内科

目的探讨HBV/HCV重叠感染患者HBV DNA、HCV RNA的复制及肝脏损害情况，加深对HBV/HCV重叠感染患者的认识。方法选取2000～2013年在深圳市第三人民医院住院治疗的HBV/HCV重叠感染患者116例为研究对象。根据患者HBV DNA、HCV RNA实时荧光定量PCR定量检测结果，将患者分为4组，即HBV单阳性组（27例）、HCV单阳性组（49例）、双阳性组（17例）和双阴性组（23例）。比较4组患者年龄、性别、可能传播途径的差异；检测比较4组患者的谷丙转氨酶（ALT）水平及肝纤维化情况；对双阳性组患者的HBV DNA水平与其HCV RNA水平的关系进行Pearson相关性分析；比较4组患者的HBV DNA及HCV RNA复制水平。结果双阴性组患者的年龄显著小于其他3组患者，差异有统计学意义（P＜0.05）；4组患者的ALT水平表现为HBV单阳性组＞双阴性组＞双阳性组＞HCV单阳性组，差异有统计学意义（P＜0.05），中重度肝纤维化表现为HBV单阳性组（25.9%)＞双阳性组（23.5%)＞HCV单阳性组（18.4%)＞双阴性组（17.4%)，但差异无统计学意义（P＞0.05）。Pearson相关性分析结果显示，双阳性组患者的HBV DNA水平与其HCV RNA水平呈负相关(r=-0.519）。双阳性组患者的HBV DNA复制水平明显低于HBV单阳性组，差异有统计学意义（P＜0.05）。结论HBV/HCV重叠感染患者体内HBV DNA与HCV RNA复制存在相互抑制和消耗情况，重叠感染患者体内HCV RNA复制占主导地位可能会促使其HBV自发阴性率有所增高。

ObjectiveTo explore the replication of HBV DNA and HCV RNA, and liver damage in patients with HBV/HCV superinfection, to deepen the understanding of patients with HBV/HCV superinfection. MethodsA total of 116 patients with HBV/HCV superinfection hospitalized in the Third People′s Hospital of Shenzhen from 2000 to 2013 were selected as the research objects. According to the real-time fluorescence quantitative PCR detection results of HBV DNA and HCV RNA, patients were divided into 4 groups, namely HBV single positive group (27 cases), HCV single positive group (49 cases), double-positive group (17 cases) and double negative group (23 cases). Age, gender, and differences in possible transmission routes of the 4 groups were compared. The alanine aminotransferase (ALT) level and liver fibrosis of the 4 groups were detected and compared. Pearson correlation analysis was used to analyze the relationship between levels of HBV DNA and HCV RNA in the double-positive group. HBV DNA and HCV RNA replication levels of the 4 groups were compared. ResultsPatients in the double negative group were significantly younger than those in the other three groups, with a statistically significant difference (P＜0.05). Descending order was presented in the ALT level following HBV single positive group, double negative group, double-positive group, and HCV single positive group, with a statistically significant difference (P＜0.05) as well as moderate-severe liver fibrosis as follows: HBV single positive group (25.9%), double-positive group (23.5%), HCV single positive group (18.4%), and double negative group (17.4%), without a statistically significant difference (P＞0.05). Pearson correlation analysis showed that the HBV DNA level was negatively correlated with its HCV RNA level in the double-positive group (r=-0.519). The HBV DNA replication level of patients in the double-positive group was significantly lower than that in the HBV single positive group, with a statistically significant difference (P＜0.05). ConclusionHBV DNA and HCV RNA replication showed mutual interactions and depletion in patients with HBV/HCV superinfection. HCV RNA replication plays a predominant role in superinfection patients, which may increase HBV spontaneous negative rate.