| Objective:China is one of the countries with high infection rate of HBV.In chronic hepatitis,HBV and HCV are the two main pathogenic factors.At the same time,HBV and HCV infection are the main causes of chronic liver diseases in the worldwide,which can lead to liver cirrhosis and hepatocellular carcinoma(HCC).Because both HBV and HCV are mainly transmitted outside the gastrointestinal tract and can be co-infected through the same way,HBV/HCV superinfection is not rare.Because of the existence of hidden HBV infection,the number of patients with HBV/HCV superinfe-ction may be underestimated.Therefore,in recent years,more and more attention has been paid to the co-infection of HBV and HCV.Due to the geographical distribution of the prevalence of HBV and HCV,the co-infection rate ranges from 1%to 15%in different regions.The co-infection rate of HBV/HCV in high-risk groups,such as intravenous drug addiction,hemodialysis,blood transfusion,organ transplantation and AIDS,has increased significantly,especially in the immunocompromised population.The old men with low immunity is the vulnerable population.Compared with patients with single virus infection,patients with HBV/HCV superinfection are more likely to suffer from severe liver damage,and the incidence of cirrhosis and hepatocellular carcinoma(HCC)is also significantly increased.Patients with HBV/HCV superinfection are also more likely to miss detection in clinical daily work.Therefore,in this study,we will explore:1.The correlation between HBV/HCV co-infection and single HBV,HCV infection in Hengshui area;2.Difference of viral load between HBV/HCV co-infection and HBV,HCV infection alone;3.The correlation between viral load and cytokine detection.Through the analysis of the above aspects,this paper provides a theoretical basis for understanding the clinical practice of HBV/HCV co-infection in Hengshui area,improving the detection rate of HBV/HCV superinfection in Hengshui area,detecting early,treating early and preventing the progress of the disease.Method:1.According to inclusion exclusion criteria,67 inpatients with HBV/HCV superinfection,127 inpatients with HBV infection and 113 patients with HCV infection were included in Hengshui Third People’s Hospital from October2016 to October 2017.2.Case inclusion criteria:1)patients with chronic liver diseases whose serum HBsAg,anti-HCV and HCV RNA were positive for more than 6months in patients with HBV/HCV superinfection;2)patients with HCV infection alone had the same diagnostic basis as those with HBV/HCV superinfection except for HBsAg negative;3)The diagnosis of HBV infection alone is based on chronic hepatitis B patients with HBsAg positive for more than 6 months or(and)HBV DNA positive;4)None of the patients received antiviral and immunomodulatory therapy;5)All the patients lived in Hengshui area.3.In the state of fasting,2 ml venous blood was collected and added into the vacuum condensation tube to let serum precipitate naturally.The collected serum was numbered and stored in the refrigerator freezer at-20℃for reserve.4.HBV serum antigen and antibody markers(HBsAg,HBsAb,HBeAg,HBeAb,HBeAb,HBcAb),HCV antibody qualitative detection,serum interleukin-1 beta(IL-1beta),interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-alpha),interleukin-4(IL-4),etc.Interleukin-10(IL-10)and other cytokines were sandwiched with ELISA double antibodies.5.The plasma prothrombin activity(PTA),albumin(Alb),globulin(Glb),aspartate aminotransferase(AST),alanine aminotransferase(ALT),total bilirubin(TB)and glutamyltransferase(GGT)were measured by Olympus automatic biochemical analyzer.6.Statistical methods:SPSS 23.0 statistical software was used to analyze the results,and P<0.05 was defined as the statistical significance.The measurement data are expressed as(mean±standard)deviation and analyzed by t-test,chi-square test of counting data statistics,correlation analysis is used to analyze the relationship between detection indicators,R represents correlation coefficient,R represents positive correlation,and R represents negative correlation.Results:1.Comparison of general data of three groups of patients:There was no significant difference in the general data of patients with HBV infection alone,HCV infection alone and HBV/HCV superinfection group(P>0.05).2.Comparison of viral load among three groups of patients:the positive rate of HBV DNA in inpatients with HBV infection alone was 70.0%,which was significantly higher than that in patients with HBV/HCV superinfection(55.2%).The difference was statistically significant(P<0.05);The positive rate of HCV RNA in inpatients with HCV infection alone was 100.0%,which was significantly higher than that in patients with HBV/HCV superinfection(31.3%).The difference was statistically significantc(P<0.05).The HBV DNA load in HBV/HCV superinfection group was(12.98±1.24)×10~3IU/ml,and that in single HBV infection group was(98.92±2.57)×10~3IU/ml.The HBV DNA load in HBV/HCV superinfection group was significantly lower than that in HBV infection group alone.There was significant difference in HBV DNA load between the two groups(P<0.05);The HCV RNA load in HBV/HCV superinfection group was(37.5±8.9)×10~3IU/ml,and that in single HCV infection group was(374.2±31.2)×10~3IU/ml.The HCV RNA load in HBV/HCV superinfection group was significantly lower than that in HCV infection group alone.There was significant difference in HCV RNA load between the two groups(P<0.05).3.Comparison of biochemical Indexes of liver function among three groups:1)Compared with the single HBV infection group,the levels of Glb,TB,ALT and GGT in the overlapping infection group increased significantly,while the levels of PTA decreased significantly(P<0.05);2)Compared with the single HCV infection group,the levels of Alb in HBV/HCV overlapping infection group decreased significantly,while the levels of Glb,TB,AST,ALT and GGT increased significantly,while the levels of PTA decreased significantly(P<0.05).4.Comparison of five items of hepatitis B between single HBV infection group and HBV/HCV superinfection group:Compared with the HBV infection group alone,the HBeAg positive rates were significantly increased in the HBV/HCV overlapping infection group,and the HBcAb positive rates were significantly decreased in the HBV/HCV overlapping infection group,with statistically significant results(P<0.05).HBeAg positive is a reliable marker of hepatitis B virus replication and infection;HBcAb is not a protective antibody,but a marker of hepatitis B virus previous infection.The decrease of HBcAb positive rate in HBV/HCV superinfection group may be related to HCV interference with HBV virus replication.5.Comparison of liver injury process among the three groups:The incidence of chronic hepatitis in the HBV/HCV replication group was significantly lower than that of the pure HBV infection group(32.84%v.s78.74%),and the incidence of chronic hepatitis in the overlapping infection group was significantly lower than that of the pure HCV infection group(32.84%v.s87.61%),and the difference was statistically significant(χ2=67.48,P<0.05).The incidence of liver cirrhosis in HBV/HCV repeated infection group was higher than that in simple HBV infection group(31.34%v.s21.26%),and the incidence of liver cirrhosis in superinfection group was significantly higher than that in HCV infection group(31.34%v.s 11.50%).The prognosis of cirrhotic patients in superinfection group was poor,and there was significant difference in prognosis and prognosis between the two groups(χ2=10.66,P<0.05).6.Comparison of viral load and cytokines in patients with HBV/HCV superinfection:The overlapping replication group was divided into two groups.Detection of group I viral load≥1.0×10~3 copies/ml by real-time fluorescence quantitative PCR,and detection of group II viral load<1.0×10~3copies/ml by real-time fluorescence quantitative PCR.The levels of IL-1β,IL-6,TNF-αand IL-4,IL-10 in group I were significantly different from those in group II(P<0.05).The levels of IL-1βand IL-6,TNF-αin II group were lower than those in group I,while the levels of IL-4,IL-10 in group I were significantly higher than those in group I(P<0.05).HBV DNA load was positive correlated with IL-1β,IL-6 and TNF-α,and negative correlated with IL-4 and IL-10,with statistically significant difference(P<0.05).HCV RNA load was positive correlated with IL-1,IL-6and TNF-α,and negative correlated with IL-4 and IL-10,with statistically significant difference(P<0.05).Conclusion:1.Compared with patients with single virus infection,patients with HBV/HCV superinfection are more likely to suffer from severe liver damage,and the incidence of liver cirrhosis is also significantly increased.2.Patients with HBV/HCV superinfection in the course of liver Cirrhosis,the lower the replication load of HBV DNA,HCV RNA virus,the more serious the liver injury,the degree of liver lesion and even the decompensation stage of liver cirrhosis,and the prognosis was poor.In the HBV/HCV superinfection group,the biochemical indexes related to liver function were significantly higher and the liver injury was more serious.The patients in the HBV/HCV superinfection group should be diagnosed early and treated at an early stage.3.In the HBV/HCV superinfection group,HBV DNA,HCV RNA load was positively correlated with IL-1β,IL-6,TNF-α,and negatively correlated with IL-4,IL-10. |
PDF Full Text Request