV的重叠感染在我国较多见；近些年，急性戊型病毒性肝炎多为散发病例，仅个别国家的某些地区有过小型流行；有学者提出了在慢性肝病基础上合并HEV感染可加重病情，也有提出两种病毒可相互作用，但该类观点尚无定论；乙戊重叠感染的高发生率和对患者预后影响的重要性不得不引起我们的深思。此次研究，我们主要对吉林省的患者进行调查分析，以了解急性散发性戊型病毒性肝炎及乙肝肝硬化患者合并HEV感染的临床特点及现状；对HEV感染所致影响等进行研究，为更进一步研究提供依据。本次研究旨在探讨本地区近6年急性散发性戊型病毒性肝炎的临床特点；分析乙肝后肝硬化患者合并HEV感染的现状及对患者的影响；探讨不同肝病基础的患者发生HEV感染后的发病情况。我们通过以下方法进行研究，对2005年1月至2011年10月吉林大学第一医院收治的抗-HEV IgM阳性的188例急性散发性戊型病毒性肝炎患者的临床数据进行回顾性分析；对其中的单纯HEV感染组与慢性乙型病毒性肝炎合并HEV感染组的临床数据进行比较分析。对2011年12月至2012年6月吉林大学第一医院收治的乙肝肝硬化患者行抗-HEV IgM与抗-HEV IgG的血清学研究，分析HEV合并感染对乙肝肝硬化人群的影响。并对急性散发性戊型病毒性肝炎中165例单纯HEV感染者、13例慢性乙型病毒性肝炎合并HEV感染者与24例乙肝肝硬化抗-HEV IgM(+)患者（急性散发性戊型病毒性肝炎中的6例与本次实验检测的18例）的临床特征及数据进行分析。本次研究的188例急性戊型病毒性肝炎均为四季散发病例，无家庭聚集现象。临床类型表现为急性黄疸型152例（80.85%）、急性无黄疸型24例（12.77%）、重型肝炎12例（6.38%）。年龄60岁患者（非高龄组）共137例，其中重型肝炎5例（3.65%），无死亡病例。年龄≥60岁（高龄组）患者51例，，其中重型肝炎7例（13.73%），死亡3例。高龄组黄疸、腹水及重症肝炎发生率明显高于非高龄组（P 0.05）；两组总胆红素(Total bilirubin,T-BIL)、直接胆红素(Direct bilirubin,D-BIL)、天门冬氨酸氨基转移酶(Aspartate amino transferase,AST)比较无统计学差异，丙氨酸氨基转移酶(Alanine-aminotransferase, ALT)、白蛋白(Albumin,ALB)、胆碱酯酶(Cholinesterase,CHE)及凝血酶原活动度(Prothrombin activity, PTA)比较差异具有统计学意义（P0.05）。高龄组7例重型肝炎中6例发现抗-HBs与抗-HBc均为阳性。在188例急性散发性戊型病毒性肝炎患者中，165例单纯HEV感染组患者的年龄比13例慢性乙型病毒性肝炎合并HEV感染组明显较高，慢性乙型病毒性肝炎合并HEV感染组的凝血酶原时间(Prothrombin time,PT)、甲胎蛋白(Alpha fetoprotein,AFP)水平明显高于单纯HEV感染组，ALT、CHE水平明显低于单纯HEV感染组（P0.05)。慢性乙型病毒性肝炎合并HEV感染组的PTA水平低于单纯HEV感染组，其谷酰转肽酶(Glutamyl transpeptidase,GGT)、T-BIL、D-BIL水平比单纯HEV感染较高，差别具有边缘显著性（0.05P 0.10）。两组间的年龄、AST、碱性磷酸酶(Alkaline phosphatase,ALP)、白蛋白(Total protein,TP)、 ALB、球蛋白(Globulin,GLB)、间接胆红素(Indirectbilirubin,I-BIL)水平无明显差别。在336例行HEV抗体血清学检测的乙肝肝硬化患者中，抗-HEV IgM（+）的患者共18例（5.36%）；其中，肝性脑病1例（5.56%），上消化道出血3例（16.67%），肝衰竭有4例(22.22%)，死亡2例（11.11%）；乙肝肝硬化抗-HEV IgM（-）的患者共318例，肝性脑病5例（1.57%），其中I期有2例，II期、III期、IV期各有1例；肝衰竭1例（0.31%），无死亡。ALT、ALP、T-BIL、D-BIL、I-BIL水平明显高于阴性组。乙肝肝硬化抗-HEV IgG(+)组的GLB水平明显高于抗-HEV IgG(-)组，A/G水平明显低于抗-HEVIgG(-)组（P0.05）。对比165例单纯HEV感染者与37乙戊重叠感染者（19例来自急性散发性戊型病毒性肝炎患者，18例来自本次检测抗-HEV IgM(+)的乙肝肝硬化患者）的临床数据，单纯HEV感染组的年龄比乙戊重叠感染组明显较高，PT水平明显低于乙戊重叠感染组，PTA、ALT、ALP、GGT、ALB、CHE水平明显高于乙戊重叠感染组。165例单纯HEV感染者与24例乙肝肝硬化抗HEV-IgM（+）患者（6例来自急性散发性戊型病毒性肝炎、18例来自本次HEV的血清学检测患者）比较发现，单纯HEV感染组患者的ALB、CHE水平明显高于乙肝肝硬化合并HEV感染组，乙肝肝硬化合并HEV感染组的PTA水平明显低于单纯HEV感染组，差别有统计学意义；乙肝肝硬化合并HEV感染组的PT水平高于单纯HEV感染组，差别具有边缘显著性（P=0.059）。13例慢性乙型病毒性肝炎合并HEV感染者的AST水平明显高于24例乙肝肝硬化合并HEV感染者（P0.05)。经过研究，我们得出以下结论：（1）急性散发性戊型病毒性肝炎患者中，急性黄疸型比例高，高龄组重症肝炎发生率高，死亡率高，其中针对抗-HBs伴随有其他抗体阳性患者，要注意隐匿性HBV感染的存在，应使用高敏感性检测方法进一步行乙肝病毒脱氧核糖核酸(Hepatitis B virusDNA,HBV DNA)定量检测，为临床诊治提供更充足的依据。乙型病毒性肝炎较一般人发生HEV感染年龄更早，且合并HEV感染后，其肝功能损伤明显重于单纯急性戊型病毒性肝炎患者。（2）乙肝后肝硬化患者合并HEV感染率较高，且发生HEV感染后肝功能明显恶化。（3）乙戊重叠感染比单纯HEV感染组的病情明显重，预后差。慢性乙型病毒性肝炎及乙肝肝硬化患者应尤其注意预防HEV的合并感染，一旦发生病情迅速恶化，应考虑到合并HEV感染的可能性。
[Abstract]:HEV is the major cause of China's adult acute sporadic hepatitis, in most areas of acute sporadic hepatitis accounted for the first cause, especially has a much higher percentage in the elderly. China is also a high incidence of hepatitis B, chronic hepatitis B and hepatitis B cirrhosis of the patients, so and the co infection of HBV and HEV in China; in recent years, the acute hepatitis E for sporadic cases, some areas only individual countries have small popular; some scholars put forward the combined HEV infection may increase the severity of chronic liver disease in the foundation, has put forward two kinds of virus interaction, but the point of view is inconclusive; superinfection hepatitis E high incidence and prognosis of patients with the influence of importance have caused us to think deeply. In this study, we mainly investigated by patients in Jilin Province, to the Objective to investigate the clinical characteristics and current status of HEV infection in patients with acute sporadic hepatitis E and hepatitis B cirrhosis, and to study the effects of HEV infection, so as to provide evidence for further research.
The purpose of this study is to explore the clinical characteristics of acute sporadic hepatitis E in the past 6 years, analyze the current situation of HEV infection in patients with hepatitis B cirrhosis and its impact on patients, and explore the incidence of HEV infection in patients with different liver diseases.
We studied through the following methods, from January 2005 to October 2011 in No.1 Hospital of Jilin University were anti -HEV IgM positive 188 cases of acute sporadic hepatitis E patients with clinical data were retrospectively analyzed; a comparative analysis of the clinical data of simple HEV infection group and the chronic hepatitis B with HEV infection group. Serological study patients with hepatitis B cirrhosis on December 2011 to June 2012 in No.1 Hospital of Jilin University were anti -HEV IgM and anti -HEV IgG, analysis of HEV infection of hepatitis B cirrhosis patients. And the acute sporadic viral hepatitis E in 165 patients with HEV infection, 13 cases of chronic hepatitis B with HEV infection and 24 cases of anti hepatitis B cirrhosis -HEV IgM (+) patients (6 cases of acute sporadic hepatitis E in this experiment and clinical detection of 18 cases) Bed features and data are analyzed.
188 cases of acute viral hepatitis E in this study were four sporadic cases, non family aggregation. Clinical manifestations of acute jaundice type in 152 cases (80.85%), acute jaundice type in 24 cases (12.77%), 12 cases of severe hepatitis (6.38%). The age of 60 patients (non elderly group) 137 cases, including 5 cases of severe hepatitis (3.65%), no deaths. Aged 60 years (elderly group) 51 cases, including 7 cases of severe hepatitis (13.73%), 3 cases of death. The age group of jaundice, ascites and severe hepatitis were significantly higher than that in non elderly group (P 0.05); the two group total bilirubin (Total bilirubin, T-BIL), direct bilirubin (Direct, bilirubin, D-BIL), aspartate aminotransferase (Aspartate amino, transferase, AST) showed no significant difference, alanine aminotransferase (Alanine-aminotransferase, ALT), albumin (Albumin, ALB), cholinesterase (Cholinesterase, CHE) and prothrombin activity The difference of Prothrombin activity (PTA) was statistically significant (P0.05). In 7 cases of severe hepatitis, 6 cases were found to be positive for both anti -HBs and anti -HBc.
In 188 cases of acute sporadic hepatitis E patients, 165 cases of HEV infected patients were older than 13 cases of chronic hepatitis B with HEV infection group was significantly higher in chronic hepatitis B patients with HEV infection group, prothrombin time (Prothrombin time, PT), alpha fetoprotein (Alpha fetoprotein, AFP) was significantly higher than that of the simple HEV infection group, ALT, CHE levels were significantly lower than the simple HEV infection group (P0.05). Chronic hepatitis B with HEV infection group the level of PTA was lower than that of pure HEV infection group, the GGT (Glutamyl transpeptidase, GGT), T-BIL, D-BIL levels higher than the HEV infection. The difference is marginally significant (0.05P 0.10). Between the two groups in age, AST, alkaline phosphatase (Alkaline phosphatase, ALP), albumin (Total protein, TP, ALB), immunoglobulin (Globulin, GLB), indirect bilirubin (Indirectbilirubin, I-BIL) of water There is no obvious difference.
In the detection of 336 cases of hepatitis B serological HEV antibody in patients with liver cirrhosis, anti -HEV IgM (+) with a total of 18 cases (5.36%); among them, 1 cases of hepatic encephalopathy (5.56%), upper gastrointestinal bleeding in 3 cases (16.67%), liver failure in 4 cases (22.22%), 2 cases of death (11.11%); -HEV IgM anti hepatitis B cirrhosis (-) patients with a total of 318 cases of hepatic encephalopathy in 5 cases (1.57%), of which 2 cases of stage I, stage II, stage III, stage IV were 1 cases; 1 cases of liver failure (0.31%), no death in.ALT, ALP, T-BIL, D-BIL, I-BIL levels were significantly higher than that of negative group. Liver cirrhosis IgG anti -HEV (+) group GLB levels were significantly higher than that of anti -HEV IgG (-) group, the A/G level was significantly lower than that of anti -HEVIgG (-) group (P0.05).
Overlapping infection compared with 165 cases of simple HEV patients and 37 patients (19 cases from B e acute sporadic hepatitis E patients, 18 cases from the detection of anti -HEV IgM (+) of patients with hepatitis B cirrhosis) clinical data, simple HEV infection group than B e age overlapping infection group were significantly more higher. The level of PT was significantly lower than that of B e superinfection group, PTA, ALT, ALP, GGT, ALB, CHE levels were significantly higher than that of Ethyl Amyl superinfection group of.165 patients with simple HEV infection and 24 cases of hepatitis B cirrhosis anti HEV-IgM (+) patients (6 cases from sporadic acute viral hepatitis, 18 cases from the HEV the serological detection of patients) comparison, simple HEV infection group were ALB, CHE levels were significantly higher than that of liver cirrhosis with liver cirrhosis with HEV infection group, HEV infection group PTA levels were significantly lower than that in HEV infected group, the difference was statistically significant; liver cirrhosis complicated with HEV infection The level of PT in the group was higher than that in the simple HEV infection group. The difference was marginally significant (P=0.059). The AST level of.13 patients with chronic hepatitis B and HEV infection was significantly higher than that of 24 cases of hepatitis B cirrhosis combined with HEV infection (P0.05).
After the study, we draw the following conclusions:
(1) patients with acute sporadic hepatitis E in acute icteric high proportion of patients with severe hepatitis with high incidence rate, high mortality, the needle against -HBs along with other antibody positive patients, attention should be paid to the occult HBV infection exists, should be used for further emotional Gao Min detection method of hepatitis B virus DNA (Hepatitis B virusDNA, HBV DNA) quantitative detection, provide a more adequate basis for clinical diagnosis and treatment. Hepatitis B virus is generally HEV infection earlier age with HEV infection, the liver injury was more severe than simple acute viral hepatitis E patients.
(2) the incidence of HEV infection in patients with hepatitis B after liver cirrhosis is higher and the liver function is obviously worse after HEV infection.
(3) the incidence of HEV infection is significantly heavier than that of the simple infection group. The prognosis is poor. Patients with chronic hepatitis B and hepatitis B cirrhosis should pay special attention to prevent HEV infection. Once the disease is deteriorating rapidly, we should take into consideration the possibility of HEV infection.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R512.6

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