HDVマ 1227 血 清 で陽 性)の2例 し た8). 疾 患 別 の 体 検 出 率 の 統 計 処 理 はx2検 成 体 検 出 率(Table 体 は,HBVキ (1.8%)に 検 出 さ れ た.疾 性 肝 疾 患62例 中6例 用:1例)感 体 は,慢 不 明 で あ る. ャ リ ア

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1 Key words: HBV carrier, anti-hd anti-hd IgM, HDAg

2 HDVマ 1227 血 清 で陽 性)の2例 し た8). 疾 患 別 の 体 検 出 率 の 統 計 処 理 はx2検 成 体 検 出 率(Table 体 は,HBVキ (1.8%)に 検 出 さ れ た.疾 性 肝 疾 患62例 中6例 用:1例)感 体 は,慢 不 明 で あ る. ャ リ ア328例 患 別 の 中5例(8.1%),無 266例 中1例(0.4%)に 検 出 さ れ,両 1).HDVの 感染経 路 薬常 り1例 は 体検 出例の臨床経 過 IgM型 群 の 検 出率 性肝 染 した と推 測 さ れ た が,残 3.IgM型 性 候 性 キ ャ リア の 間 に 有 意 の 差 が 認 め ら れ た(p<0.01).慢 原 は肝 生 検 を施 行 した3例 に 認 め られ た(Fig. にっ い て は,血 液 を 介 して(輸 血:4例,麻 1) 中 原 は い ず れ の 例 で も 検 出 で き な か った 中1例 績 疾 患 別 の に 持 続 し て検 出 され た.血 が,組 織 中 の 定 で 行 っ た. 1.肝 ー カー の検 出 体 が 持 続 し て 検 出 さ れ た2症 例 の 臨 床 経 過 を 示 す, 疾 患 を 慢 性 肝 炎 と 肝 硬 変 肝 細 胞 癌 に 分 類 し た 症 例1(59歳,男 1971年 交 通 事 故 の た め 右 腎 摘 出 手 術 の 際 に 体 検 出 率 は,慢 (6.3%),肝 性 肝 硬 変 肝 細 胞 癌14例 で あ り,両 炎48例 中3例 4,000mlの 中2例(14.3%) 群 間 に 有 意 の 差 は 認 め ら れ な か っ た. 2. 体 検 出 例 の 臨 床 的 特 徴(Table 体 は,6例 歳 の 男 性)に10年 型 のHBVキ 2) ャ リア(47歳 66 体 が 高 力 価(104倍 と も にIgM型 が 持 続 して 検 出 され て い る. 体 体は輸血 か ら6ヵ 月 後 に 出 現 し,現 在 ま で 持 続 して検 出 さ れ の希釈 Fig. 1 Localization HBV HDAg Frequency in HBV 月後 の急 性増 悪 間 以 上 持 続 し て 検 出 さ れ た.IgM 体 は 1 輸 血 を 受 け,3ヵ (GPT値:380IU/l)と an Table 性,慢 性 非 活 動 性 肝 炎) seropositivity was carrier seen munoperoxidase for and-hd (Case in stain, HDAg in the tissue 3) nuclei Original hepatocytes (im- mag. ~400) carriers AsC: asymptomatic ease, LC: carrier, cirrhosis, CLD: HCC: chronic hepatocellular discar- cinoma, *p<0.01. Table CIH: chronic determined, inactive BT: 平 成4年9月20日 blood hepatitis, transfusion 2 LC: Clinical cirrhosis, features. HCC: HBV hepatocellular carriers with carcinoma, anti-hd AsC: asymptomatic carrier, ND: not

3 Fig. 2 Clinical course and presence HDV markers in an HBV carrier (Case 1)

4 & Kurimura, T.: Prevalence antibody to delta antigen among HBV carriers in Japan. J. Med. Virol., 22: , ) Ichimura, H., Tamura, I., Tsubakio, T., Kurimura, O. & Kurimura, T.: Influence hepa- titis delta virus superinfection on the clearance hepatitis B virus (HBV) markers in HBV carriers in Japan. J. Med. Virol., 26: 49-55, ) Tamura, I., Ichimura, H., Koda, T., Katayama, S., Kurimura, O. & Kurimura, T.: Hepatitis s virus infection in different time periods in Japan. J. Gastroenterol. Hepatol., 5: , ) Kada, T., Tamura, I., Ichimura, H., Murakami, S., Takezaki, E., Kurimura, O. & Kurahori, T.: A long-term follow-up five patients with hepatitis delta virus in Japan. J. Internal. Med Res., 19: , ) Rizzetto, M., Shih, J. W.-K., Gocke, D. J., Purcell, R. H., Verme, G. & Gerin, J. L.: Incidence and significance antibodies to delta antigen in hepatitis B virus infection. Lancet, ii: ) Smedile, A., Farci, P., Verme, G., Caredda, F., Cargnel, A., Caporaso, N., Dentico, P., Trepo, C., Opolon, P., Gimson, A., Vergani, D., Williams, R. & Rizzetto, M.: Influence delta infection on severity hepatitis B. Lancet, ii: , ) Imazeki, F., Omata, M. & Ohto, M.: Heterogeneity and evolution rates delta virus 1) Rizzetto, M., Canese, M. G., Gerin, J. L., London, W. T., Sly, D. L. & Purcell, R. H.: Transmission the hepatitis B virus-associated delta RNA sequences. J. Virol., 64: , antigen to chimpanzees. J. Infec. Dis., 141: 590 2) Rizzetto, M., Purcell, R. H. & Gerin, J. L.: Epidemiology HBV-associated delta agent: Geographical distribution and-delta and prevalence in polytransfused HBsAg carriers. Lancet, i: , ) Farci, P., Gerin, J. L., Aragona, M., Lindsey, I., Crivelli, 0., Balestrieri, A., Smedile, A., Thomas, H.C. & Rizzetto, M.: Diagnostic and 4) Mori, J., Ito, Y., Yokosuka, O. & Okuda, K.: prognostic significance the IgM antibody to Delta infection in Japan: Immunohistological the hepatitis delta virus. J. A. M. A., 255: 1443 and immuno-electron microscopic study delta antigen in tissue. J. Gastroenterol. 15) Dimitrakakis, M., Waters, M.-J., Wootton, A. Hepatol., 1: 33-38, & Gust, I.: Detection IgM antibodies to 5) Tamura, I., Ichimura, H., Itoh, Y., Kurimura, O. delta antigen after coinfection and superinfection with the delta virus. J. Med. Virol., 20: ) Shattock, A. G., Morris, M., Kinane, K. & Fagan, C.: The serology delta hepatitis and the detection IgM anti-hd by EIA using

5 serum derived delta antigen. J. Virol. Methods, 23: , ) Lau, J. Y. N., Smith, H. M., Chaggar, K., Hansen, L. J., Portmann, B. C., Alexander, G. J. M. & Williams, R.: Significance IgM antihepatitis D virus (HDV) in chronic HDV infection. J. Med. Virol., 33: , ) Choo, Q.-L., Kuo, G., Weiner, A. J., Overby, L. R., Bradkey, D. W. & Houghton, M.: Isolation a cdna clone from a bloodborne non-a,non-b viral hepatitis genome. Science, 244: , ) Fattovich, G., Tagger, A., Blloro, L., Giustina, G., Pontisso, P., Realdi, G., Alberti, A. & Ruol, A.: Hepatitis C virus infection in chronic hepatitis B virus carriers. J. Infect. Dis., 163: , Detection Hepatitis Delta Virus (HDV) Markers in HBV Carriers Ikuo TAMURA, Tetsuzo KODA & Osamu KURIMURA Institute Clinical Research, Kure National Hospital To investigate the prevalence and clinical features hepatitis delta virus (HDV) superinfection in hepatitis B virus (HBV) carriers, antibody to hepatitis delta antigen (anti-hd) was determined in the sera 328 HBV carriers in Japan. 1) Of the 328 HBV carriers, six (1.8%) were seropositive for and-hd by enzyme linked immunosorbent assay. IgM-antibody to hepatitis delta antigen was detected in 2/6 patients with a high anti-hdv titer. None the patients was positive for hepatitis delta antigen. 2) HBV carriers with chronic disease had a greater frequency seropositivity and-hd than asymptomatic HBV carriers. These data indicate that HDV superinfection may be an etiologic agent chronic disease in HBV carriers.

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