Histologic Studies of Severe Delta Agent Infection in Venezuelan Indians
Histologic Studies of Severe Delta Agent Infection in Venezuelan Indians
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委内瑞拉印第安人严重三角洲毒剂感染的组织学研究
DOI：
10.1002/hep.1840030603
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发表时间：
2007
期刊：
影响因子：
13.5
通讯作者：
R. Purcell
中科院分区：
文献类型：
--
作者：
H. Popper;S. Thung;M. Gerber;S. Hadler;M. D. Monzón;A. Ponzetto;E. Anzola;D. Rivera;A. Mondolfi;A. Bracho;D. Francis;J. Gerin;J. Maynard;R. Purcell
为了补充对委内瑞拉印第安人在偏远山谷中爆发的病毒性肝炎（显然是由三角洲病原体感染引起）的详细流行病学研究，我们对 10 份尸检标本进行了组织学和免疫细胞化学研究，并对 5 份活检标本进行了检查。患者是儿童和年轻人，主要是男性。假设了肝炎的一系列过程，从局灶性坏死伴明显的小液滴脂肪变性，到大面积坏死、长时间的坏死后塌陷，再到早期肝硬化伴大片塌陷。组织学变化初步表明 delta 剂具有细胞病变作用，但没有明显的淋巴细胞毒性迹象，至少在实质中是这样。在局灶性坏死阶段的肝细胞核中和在大面积坏死阶段的孤立细胞中发现了中等量的 Delta 剂，但在向肝硬化过渡期间却发现了大量的 Delta 剂。这些肝脏中既未显示出 HBcAg 也未显示出 HBsAg 的患者是否仅遭受乙型肝炎病毒携带者的重复感染和/或乙型肝炎病毒与 delta 剂的合并感染仍有待解决。 Delta 感染可能发生在孤立的环境中，与意大利血统、毒瘾或多输血无关。感染的传播范围比之前假设的要广泛得多。
To supplement a detailed epidemiologic study of an outbreak of viral hepatitis in Venezuelan Indians in isolated valleys, apparently resulting from delta agent infection, 10 autopsy specimens were studied histologically and immunocytochemically, and five biopsy specimens were examined. The patients were children and young adults and predominantly males. A sequence of hepatitis from focal necrosis with conspicuous small‐droplet steatosis, through massive necrosis, prolonged postnecrotic collapse to early cirrhosis with massive collapse was postulated. The histologic changes tentatively suggest a cytopathic effect of the delta agent without significant indication of lympho‐cytotoxicity, at least in the parenchyma. Delta agent was demonstrated in hepatocyte nuclei in moderate amounts in the focal‐necrotic stage and in isolated cells in the massive‐necrotic stage, but in large amounts during the transition to cirrhosis. Whether these patients, in whom neither HBcAg nor HBsAg were demonstrable in the liver, suffered exclusively from superinfection of hepatitis B virus carriers and/or coinfection of hepatitis B virus with the delta agent remains to be resolved. Delta infection may occur in isolated settings with no relation to Italian origin, drug addiction, or polytransfusion. The infection is far more widely spread than previously assumed.