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肝移植术后丁型肝炎病毒再感染

Author
Anna SF Lok, MD
Section Editor
Robert S Brown, Jr, MD, MPH
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF
Translators
饶伟, 副主任医师

引言

在美国，丁型肝炎病毒(hepatitis D virus, HDV)感染并不常见。不到3%的急性乙型肝炎病毒(hepatitis B virus, HBV)感染患者共感染了HDV。基于20多年前进行的研究，估计大约有70,000名美国人是HDV慢性携带者，并且每年因HDV相关肝病死亡的患者多达1000例[1]。这些数据尚未更新。

HDV感染通常仅发生于共感染HBV的患者，其临床病程高度可变[1,2]。比如，尽管HBV和HDV共感染通常引起自限性的急性肝炎，但是据报道，在静脉吸毒者中暴发性肝衰竭的发病率很高[2]。类似地，HBV携带者的HDV二重感染可能是临床不明显的，或可能表现为既已存在的慢性肝炎的恶化并快速进展为肝硬化[3]。

由于HDV相关肝病的内科处理效果有限，一些患者将需要肝脏移植[4,5]。一项1995年的年度报告估计，美国每年大约有100例患者因HBV相关肝衰竭接受肝移植手术，其中仅有一小部分(10%-20%)患者共感染HDV[6]。

本专题将总结肝移植术后的HDV再感染。HDV感染的发病机制、临床表现、预防和治疗将单独讨论(参见“Pathogenesis, epidemiology, natural history, and clinical manifestations of hepatitis D virus infection”和“丁型肝炎病毒感染的治疗与预防”)。

再感染的类型和发生率

肝移植术后单独的HDV再感染通常只持续很短时间，且不会导致肝病复发，除非随后发生HBV再感染。然而，HDV再感染也可发生于不存在HBV再感染标志物的情况下，这个观察结果为认识HDV复制的生物学和HDV相关肝病的发病机制提供了重要的见解。

          

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Literature review current through: 2017-06 . | This topic last updated: 2016-12-15.
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References
Top
  1. Alter MJ, Hadler SC. Delta hepatitis and infection in North America. Prog Clin Biol Res 1993; 382:243.
  2. Hoofnagle JH. Type D (delta) hepatitis. JAMA 1989; 261:1321.
  3. Rizzetto M, Durazzo M. Hepatitis delta virus (HDV) infections. Epidemiological and clinical heterogeneity. J Hepatol 1991; 13 Suppl 4:S116.
  4. Farci P, Mandas A, Coiana A, et al. Treatment of chronic hepatitis D with interferon alfa-2a. N Engl J Med 1994; 330:88.
  5. Rosina F, Pintus C, Meschievitz C, Rizzetto M. A randomized controlled trial of a 12-month course of recombinant human interferon-alpha in chronic delta (type D) hepatitis: a multicenter Italian study. Hepatology 1991; 13:1052.
  6. Annual Report of the US Scientific Registry of Transplant Recipients and the Organ Procurement and Transplantation Network. US Department of Health and Human Services, 1995.
  7. Modahl LE, Lai MM. Hepatitis delta virus: the molecular basis of laboratory diagnosis. Crit Rev Clin Lab Sci 2000; 37:45.
  8. Mason WS, Taylor JM. Experimental systems for the study of hepadnavirus and hepatitis delta virus infections. Hepatology 1989; 9:635.
  9. Mason WS, Taylor JM. Liver transplantation: a model for the transmission of hepatitis delta virus. Gastroenterology 1991; 101:1741.
  10. Glenn JS, Taylor JM, White JM. In vitro-synthesized hepatitis delta virus RNA initiates genome replication in cultured cells. J Virol 1990; 64:3104.
  11. Netter HJ, Gerin JL, Tennant BC, Taylor JM. Apparent helper-independent infection of woodchucks by hepatitis delta virus and subsequent rescue with woodchuck hepatitis virus. J Virol 1994; 68:5344.
  12. Smedile A, Casey JL, Cote PJ, et al. Hepatitis D viremia following orthotopic liver transplantation involves a typical HDV virion with a hepatitis B surface antigen envelope. Hepatology 1998; 27:1723.
  13. Samuel D, Zignego AL, Reynes M, et al. Long-term clinical and virological outcome after liver transplantation for cirrhosis caused by chronic delta hepatitis. Hepatology 1995; 21:333.
  14. Ottobrelli A, Marzano A, Smedile A, et al. Patterns of hepatitis delta virus reinfection and disease in liver transplantation. Gastroenterology 1991; 101:1649.
  15. Zignego AL, Dubois F, Samuel D, et al. Serum hepatitis delta virus RNA in patients with delta hepatitis and in liver graft recipients. J Hepatol 1990; 11:102.
  16. Demetris AJ, Todo S, Van Thiel DH, et al. Evolution of hepatitis B virus liver disease after hepatic replacement. Practical and theoretical considerations. Am J Pathol 1990; 137:667.
  17. David E, Rahier J, Pucci A, et al. Recurrence of hepatitis D (delta) in liver transplants: histopathological aspects. Gastroenterology 1993; 104:1122.
  18. Davies SE, Lau JY, O'Grady JG, et al. Evidence that hepatitis D virus needs hepatitis B virus to cause hepatocellular damage. Am J Clin Pathol 1992; 98:554.
  19. Lau JY, Portmann BC, Alexander GJ, Williams R. Differential effect of chronic hepatitis D virus infection on intrahepatic expression of hepatitis B viral antigen. J Clin Pathol 1992; 45:314.
  20. Samuel D, Muller R, Alexander G, et al. Liver transplantation in European patients with the hepatitis B surface antigen. N Engl J Med 1993; 329:1842.
  21. Lerut JP, Donataccio M, Ciccarelli O, et al. Liver transplantation and HBsAg-positive postnecrotic cirrhosis: adequate immunoprophylaxis and delta virus co-infection as the significant determinants of long-term prognosis. J Hepatol 1999; 30:706.
  22. Rifai K, Wedemeyer H, Rosenau J, et al. Longer survival of liver transplant recipients with hepatitis virus coinfections. Clin Transplant 2007; 21:258.
  23. Krogsgaard K, Kryger P, Aldershvile J, et al. Delta-infection and suppression of hepatitis B virus replication in chronic HBsAg carriers. Hepatology 1987; 7:42.
  24. Genesca J, Jardi R, Buti M, et al. Hepatitis B virus replication in acute hepatitis B, acute hepatitis B virus-hepatitis delta virus coinfection and acute hepatitis delta superinfection. Hepatology 1987; 7:569.
  25. Taniguchi M, Shakil AO, Vargas HE, et al. Clinical and virologic outcomes of hepatitis B and C viral coinfection after liver transplantation: effect of viral hepatitis D. Liver Transpl 2000; 6:92.
  26. Saigal S, Smith HM, Heaton ND, et al. Suppression of hepatitis B and hepatitis C viremia by concurrent delta virus infection: Its beneficial effect on the outcome of orthotopic liver transplantation (abstract). Hepatology 1999; 30:302A.
  27. Pontisso P, Ruvoletto MG, Fattovich G, et al. Clinical and virological profiles in patients with multiple hepatitis virus infections. Gastroenterology 1993; 105:1529.
  28. Lake JR, Wright TL. Liver transplantation for patients with hepatitis B: what have we learned from our results? Hepatology 1991; 13:796.
  29. Gish RG, Keeffe EB, Lim J, et al. Survival after liver transplantation for chronic hepatitis B using reduced immunosuppression. J Hepatol 1995; 22:257.
  30. Wright HI, Gavaler JS, Van Theil DH. Preliminary experience with alpha-2b-interferon therapy of viral hepatitis in liver allograft recipients. Transplantation 1992; 53:121.
  31. Rasshofer R, Choi SS, Wolf P, et al. of HDV RNA replication in vitro by ribavirin and suramin. In: Viral Hepatitis and liver Disease, Hollinger FB, Lemon SM, Margolis HS (Eds), Williams and Wilkins, Baltimore 1991. p.659.