急性戊肝与慢性乙肝重叠感染的临床研究

目的了解急性戊肝与慢性乙肝重叠感染的临床特点及影响散发性戊肝发病的危险因素，探讨选择合理治疗方案减少重叠感染重型肝炎的发生率和病死率。方法2004年1月至2010年12月住院诊断为急性戊肝患者115例，将慢性乙肝重叠HEV感染（简称戊乙肝）与单纯HEV感染进行对照研究。结果115例戊型肝炎均为急性起病，平均年龄（42±15）岁，其中戊乙肝44例，单纯戊肝71例；男女比例2．83：1。戊乙肝组入院时重度黄疸（总胆红素〉200μmol／L）、重度凝血功能异常（凝血酶原活动度〈40％）、低蛋白血症的发生率明显高于单纯戊肝组（P〈0．05）；戊乙肝组肝性脑病发生率为15．90％，明显高于单纯戊肝组（P〈0．05）；戊乙肝组重型肝炎发生率为38．64％，病死率为35．29％，明显高于单纯戊肝组（P〈0．05）；人工肝支持系统（ALSS）＋内科综合治疗可提高重型肝炎存活率（P〈0．05）。结论海鲜食用史是戊肝发病的主要危险因素；慢性乙肝重叠HEV急性感染易导致慢性乙型肝炎病情加重，易发生重型肝炎，病死率高；在内科综合治疗基础上，早期使用ALSS可明显降低重型肝炎的病死率。

Clinical study on chronic hepatitis B virus infected patients superinfected with hepatitis E virus

Objective To investigate the clinical features of chronic hepatitis B virus （HBV） infected patients superinfected with hepatitis E virus （HEV）, and the risk factors of acute sporadic HEV case. Explore reasonable treatment to reduce the incidence of severe viral hepatitis and mortality in the HBV/HEV superinfection. Methods The clinical characteristics of the patients with HBV and HEV su- perinfection were compared with those simple HEV infection. Results A total of 115 hepatitis E cases were all acute attack with an average of （42 ± 15） years old and the ratio of male to female was 2. 83： 1. The 44 cases of them were HBV/HEV superinfection, the other 71 cases were the simple hepatitis E. In the HBV/HEV superinfection group the sever jaundice （TB 〉 200μmol/L）, the severe abnormal coagu- lation function （PTA 〈 40% ）, the hypoalbuminemia was obviously more than that in the simple hepatitis E group（ P 〈 0. 05）. The incidence of hepatic encephalopathy was 15.90%, the severe hepatitis rate was 38.64% , obviously higher than that in the simple hepatitis E group （P 〈 0. 05 ）. ALSS has good effects in the treatment of the patients with severe viral hepatitis. Conclusions Seafood were the risk factors in the infection of HEV. Superinfection of HBV and HEV can cause chronic and more severe hep- atitis, with high mortality. Combined hepatotherapy with ALSS has good effects, the general survival rate is higher, especially in early stage.