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目的为了更好地了解戊肝患者重叠慢性乙型肝炎病毒感染后的临床表现及预防,对22例患者的临床资料进行分析。方法对236例2006年1月至2007年5月在沈阳市第六人民医院急肝病房戊肝住院患者的病历进行回顾性分析。结果236例戊肝患者中,单一戊肝组213例(占90.3%),乙戊肝重叠感染组22例(占9.3%)。丙戊重叠感染组1例(占0.4%)。三组中ALT(发病后10d内所测结果)单一戊肝组(1592±535)U/L,乙戊肝组为(1486±582)U/L,无明显差异(P>0.05);重度黄疸数(TB≥200μmol/L)单一戊肝组18例。乙戊肝组10例,乙戊肝组显著多于单一戊肝组(P<0.01),凝血酶原时间延长(PT超过正常值3s),单一戊肝组为10例,乙戊肝组为7例,乙戊肝组显著多余单一戊肝组(P<0.01),ALT的复常时间,单一戊肝组为(20.6±10.2)d。乙戊肝组(22.4±11.3)d,乙戊肝组与单一戊肝组无明显差异(P>0.05);TBIL的复常时间,单一戊肝组为(29.5±13.7)d,乙戊肝为(38.2±19.6)d,乙戊肝组明显长于单一戊肝组(P<0.01);PT的复常时间,单一戊肝组为(22.5±8.9)d,乙戊肝组为(36.8±12.6)d,乙戊肝组显著长于单一戊肝组(P<0.01)。本组236例戊肝患者中发生重型肝炎14例,单一戊肝组213例中6例(占2.8%),出现上消化道出血1例,出现自发性细菌性腹膜炎3例,均抢救存活。乙戊肝组重型肝炎8例(36.4%),均为慢性乙型肝炎和乙肝后肝硬化。7例出现自发性细菌性腹膜炎,2例出现上消化道出血,1例出现II度以上肝性脑病,其中2例死亡。结论戊型肝炎病毒感染一般多表现为急性,以瘀胆为主,死亡1%～4%。重叠感染者的病情重,病程长,病死率高。这可能与慢性乙型肝炎患者多存在细胞免疫功能缺陷,不能及时清除病毒有关。另外,慢性乙型肝炎患者多有不同程度的肝功能受损,戊肝病毒感染是原有的肝脏损伤进一步加重,诱发肝功能衰竭。因此,乙型肝炎病毒感染患者要注意个人饮食卫生,加强对HEV感染的预防是十分必要的。更应持警惕的态度,及时有效的治疗,防止病情加重。
Objective To understand the clinical manifestation and prevention of hepatitis E patients with overlapping hepatitis B virus infection, the clinical data of 22 patients were analyzed. Methods A retrospective analysis was performed on the medical records of 236 patients admitted to the emergency room of hepatic ward in Hepatitis E from January 2006 to May 2007 in Shenyang Sixth People ’s Hospital. Results Among the 236 patients with hepatitis E, 213 patients (90.3%) had hepatitis E alone and 22 patients (9.3%) had hepatitis E hepatitis overlapping infection. Propranolol overlap infection in 1 case (0.4%). ALT in the three groups (1592 ± 535 U / L vs 1486 ± 582 U / L) was not significantly different between the two groups (P> 0.05) Jaundice number (TB ≥ 200μmol / L) single eighteen patients with hepatitis E group. There were 10 cases in group B and group B, and there were more cases in group B and group E than those in group E (P <0.01). Prothrombin time was prolonged (PT exceeded 3s) In 7 cases, there was a significant excess of single hepatitis E (P <0.01) in ALD group, and the duration of ALT was (20.6 ± 10.2) days in single hepatitis E group. There was no significant difference between group B and group E (22.4 ± 11.3) d, group B and group E (P> 0.05). The time of TBIL recanalization was (29.5 ± 13.7) d and group B Was (38.2 ± 19.6) d, and the duration of PT was (22.5 ± 8.9) d in the group of single ehepatitis and (36.8 ± 12.6) d, B and E group was significantly longer than single HepG group (P <0.01). The group of 236 cases of hepatitis E patients occurred in 14 cases of severe hepatitis, single hepatitis E group 213 cases in 6 cases (2.8%), 1 case of upper gastrointestinal bleeding, spontaneous bacterial peritonitis occurred in 3 cases, were rescued. Eight cases of hepatitis B hepatitis B (36.4%) were chronic hepatitis B and hepatitis B cirrhosis. Seven cases of spontaneous bacterial peritonitis, 2 cases of upper gastrointestinal bleeding, 1 case of hepatic encephalopathy over II degrees, of which 2 died. Conclusions Hepatitis E virus infection is mostly acute, with stasis and gallbladder, with a mortality rate of 1% to 4%. Overlapped patients with severe illness, longer duration, high mortality. This may be associated with chronic hepatitis B patients with many cellular immune dysfunction, can not be timely virus removal. In addition, patients with chronic hepatitis B have varying degrees of liver damage, hepatitis E virus infection is the original liver injury further aggravated, induced liver failure. Therefore, patients with hepatitis B virus infection should pay attention to personal hygiene, strengthen the prevention of HEV infection is very necessary. Should be vigilant attitude, timely and effective treatment to prevent aggravating.