过去HBV感染对慢性丙型肝炎自然史和治疗结果的影响

tonychant

分类：丙型肝炎――自然史/丙型肝炎――治疗――干扰素/病毒唑
乙型和丙型肝炎病毒是导致慢性肝病的最常见原因，且其垂直传播具有共同的危险因素。二者感染的自然史依赖于宿主的免疫状态。
慢性乙型肝炎患者合并丙型肝炎病毒感染的发生率很低，然而大约有1/3的丙型肝炎患者的血清中可以检出过去HBV感染的标记物（抗HBc阳性/HBsAg阴性）。
近来的研究显示血清中具有较低滴度HBV-DNA的存在和患者肝组织学具有过去感染的血清学证据有关。本研究的目的是观察过去HBV感染对HCV自然史和其对抗病毒治疗的应答的影响。
对我们临床中心在1999年到2002年登记HCV感染者进行回顾性分析。研究剔除了过去6个月内合并HIV感染、同时在进行血液透析、HBsAg阳性、或酒精Hx阳性者。
共有感染HCV的96位患者进入分析，其中40位患者具有抗HBc阳性（42％），56位抗HBc阴性（58％）。对两组的人口统计学特征、ALT水平、病毒负荷、基因型、铁蛋白、转铁蛋白饱和度和组织学、以及METAVIR分期、肝铁分布（细胞内和小叶内），治疗应答进行了比较。
结果
抗HBc阳性者常见于非洲籍美国患者25/47（52％），而高加索人为15/49（31％）。这一差距具有明显的统计学差异（Chi 卡方 5.03, p<0.02）
抗HBc阳性者其HCV-RNA滴度较低。门脉和小叶3区较高的肝铁评分在抗HBc阳性者具有显著的差异性。
两组在年龄、性别、乙醇利用的Hx、体重指数、ALT、铁蛋白、转铁蛋白饱和度、HCV基因型、组织学活动度或纤维化指数方面没有差异。
两组对治疗亦没有可鉴定的差异，其应答率分别为6/24（25％）和4/31（12％）。
过去暴露于HBV感染更常见于非洲籍美国人中，同时伴有较低滴度的HCV-RNA水平，更多巨噬细胞和门脉区肝铁蓄积。
总之，作者写到，这一发现将为对那些过去感染HBV者免疫状态的改变提供证据。其对HCV感染者的组织学和治疗应答无明显影响可能于研究样本量太少有关。对更多患者的血清和肝脏组织中HBV-DNA的评估正在进行。
Impact of Past HBV Infection on the Natural History of Chronic Hepatitis C and Treatment Outcome
Hepatitis B (HBV) and C (HCV) viruses are important causes of chronic liver disease and are transmitted parenterally with common risk factors. The natural history of these infections is dependant on the host immune status.
The prevalence of chronic HBV infection in patients with HCV is low, however, approximately 1/3 of patients with HCV have serological markers of past HBV infection (antiHbc positive/HbsAg Negative).
Recent studies have shown the presence of low levels of HBV DNA in serum and hepatic tissue of patients with serological evidence of past infection. The aim of the present study was to study the impact of past HBV infection on the natural history of HCV and on response to antiviral treatment.
Records of patients with HCV evaluated through our clinic between 1999-2002 were reviewed. Patients with HIV, on Hemodialysis, HBsAg positive, or Hx of alcohol use in the last six months were excluded.
Ninety-six patients with HCV were enrolled in the analysis. Forty patients were antiHbc positive (42%) and 56 were antiHbc negative (58%). The two groups were compared with respect to demographics, ALT, viral load, genotype, ferritin, transferrin saturation, histological grading and staging (METAVIR), hepatic iron distribution(cellular and zonal), and treatment response.
Results
AntiHBc positive was more frequent in African American (AA) patients 25/47(52%) compared to Caucasians 15/49(31 %). These differences were statistically significant (Chi square 5.03, p< 0.02).
HCV RNA was lower in patients with positive antiHBc. Hepatic iron distribution revealed significant differences with higher iron score in portal triads and zone 3 in patients with antiHBc positive.
There were no differences in the two groups regarding age, sex, Hx of ETOH use, BMI, ALT, ferritin, transferrin saturation, HCV genotype, histologic activity or fibrosis indices.
There was no identifiable difference in response to treatment between the two groups 6/24 (25%) vs 4/31(12%).
Evidence of past exposure to HBV was more prevalent in AA and was associated with lower HCV RNA levels and more macrophage and portal hepatic iron.
In conclusion, the authors write, 揟hese findings would suggest evidence for altered immune status in patients with past HBV infection. The lack of demonstrable impact on hepatic histology and response to HCV therapy is likely related to the small size of the study population. Evaluation is underway with larger number of patients and serum and hepatic HBV DNA assay.?/span>
05/24/04
Reference
M Azzouz and others. Impact of Past HBV Infection on the Natural History of Chronic Hepatitis C and Treatment Outcome. Abstract 2037 (poster). Digestive Disease Week. May 15-20, 2004. New Orleans, LA.