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目的研究慢性乙型肝炎重叠戊肝感染的临床及免疫指标的变化特点与临床转归。方法选择慢性乙肝重叠戊型肝炎患者及同期单纯慢性乙肝患者各30例,分为重叠感染组和对照组,采用ELISA法检测戊型肝炎病毒以及乙肝病毒e系统状态,PCR法检测HBV-DNA,对慢性乙型肝炎重叠戊肝感染患者进行肝功能、免疫指标IL-4、TNF-α、IFN-γ、Th1/Th2的检测,并与单纯慢性乙型肝炎进行对照分析,观察两组在治疗8周时的肝功能恢复情况。结果重叠感染戊肝患者发生重症肝炎的人数多(9例vs 6例,P<0.05),e抗原转阴比例高(2例vs 1例),ALT、TBIL恢复较差,免疫指标提示与对照组相比,重叠感染组IL-4水平降低(P<0.05)、TNF-α、IFN-γ变化不大(P>0.05),Th1/Th2水平明显增高(P<0.05)。结论慢性乙型肝炎重叠HEV感染后病情趋向重症化,可能是由于抗炎性细胞因子IL-4表达减少,细胞免疫增强导致肝细胞大量损害所致。
Objective To study the clinical characteristics and clinical characteristics of clinical and immunological indexes of hepatitis B overlap hepatitis E infection. Methods Thirty patients with chronic hepatitis B and chronic hepatitis B were enrolled in this study. The patients were divided into overlapping infection group and control group. The status of hepatitis E virus and hepatitis B virus e were detected by ELISA. HBV-DNA, The levels of IL-4, TNF-α, IFN-γ and Th1 / Th2 in patients with chronic hepatitis B and hepatitis E infection were measured and compared with that of chronic hepatitis B. The levels of IL-4, Liver function recovery at 8 weeks. Results The number of patients with severe hepatitis with overlapping hepatitis E infection was higher (9 vs 6, P <0.05) and e antigen with high negative ratio (2 vs 1). The recovery of ALT and TBIL was poor. Compared with control group, IL-4 level in overlapping infection group decreased (P <0.05), TNF-α and IFN-γ level changed little (P> 0.05) and Th1 / Th2 level increased significantly (P <0.05). CONCLUSION: The disease tends to be severe after HEV infection. It may be due to the decrease of the expression of anti-inflammatory cytokine IL-4 and the increase of cellular immunity resulting in a large number of liver cell damage.