第六章 乙型肝炎重症化的其他影响因素

内容提要

1.宿主的许多因素可影响乙型肝炎重症化的发生和发展，主要包括性别、年龄、基础疾病(如酒精性肝病、脂肪肝、糖尿病、甲状腺功能亢进症、肾脏疾病、结核病、结缔组织病等)，以及妊娠、外科手术等。

2.肠道屏障功能受损和肠道微生态的改变可过度激活机体免疫系统，加重肝细胞凋亡、坏死，促进乙型肝炎重症化及其并发症的发生和发展。

3.肝纤维化和肝硬化对乙型肝炎重症化的影响是全方位的：肝纤维化的原有病理改变、异常血流动力学、肝脏免疫状态、并发症(如感染和炎症反应)、肝细胞再生受抑均可影响慢性乙型肝炎重症化的发生、发展及预后。

4.肝癌的病情进展、并发症的发生、治疗相关性损伤、发生HBV再激活等因素，均可引起进行性肝功能损害，导致慢性乙型肝炎重症化的发生和发展，并严重影响预后。

5.在诱导乙型肝炎重症化发生的各种因素中，合并各种病原体感染(尤其是其他嗜肝病毒)最为常见；各种肝毒性的物质(包括化学物质、毒素、酒精、药物等)以及乙型肝炎病毒再激活均可引起乙型肝炎重症化。(https://www.daowen.com)

Abstract 6

1.Severalhost factors，including gender，age，underlying diseases(such as alcoholic liver disease，fatty liver，diabetes，hyperthyroidism，kidney disease，tuberculosis，connective tissue disease)，pregnancy，surgery and so on，may influence the occurrence and development of severehepatitis B.

2.Functional damage to the intestinal barrier and changes in microecology may excessively activate the immune system，aggravate liver cell apoptosis and necrosis，and promote the development of severehepatitis B and its complications.

3.Liver fibrosis and cirrhosishave a major effect on the development of severehepatitis B.Pathological changes in liver fibrosis，abnormalhemodynamics，liver immune state,complications (such as infection,inflammatory reaction),and inhibition ofhepatocyte regeneration can all affect the occurrence，development and prognosis of severe chronichepatitis B.

4.Liver cancer progression，complications of liver cancer，treatment related damage，and HBV reactivation can all cause progressive liver damage，leading to the exacerbation of chronichepatitis B，andhave a negative effect on patient prognosis.

5.Co-infection with other pathogens(especially otherhepadnaviruses)is the most frequent factor inducing severehepatitis B.Varioushepatotoxins(including chemicals，toxins，alcohol，and drugs)and HBV reactivation can cause severehepatitis B.