Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C
Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C
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DOI：
10.1056/nejm199801293380503
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发表时间：
1998-01-29
影响因子：
158.5
通讯作者：
Concia, E
中科院分区：
文献类型：
--
作者：
Vento, S;Garofano, T;Concia, E
背景甲型肝炎病毒（HAV）感染很少引起无基础肝病的人暴发性肝衰竭。慢性B型肝炎和慢性丙型肝炎患者的感染过程中有有限的数据。方法我们前瞻性地随访，从1990年6月至1997年7月，595例成人的生化和组织学证据的慢性乙型肝炎B（163例）或慢性丙型肝炎（432例）谁是HAV抗体阴性。每4个月检测一次血清抗HAV IgM和IgG抗体。结果27例HAV重叠感染者中，慢性B型肝炎10例，慢性丙型肝炎17例。其中一名慢性B型肝炎患者同时患有肝硬化，有明显的胆汁淤积（血清胆红素峰值水平为28 mg/dl [479 μ mol/L]）;其他9名患者的甲型肝炎病程不复杂。7名慢性丙型肝炎患者发生了暴发性肝功能衰竭，除1人外均死亡。结论虽然大多数慢性B型肝炎患者获得性HAV感染有一个简单的过程，慢性丙型肝炎患者有很大的风险暴发性肝炎和死亡与HAV重叠感染。我们的数据表明，慢性丙型肝炎患者应接种甲型肝炎疫苗，（C）1998，马萨诸塞州医学会。
Background Hepatitis A virus (HAV) infection rarely causes fulminant hepatic failure in people with no underlying liver disease. There are limited data on the course of this infection in patients with chronic hepatitis B and chronic hepatitis C.Methods We prospectively followed, from June 1990 to July 1997, 595 adults with biochemical and histologic evidence of chronic hepatitis B (163 patients) or chronic hepatitis C (432 patients) who were seronegative for HAV antibodies. All were tested every four months for serum IgM and IgG antibodies to HAV.Results Twenty-seven patients acquired HAV superinfection, 10 of whom had chronic hepatitis B and 17 of whom had chronic hepatitis C. One of the patients with chronic hepatitis B, who also had cirrhosis, had marked cholestasis (peak serum bilirubin level, 28 mg per deciliter [479 mu mol per liter]); the other nine had uncomplicated courses of hepatitis A. Fulminant hepatic failure developed in seven of the patients with chronic hepatitis C, all but one of whom died. The other 10 patients with chronic hepatitis C had uncomplicated courses of hepatitis A.Conclusions Although most patients with chronic hepatitis B who acquired HAV infection had an uncomplicated course, patients with chronic hepatitis C had a substantial risk of fulminant hepatitis and death associated with HAV superinfection. Our data suggest that patients with chronic hepatitis C should be vaccinated against hepatitis A, (C) 1998, Massachusetts Medical Society.