Changing patterns of acute viral hepatitis at a major urban referral center in Egypt.
Changing patterns of acute viral hepatitis at a major urban referral center in Egypt.
复制标题
埃及一个主要城市转诊中心的急性病毒性肝炎模式正在发生变化。
DOI：
10.1086/511074
复制
发表时间：
2007
期刊：
影响因子：
--
通讯作者：
Zakaria,Serag
中科院分区：
文献类型：
--
作者：
Zakaria,Soheir;Fouad,Rabab;Shaker,Olfat;Zaki,Sami;Hashem,Ahmed;El-Kamary,SamerS;Esmat,Gamal;Zakaria,Serag
背景住院患者病毒病原学的变化可以告知我们急性病毒性肝炎感染的总体流行病学变化。我们假设，在过去的20年里，埃及医疗保健和卫生设施的改善对住院患者急性病毒性肝炎的病毒病因产生了显着影响。我们比较了一个主要城市转诊中心的急性病毒性肝炎的病毒病因与20年前同一中心报告的结果。在为期10个月的研究中，纳入了200例临床急性病毒性肝炎的连续住院患者，并对血清样本进行了甲型至戊型肝炎、巨细胞病毒和EB病毒的检测。急性B型肝炎病毒感染作为症状性肝炎的原因的频率从1983年的43.4%下降到2002年的28.5%（P<0.01），急性甲型肝炎病毒感染从1983年的2.1%上升到2002年的34%（P<0.01），并且发生在老年人中。1983年，非甲非乙型肝炎病毒感染引起急性病毒性肝炎的病例占38.7%，而本研究为31%（P= 0.12）。合并感染患者的平均丙氨酸氨基转移酶水平最高，临床表现不能区分不同的病毒性肝炎病因。自1983年进行早期研究以来，B型肝炎病毒感染显著减少，甲型肝炎病毒感染增加。B型肝炎病毒感染的减少是由于1991年开始的婴儿B型肝炎病毒普遍免疫接种导致儿童中B型肝炎病毒感染的急剧减少。临床甲型肝炎病毒感染的增加发生在老年患者中，这可能归因于卫生条件的改善，推迟了个人最初接触病毒的时间。
Background. Changes in the viral etiology of hospitalized patients can inform us of changes in the overall epidemiology of acute viral hepatitis infections. We hypothesized that improvements in health care and sanitation in the past 2 decades in Egypt have significantly impacted the viral causes of acute viral hepatitis in hospitalized patients. We compared the viral causes of acute viral hepatitis at a major urban referral center with results reported from the same center 20 years earlier.Methods. Over a period of 10 months, 200 consecutive inpatients with clinical acute viral hepatitis were enrolled in the study, and serum samples were tested for hepatitis A through E, cytomegalovirus, and Epstein-Barr virus.Results. The frequency of acute hepatitis B virus infection as a cause of symptomatic hepatitis decreased from 43.4% in 1983 to 28.5% in 2002 (P< .01), and acute hepatitis A virus infection increased from 2.1% in 1983 to 34% in 2002 (P< .01), and occurred at older ages. In 1983, non—A, non-B hepatitis virus infection caused acute viral hepatitis in 38.7% of cases, compared with 31% in the present study (P= .12). The mean alanine aminotransferase level was highest in patients with combined infections, and clinical presentation did not distinguish between different viral etiologies of hepatitis.Conclusions. A significant decrease in hepatitis B virus infection and an increase in hepatitis A virus infection have occurred since the earlier study was performed in 1983. The decrease in hepatitis B virus infection is attributable to the steep decrease in hepatitis B virus infection among children that resulted from the universal hepatitis B virus immunization of infants that was initiated in 1991. The increase in clinical hepatitis A virus infection occurred in older patients and could be attributed to improved sanitation that delayed individuals' initial exposures to the virus.