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目的 :分析丁型肝炎病毒(HDV)感染患者临床特点 ,探讨丁型肝炎发病机制。方法 :对507例HDV( +)肝炎患者各临床类型肝炎的发病率、疾病转归、临床表现、肝功能、肝炎病毒标志物等进行统计分析 ,以213例HDV( -)乙型肝炎患者作对照。结果 :HDV感染后重型肝炎和肝硬化的发生率及病死率均较HDV( -)者高(P<0.01)。HDV( +)患者出血、腹水、肝性脑病、并发症的发生率及ALT反复增高和增高幅度均较HDV( -)者高 (P<0.01或0.05) ,且慢性肝炎重度和重型肝炎患者主要肝功能改变也较对照组明显 (P<0.01) ,而血清HBeAg检出率降低 (P<0.01)。HDV( +)的HBVDNA( -)组的HBeAg( -)表达高于HBVDNA( +)组 (P<0.01)。急性肝炎、重型肝炎和肝硬化HDAg( +)HBeAg( -)表达高于HDAg( +)HBeAg( +)表达 (P<0.01或P<0.05)。结论 :HDV感染与慢性肝炎重度、重型肝炎和肝硬化的发生及预后密切相关。HDV感染可抑制HBVDNA复制或HBcAg表达。HDV的直接细胞毒性作用在急性肝炎中可能起主要致病作用。HDV重叠感染的乙肝患者其病情加重、病死率增高和慢性化过程中 ,HDV可能起了主要促进作用。
Objective: To analyze the clinical characteristics of patients with hepatitis D virus (HDV) infection and to explore the pathogenesis of hepatitis D. Methods: The incidence, clinical manifestation, liver function and hepatitis virus markers of 507 patients with HDV (+) hepatitis were analyzed statistically. A total of 213 patients with HDV (-) hepatitis B Control. Results: The incidence and mortality of severe hepatitis and cirrhosis after HDV infection were higher than those with HDV (-) (P <0.01). The incidence of hemorrhage, ascites, hepatic encephalopathy, complications and the increase and increase of ALT in HDV (+) patients were higher than those in HDV (-) patients (P <0.01 or 0.05), and those in chronic hepatitis with severe and severe hepatitis The change of liver function was also significantly higher than that of the control group (P <0.01), while the detection rate of serum HBeAg was lower (P <0.01). HBeAg (-) expression in HDV (+) HBVDNA (-) group was higher than that in HBVDNA (+) group (P <0.01). The HDAg (+) HBeAg (-) expression in acute hepatitis, severe hepatitis and cirrhosis was higher than that in HDAg (+) HBeAg (+) (P <0.01 or P <0.05). Conclusion: HDV infection is closely related to the occurrence and prognosis of severe chronic hepatitis, severe hepatitis and cirrhosis. HDV infection can inhibit HBVDNA replication or HBcAg expression. The direct cytotoxic effect of HDV may play a major pathogenic role in acute hepatitis. HDV may play a major role in the progression of hepatitis B patients with overlapping HDV infections, increased mortality and chronic disease.