دورية أكاديمية

慢性B型和D型肝炎對愛滋病毒感染者病程之影響 ; Impact of Chronic Hepatitis B and D Infection on the Outcomes of Patients with Human Immunodeficiency Virus Infection

التفاصيل البيبلوغرافية
العنوان: 慢性B型和D型肝炎對愛滋病毒感染者病程之影響 ; Impact of Chronic Hepatitis B and D Infection on the Outcomes of Patients with Human Immunodeficiency Virus Infection
المؤلفون: 盛望徽, Sheng, Wang-Huei
المساهمون: 張上淳, 高嘉宏, 黃立民, 臺灣大學:
سنة النشر: 2007
المجموعة: National Taiwan University Institutional Repository (NTUR)
مصطلحات موضوعية: B型肝炎病毒, B型肝炎病毒基因型, 愛滋病毒, 急性肝炎, 肝代償失調, 高效能抗HIV病毒療法, D型肝炎病毒, B型肝炎血清標記, B型肝炎疫苗注射, hepatitis B virus, HBV genotype, human immunodeficiency virus, acute hepatitis, liver decompensation, highly active antiretroviral therapy, hepatitis D virus, HBV serological markers, HBV vaccination
الوصف: B型肝炎病毒(hepatitis B virus,HBV)與愛滋病毒(human immunodeficiency virus,HIV)是威脅人類健康最重要的兩種病毒。根據世界衛生組織的估計,全世界現有四千萬個HIV感染存活者,每年新增HIV感染個案有五百萬人,且每年有三百萬人死於愛滋病。慢性HBV感染者約有三億五千萬人,其中15%至25%病患經過20至30年的慢性肝炎急性發作後(廓清期),將演變為肝硬化或肝癌,每年因為B型肝炎死亡者約有一百萬人。由於此兩種病毒感染途徑相同,均是經由性行為、血液交換以及母子間垂直感染,因此同時感染HIV及HBV者並不少見。過去由於沒有很好的治療HIV藥物,大多數HIV患者很早就死於愛滋病相關的伺機性感染或腫瘤,使得慢性B型肝炎相關的併發症往往不易察覺。但是自從1996年開始使用高效能抗HIV病毒療法(highly active anti-retroviral therapy,HAART),病患得以長期存活,因此B型肝炎感染相關的併發症現在已經成為臨床照顧HIV病患的重要問題。 歐美開發國家一般族群之慢性HBV感染盛行率(HBV surface antigen;HBsAg血症持續超過6個月)約為0.5至2%,而HIV感染者中約有6至10%同時具有慢性HBV感染。台灣是HBV高流行的地區,一般族群慢性HBV感染約為15至17%,HIV感染的盛行率約為0.07%。根據本研究調查1994年至2005年在臺大醫院追蹤之1016位HIV感染者,其中有217位(21.4%)呈現血清HBV表面抗原(HBsAg)陽性;167位(16.4%)為慢性HBsAg帶原者(carrier);在217位HBsAg陽性患者中有47位(21.7%)血清HBV e抗原(HBV e antigen;HBeAg)陽性,此與一般族群之慢性HBV感染情況相似;在162位慢性HBsAg 帶原者中,36位(22.2%)為anti-HDV抗體陽性表示為D型肝炎病毒(hepatitis D virus;HDV)感染;1016位HIV感染者其中有91位(9.0%)為anti-HCV抗體陽性,表示為C型肝炎病毒(hepatitis C virus;HCV)感染。 在第一部分的研究,從1994年至2003年間,在排除C型肝炎感染的個案後,以111位具有慢性HBsAg帶原的HIV感染者及387位非HBsAg抗原帶原的HIV感染者做前瞻性分析。兩組在年齡、性別、感染HIV的危險因子、是否接受高效能抗HIV病毒療法、基礎之CD4淋巴球數與HIV病毒量、是否發生伺機性感染及基礎肝功能指標均無明顯之統計差異,平均觀察2年(25個月),結果發現合併慢性HBsAg帶原的HIV感染者比無HBsAg帶原感染者發生急性肝炎、肝代償失調(如凝血異常、腹水、黃疸、肝性腦病變等)及肝硬化的機會均明顯增加;特別是在高效能抗HIV病毒療法問世之後,合併慢性HBsAg帶原的HIV感染者比無HBsAg帶原者死亡率高。兩組患者在接受高效能抗HIV病毒療法後之血液CD4淋巴球數回升與發生伺機性感染並無顯著差異,但慢性HBsAg帶原的HIV感染者在治療過程中因急性肝炎發作而停止HIV治療導致HIV治療失敗的比例較無HBsAg帶原者高(p = 0.05)。不同的B型肝炎病毒基因型(基因型B與基因型C)在年齡、性別、感染HIV之危險因子、伺機性感染、血液CD4淋巴球數之上升、血清HIV病毒量之控制、發生急性肝炎之機會、肝代償失調、肝癌及死亡率並無統計上之顯著差異。由此可知慢性B型肝炎對HIV感染者臨床病程之影響極大,因此對於同時感染HIV及HBV的患者,應定期接受肝功能及腹部超音波檢查,對HBV無免疫力者,應考慮是否接受B型肝炎疫苗注射以避免感染。 D型肝炎病毒本身需要藉由HBsAg才能有複製功能,因此慢性HBsAg帶原者為HDV感染之高危險群。在非HIV患者之研究發現:HBsAg帶原者合併感染HDV時會加速肝功能惡化,發生肝硬化及肝代償失調的機會亦明顯增加。由於HDV也與HBV和HIV藉由相同途徑感染,因此HIV感染者很可能同時感染HBV及HDV。在第二部分的研究我們收集自1995年至2003年的HIV病患依1:3病例對照分析,以26位同時合併慢性感染HDV、HBV、HIV之患者與78位具有相同性別、年齡(± 2 歲)、起始點血液CD4淋巴球數、收案時間(± 3月)、血清白蛋白(albumin ± 0.5 g/dL)、直接型膽紅素(direct bilirubin ± 0.3 mg/dL),同時合併慢性感染HBV與HIV對照組患者,平均觀察4.5年(54.7個月)。研究結果發現合併HDV感染者有較高的靜脈藥癮患者比例(7.7%比1.3%,p = 0.05),且HDV感染者之基礎HBV病毒量較低(平均起始HBV病毒量為 4.04 log10比5.75 log10 copies/mL,p ...
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http://ntur.lib.ntu.edu.tw/bitstream/246246/55493/1/ntu-96-D89421005-1.pdfTest
رقم الانضمام: edsbas.EBAD84D7
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