人类非嗜肝病毒所致肝炎患者临床特征的相关性分析

Correlation analysis of clinical features of patients with hepatitis caused by human non-hepatotropic viruses

摘要:

目的  探讨人类非嗜肝病毒所致肝炎的病因和临床特征。方法  对176例人类非嗜肝病毒性肝炎患者进行临床研究，用常规方法检测112例甲-戊型肝炎标志物，排除嗜肝病毒感染。检测单纯疱疹病毒（HSV）、EB病毒（EBV）、巨细胞病毒（CMV）、柯萨奇病毒（CoxV）等病毒的IgM、IgG型抗体和自身抗体（线粒体抗体和抗核抗体），随访6个月，并将其临床症状体征、肝功能指标与同期急性病毒性肝炎比较。结果  非嗜肝病毒肝炎患者病原体以CMV感染最多（34.7%），其次分别为EB病毒和轮状病毒感染（24.4%、9.6%），非嗜肝病毒肝炎患者的乏力、纳差、厌油、恶心、肝肿大、皮肤黄染发生率较同期急性病毒性肝炎低，两者比较差异有统计学意义（P <0.01），其脾肿大、淋巴结肿大的发生率较同期急性病毒性肝炎高，两者比较差异有统计学意义（P <0.01）；非嗜肝病毒肝炎患者肝功能的ALT、AST、TBIL值较同期的急性病毒性肝炎值低，两者比较差异有统计学意义（P <0.01），清蛋白、凝血酶原时间值与急性病毒性肝炎比较，差异无统计学意义（P > 0.05）；非嗜肝病毒肝炎患者的单一感染的ALT、AST、TBIL较复合感染时间短，两者比较差异有统计学意义（P <0.01）。结论  巨细胞病毒、EB病毒等为非嗜肝病毒肝炎的常见病原体，临床表现为急性肝损伤，但较急性病毒性肝炎轻，单一感染较复合感染轻，预后较好。

Abstract:

Objective To explore the etiology and clinical features of hepatitis caused by human non-hepatotropic viruses. Methods This clinical research included 176 cases of viral hepatitis caused by non-hepatotropic viruses. Conventional method was used to detect hepatitis A to E markers in 112 cases to exclude hepatotropic virus infection. IgM and IgG antibodies and autoantibodies (mitochondrial antibody and antinuclear antibody) against Herpes simplex virus (HSV), Epstein-Barr virus (EB), Cytomegalovirus (CMV), Coxsackie virus (CoxV) and other viruses were detected. The patients were followed up for 6 months. Their clinical symptoms and signs, and liver function indexes were compared with those of the patients with acute viral hepatitis during the same period. Results  The most common non-hepatotropic pathogen for viral hepatitis was Cytomegalovirus(34.7%), followed by Epstein-Barr virus and Rotavirus (24.4% and 9.6%). The incidences of fatigue, nausea, anorexia, hepatomegaly and jaundice were significantly lower while the incidences of splenomegaly and lymph node enlargement were significantly higher in the patients with non-hepatotropic virus hepatitis than in the patients with acute viral hepatitis during the same period (P < 0.01). ALT, AST and TBIL levels in the patients with non-hepatotropic virus hepatitis were significantly lower than those in the patients with acute viral hepatitis (P < 0.01); while albumin and prothrombin time had no statisti cally significant differences between them (P > 0.05). ALT, AST and TBIL in the patients with single non-hepato-tropic virus infection were significantly lower than those in the patients with compound infection (P < 0.01). Conclusions CMV and EB virus are common pathogens of hepatitis caused by non-hepatotropic viruses. The clinical manifestation is acute liver damage which is lighter than that of acute viral hepatitis and lighter in single infection than in compound infection. The prognosis of non-hepatotropic virus hepatitis is good.