戊型肝炎病毒感染对慢性丙型肝炎患者病情严重程度的影响

肝脏 ›› 2023, Vol. 28 ›› Issue (5): 537-540.

戊型肝炎病毒感染对慢性丙型肝炎患者病情严重程度的影响

刘皇村, 李优磊, 刘永成

716000 延安延安大学医学院(刘皇村,李优磊);延安大学附属医院病理科(刘永成)

收稿日期:2022-10-08 出版日期:2023-05-31 发布日期:2023-08-29
通讯作者: 刘皇村,Email:huangcunliu2023@163.com
基金资助:
延安大学校级科研项目(YDY2020-20)

Influence of hepatitis E virus infection on the severity of chronic hepatitis C patients

LIU Huang-cun¹, LI You-lei¹, LIU Yong-cheng²

1. Yan’an University School of Medicine, Shaanxi 716000 China;
2. Department of Pathology, Yan’an University Hosital, Shaanxi 716000, China

Received:2022-10-08 Online:2023-05-31 Published:2023-08-29
Contact: LIU Huang-cun,Email:huangcunliu2023@163.com

摘要/Abstract

摘要： 目的评估慢性丙型肝炎(CHC)患者中戊型肝炎病毒(HEV)感染的患病率及其对肝纤维化严重程度的影响。方法收集2016年1月—2021年10月期间广西壮族自治区南溪山医院收治的CHC患者184例,其中男性86例、女性98例,年龄60(31, 80)岁。依据CHC患者是否合并感染HEV分为单纯CHC组、合并HEV组,比较两组一般资料、血清肝纤维化指标及临床转归结果。结果 CHC患者中22例(11.9%)检测为抗HEV-IgG阳性,3例(1.6%)检测为抗HEV-IgM阳性,另有1例(0.5%)检测为抗HEV-IgM、抗HEV-IgG均为阳性,HEV感染率为14.1%(26/184)。比较临床资料,单纯CHC组年龄为60(31, 70)岁,显著低于合并HEV组[66(52, 80), P<0.05];与合并HEV组[14例(53.8%)]比,单纯CHC组糖尿病比例明显降低[33例(20.9%), P<0.05];单纯CHC组PLT为182(111, 304)×10⁹/L,显著高于合并HEV组[116(70, 192)×10⁹/L, P<0.05];单纯CHC组ALT、TBil为111(81, 194)U/L、124.2(70.8, 255.5)μmol/L,均分别显著低于合并HEV组[163(102, 321)U/L、204.8(110.6, 375.0)μmol/L,P<0.05]。单纯CHC组HA、PⅢNP、C-Ⅳ及LN为126(86, 190)ng/mL、8.7(6.0, 13.4)ng/mL、118(74, 168)ng/mL及112(93, 128)ng/mL,均分别显著低于合并HEV组[310(178, 502)ng/mL、24.4(17.2, 27.0)ng/mL、292(144, 380)ng/mL及130(114, 175)ng/mL, P<0.05]。单纯CHC组黄疸持续时间、病程持续时间为26(18, 40)d、26.5(22.0, 33.5)月,均显著短于合并HEV组[38(33, 52)d、45.0(38.5, 55.0)月,P<0.05]。结论 HCV感染患者中HEV血清阳性率较高,同时肝纤维化程度更高、临床转归更差。HEV筛查应当在HCV感染患者中常规开展。

关键词: 慢性丙型肝炎, 戊型肝炎病毒, 透明质酸

Abstract: Objective To evaluate the prevalence of HEV infection in patients with chronic hepatitis C (CHC) and its influence on the severity and the incidence of liver fibrosis.Methods A total of 184 patients with CHC were collected from January 2016 to October 2021, including 86 males and 98 females, with an average age of 60 (31, 80) years old. Patients with CHC were divided into simple CHC group and HEV group according to whether they were infected with HEV. The general data and pathological results of the two groups of patients were compared.Results 22 cases (11.9%) of CHC patients were positive for anti-HEV-IgM, 3 cases (1.6%) were positive for anti-HEV-IgM, and 1 case (0.5%) was positive for both anti-HEV-IgM and anti-HEV-IgG. The infection rate of HEV was 14.1% (26/184). Compared with clinical data, the average age of simple CHC group was 60 (31, 70) years old, which was significantly lower than that of HEV group [66 (52, 80), P<0.05]. Compared with HEV group [14 cases (53.8%)], the proportion of diabetes in CHC group alone was significantly lower [33 cases (20.9%), P<0.05]; the PLT of simple CHC group was 182 (111, 304) ×10⁹/L, which was significantly higher than that of HEV group [116 (70, 192) ×10⁹/L, P<0.05]. The ALT and TBil in CHC group were 111 (81, 194) U/L and 124.2 (70.8, 255.5) μmol/L, which were lower than those in HEV group [163 (102, 321) U/L and 204.8 (110.6, 375.0) μmol/L, respectively. HA, pIIINP, c-IV and LN in CHC group were 126 (86, 190) ng/mL, 8.7 (6.0, 13.4) ng/mL, 118 (74, 168) ng/mL and 112 (93, 128) ng/mL, which were lower than those of 310 (178, 502) ng/mL, 24.4 (17.2, 27.0) ng/mL, 292 (144, 380) ng/mL and 130 (114, 175) ng/mL in the combined HEV group (P<0.05). The duration and course of jaundice in CHC group were 26 (18, 40) days and 26.5 (22.0, 33.5) months, which were significantly shorter than those in HEV group [38 (33, 52) days and 45.0 (38.5, 55.0) months, P<0.05].Conclusion In HCV infected patients, the positive rate of HEV serum is high, while the degree of liver fibrosis is higher and the clinical outcome is worse. HEV screening should be routinely carried out in HCV infected patients.

Key words: Chronic hepatitis C, Hepatitis E virus, Hyaluronic acid

刘皇村, 李优磊, 刘永成. 戊型肝炎病毒感染对慢性丙型肝炎患者病情严重程度的影响[J]. 肝脏, 2023, 28(5): 537-540.

LIU Huang-cun, LI You-lei, LIU Yong-cheng. Influence of hepatitis E virus infection on the severity of chronic hepatitis C patients[J]. Chinese Hepatolgy, 2023, 28(5): 537-540.

参考文献

[1] Aggarwal R, Goel A. Advances in hepatitis E - I: virology, pathogenesis and diagnosis. Expert Rev Gastroenterol Hepatol, 2016, 10(9):1053-1063.
[2] Drexler JF, Seelen A, Corman VM, et al. Bats worldwide carry hepatitis E virus-related viruses that form a putative novel genus within the family Hepeviridae. J Virol, 2012, 86(17):9134-9147.
[3] Ankcorn M, Said B, Morgan D, et al. Persistent hepatitis E virus infection across England and Wales 2009-2017: Demography, virology and outcomes. J Viral Hepat, 2021, 28(2):420-430.
[4] Sagnelli E, Coppola N, Pisaturo M, et al. HBV superinfection in HCV chronic carriers: a disease that is frequently severe but associated with the eradication of HCV. Hepatology, 2009, 49(4):1090-1097.
[5] Konstantinou D, Deutsch M. The spectrum of HBV/HCV coinfection: epidemiology, clinical characteristics, viralinteractions and management. Ann Gastroenterol, 2015, 28(2):221-228.
[6] Desikan P, Rangnekar A, Khan Z, et al. Sero-occurrence of HBV/HCV co-infection and levels of liver enzymes among patients at a tertiary care hospital in central India: a pilot study. Cent Asian J Glob Health, 2019, 8(1):313.
[7] Kyvernitakis A, Taremi M, Blechacz B, et al. Impact of hepatitis E virus seropositivity on chronic liver disease in cancer patients with hepatitis C virus infection. Hepatol Res, 2015, 45(11):1146-1151.
[8] 陈文, 杨春, 邓存良, 等. HBV与HEV重叠感染致慢加急性肝衰竭临床特征分析. 肝脏, 2014, (30):4007-4009.
[9] Bricks G, Senise JF, Pott Junior H, et al. Seroprevalence of hepatitis E virus in chronic hepatitis C in Brazil. Braz J Infect Dis, 2018, 22(2):85-91.
[10] Desbois AC, Cacoub P. Diabetes mellitus, insulin resistance and hepatitis C virus infection: A contemporary review. World J Gastroenterol, 2017, 23(9):1697-1711.
[11] Lee H, Chien RN, Pao LH, et al. Decoupled glucose and lipid metabolic recovery after viral clearance in direct-acting antiviral-treated HCV patients: A 3-year prospective cohort study. Cells, 2021, 10(11):2934.
[12] Mahmoud B, Moneim AA, Mabrouk D. The impact of HCV eradication on hyperglycemia, insulin resistance, cytokine production, and insulin receptor substrate-1 and 2 expression in patients with HCV infection. Clin Exp Med, 2021, 22(4):583-593.
[13] Bricks G, Senise JF, Pott-Jr H, et al. Previous hepatitis E virus infection, cirrhosis and insulin resistance in patients with chronic hepatitis C. Braz J Infect Dis, 2019, 23(1):45-52.
[14] Wallace SJ, Swann R, Donnelly M, et al. Mortality and morbidity of locally acquired hepatitis E in the national Scottish cohort: a multicentre retrospective study. Aliment Pharmacol Ther, 2020, 51(10):974-986.
[15] Zhang X, Ke W, Xie J, et al. Comparison of effects of hepatitis E or A viral superinfection in patients with chronic hepatitis B. Hepatol Int, 2010, 4(3):615-620.