The Research Of Sporadic Cases Of Acute Viral Hepatitis E And HEV Co-infection In HBV Patients

HEV is one of the main pathogens causing sporadic cases of acute hepatitis in adult inChina. Acute viral hepatitis E has accounted for the first place of acute sporadic hepatitis inmost areas of China and the incidence of this disease is higher in the elderly. With high rate ofHBV infection, our country has a mass of patients of chronic viral hepatitis B (CHB) orHBV-induced liver cirrhosis(HLC). So,there is a high incidence of HEV co-infection in HBVpatients. In recent years,most patients with acute viral hepatitis E are sporadic cases, andlimited epidemics have occurred in few countries.The idea that HEV co-infection in patientsof chronic liver can accentuate further disease had been put forward by some scholars, as wellas the exist of interaction between HEV and HBV.However, no final conclusions have yetbeen reached on these matters.The high incidence and severe impact on prognosis ofoverlapping infection of HBV and HEV cause our reflection.In this research, patients in Jilinprovince were investigated to realize the clinical manifestations and current situation ofsporadic of acute hepatitis E and HEV co-infection in chronic viral hepatitis B,and providemore evidences for the impaction of HEV.Our study designed to explore the clinical characteristics of sporadic cases of acutehepatitis E in Jilin province of China in recent six years and the current situation of HEVco-infection in patients of HLC. Analyzing the affection imposed by HEV co-infection inpatients of HLC and CHB.Retrospective analysis of188sporadic cases of acute hepatitis E was made,which werecollected from1st hospital of Jilin University from January2005to October2011.Comparative analysis of clinical data was made between the165patients of HEV infectionalone and13patients of HEV co-infection in CHB，which all came from the188sporadiccases of acute hepatitis E. Serological studies of anti-HEV IgM and anti-HEV IgG was madein patients with HLC，who were in hospital from December2011to June2012in1st hospitalof Jilin University. The clinical characteristics and laboratory reports of HEV co-infection of CHB and HLC were analysed. Clinical data of165patients of HEV infection alone and13patients of HEV co-infection in CHB were compared with24patients of HLC with positiveanti-HEV IgM, which consisted of6sporadic cases of acute hepatitis E and18cases of HLCwith positive anti-HEV IgM detected in this experiment test.All of the188cases of acute hepatitis E are sporadic cases in four seasons without familyaggregation. There are152cases of acute jaundice（80.85%）,24cases of acute jaundice-free（12.77%）,12cases of severe hepatitis（6.38%）. In non-elderly group,5patients are severehepatitis cases (3.65%) who were cured. In elderly group,7patients are severe hepatitis cases(13.73%), and3patients died. The incidence of fatigue, jaundice, ascites, and severe hepatitisin elderly group are significantly higher than in non-elderly group, there are significantstatistical differences between the two groups(P<0.05)；There are no significant statisticaldifferences between the two groups of T-BIL, D-BIL, ALT, AST. ALB, CHE, andprothrombin activity (PTA) was statistically different(P<0.05).7patients with severe hepatitisin elderly group,6cases are found be positive with anti-HBs and anti-HBc.In the188sporadic cases of acute hepatitis E, the age and the levels of ALT and CHE in165cases of HEV co-infection in CHB is significantly lower than the13cases of HEVinfection alone. The result of comparison of PT and AFP are quite the opposite（P<0.05).Thelevel of PTA is lower in HEV co-infection in CHB, and the levels of GGT,T-BIL,D-BIL arelower in HEV infection alone(0.05<P <0.10).There are no obvious distinction with levels ofAST,ALP,TP,ALB,GLB and I-BIL between the two groups.Among the336patients of HLC detected HEV serologically,there is a total of18patientscombined positive anti-HEV IgM, which have1case of hepatic encephalopathy,3cases ofupper gastrointestinal hemorrhage,4cases of liver failure and2cases of death in the group ofHLC above.However, in318patients combined negative anti-HEV IgM, there are5cases ofhepatic encephalopathy,1case of liver failure and no death among them.The levels ofALT,ALP,T-BIL,D-BIL,I-BIL in group of positive anti-HEV IgM are significantly higherthan the group of negative anti-HEV IgM.The levels of GLB in group of positive anti-HEVIgG are significantly higher than the group of negative anti-HEV IgG. And the level of A/Gobviously lower than the group of negative anti-HEV IgG. Comparison of clinical data was made between165cases of HEV infection alone and37cases of co-infection with patients of HBV (19cases of the188sporadic cases of acutehepatitis E and18cases of HLC with positive anti-HEV IgM detected in this experiment.Theage and the levels of PTA，ALT，ALP，GGT，ALB，CHE in group of HEV infection aloneis significantly higher than the group of HEV co-infection with patients of HBV. The level ofPT is quite the opposite.Clinical data of165cases of HEV infection alone were comparedwith24cases of HLC with positive anti-HEV IgM (6cases in188sporadic cases of acutehepatitis E and18cases of HBV-induced liver cirrhosis with positive anti-HEV IgM whichdetected in this experiment). Patients in group of HEV infection alone had higher levels ofALB,CHE than the group of HLC with positive anti-HEV IgM,and higher level ofPTA(P<0.05).The level of AST in13cases of CHB with positive anti-HEV IgM issignificantly higher than24cases of HLC with positive anti-HEV IgM (P<0.05).In sporadic cases of acute hepatitis E patients, acute jaundice type account for a highproportion. There is a high incidence and high mortality of severe hepatitis in elderly patients.Patients accompanied by anti-HBs associated with other antibody-positive should beware ofoccult HBV Infection. High sensitivity of detection methods should be used to do HBV DNAdetection,to provide a better basis for clinical diagnosis and treatment. Patients of viralhepatitis B may prior to earlier HEV than common human.Nowadays, there is a higherincidence of HEV co-infection in patients with HBV-induced liver cirrhosis. HEVco-infection can obviously accentuate further disease. Patients in group of HEV co-infectionwith patients of HBV had more severe disease than patients with CHB or HEV infectionalone.HEV co-infection should be pay more attention to patients of HBV. Once the conditionof patients of HBV deteriorated rapidly, the possibility of HEV co-infection should beconsidered.