各型病毒性肝炎、肝癌抗—HCV检测及HCV感染与输血的关系

本文对各型病毒性肝炎、肝癌２００例进行血清抗－ＨＶＣ检测，阳性率为２０．５％，以重型肝炎和肝硬化检出率为高，分别为４２．８６５、４６．１５％，二者与其他型肝炎相比，有显著性差异（Ｐ＜０．０５）。输血后肝炎抗－ＨＣＶ阳性率为６７．５％，健康献血员抗－ＨＣＶ阳性率为２０．４７％，而输血后乙型肝炎仅占２．５％。说明输血是造成丙型肝炎传播的重要途径，因此，对献血员应进行严格筛选。观察表明，ＨＢＶ与ＨＣＶ双     

新疆地区维吾尔族人群HCV感染状况及HCV基因型分布调查

对采自新疆地区维吾尔族自然人群、职业献血员、肝硬化、肝细胞癌患者血清分别进行了抗－ＨＣＶＥＬＩＳＡ和ＨＣＶＲＮＡ基因型检测。结果显示：该地区自然人群、职业献血员、肝硬化、肝细胞癌患者抗－ＨＣＶ阳性率分别为２．０％、３５．７％、４２．５％、２０．８％，ＨＣＶ感染者中多数具有输血及献血史，职业献血员、肝硬化和肝细胞癌患者ＨＣＶ感染比例较高。该人群ＨＣＶ基因型以混合型感染（占４９．７％）为主，单一基因型感染以Ⅱ型（占２６．２％）为主，提示当地可能存在严重的不同基因型ＨＣＶ的混合感染。     

献血员抗HCV筛查效果的再评价

采用 ＥＬＩＳＡ及 ＲＴ－Ｎｅｓｔｅｄ ＰＣＲ对献血员与接受输血治疗者血清 ＨＣＶ感染标志进行了调查。结果表明，在筛选措施开展前献血员抗ＨＣＶ阳性率为１１．５４％，经地方血站筛选后献血员抗ＨＣＶ阳性率可降至２．５５％。同期受血者抗ＨＣＶ阳性率为８．８２％，而８例接受抗ＨＣＶ阳性血液者的血清抗ＨＣＶ与ＨＣＶＲＮＡ阳转比例分别为５／８与６／８。表明抗ＨＣＶ筛查措施在我国输血后丙肝预防中已起到十分重要的作用。进一步研究发现，在３０例抗ＨＣＶ阴性的献血员中，６例（２０％）血清ＨＣＶ ＲＮＡ阳性。３４例抗ＨＣＶ与血浆ＨＣＶ ＲＮＡ均阴性的献血员中 ５例（１４． ７１％）外周血单个核细胞内检出 ＨＣＶ ＲＮＡ。这一结果表明，采用血清抗ＨＣ Ｖ筛选措施不能完全筛除献血员中的ＨＣＶ感染者。部分抗ＨＣＶ阴性献血员血清及外周血单个核细胞中隐藏的 ＨＣＶ可能是抗 ＨＣＶ阴性血液传播ＨＣＶ感染的重要因素。     

齐齐哈尔市丙型肝炎感染现状调查

为了解齐齐哈尔市丙型肝炎感染现状，应用ＥＬＩＳＡ法对齐齐哈尔市肝病患者，献血员、受血者及自然人群血清共２１２７份，进行了丙型肝炎感染情况调查。结果抗—ＨＣＶ总感染率为４．２３％，肝病患者、献血员、受血者和自然人群抗—ＨＣＶ阳性率分别为２０．００％、１．７０％、１９．０４％和６．１９％。１３５例肝病患者中急性肝炎、慢性肝炎、肝硬化、肝细胞癌、输血后肝炎抗—ＨＣＶ阳性率分别为４．１６％、１３．３３％、１０．７１％、７．６９％、６４．００％。提示应加强对ＨＣＶ检测，以预防和控制输血后肝炎的发生     

广东不同人群HCV感染的血清流行病学调查

对广东不同人群进行丙型肝炎病毒（ＨＣＶ）感染的血清流行病学调查。结果发现，抗－ＨＣＶ阳性率正常人群为１．４５％（２２／１５２０）。血液透析病人中有输血史的抗－ＨＣＶ阳性率为８９．１６％（７４／８３），无输血史者为６０．７１％（１７／２８），前者显著高于后者（ｐ＜０．０１）。在２２８例吸毒者中，静脉吸毒者的抗－ＨＣＶ阳性率为６５．２９％，显著高于非静脉吸毒者（２１．５０％）。值得注意的是职业献血员抗－ＨＣＶ阳性率为１２．２１％（２１／１７２），显著高于正常人群（ｐ＜０．０１）。卖淫妇女的抗－ＨＣＶ阳性率为２．３８％，略高于正常人群，两者差异无显著性。结果显示血液透析病人、静脉吸毒者、职业献血员感染ＨＣＶ的危险性极高，与国外同类研究结果一致。提示血途径是ＨＣＶ感染的主要传播途径。     

广西百色地区肝病患者及受血者HCV感染现状调查

笔者应用ＥＬＩＳＡ法对广西百色地区１７９例各类肝病患者及４１例受血者血清进行了抗－ＨＣＶ检测。结果各类肝病抗－ＨＣＶ阳性率为１７．９％，受血者抗－ＨＣＶ阳性率为３１．７％。在急性肝炎（急肝）、慢性肝炎（慢肝）、肝硬化和肝癌中，抗－ＨＣＶ阳性率各为４．３％（１／２３）、１２．８％（１０／７８）、２８．６％（１２／４２）和２５．０％（９／３６）。抗－ＨＣＶ阳性率有随肝病慢性比而增高的趋势，肝硬化的抗－ＨＣＶ阳性率明显高于急肝或慢肝（Ｐ＜０．０５），而肝癌的抗－ＨＣＶ阳性率与急肝或慢肝相差不显著（Ｐ＞０．０５或０．１），且发现ＨＢｓＡｇ阴性肝病者的抗－ＨＣＶ阳性率明显高于ＨＢｓＡｇ阳性患者（Ｐ＜０．５），肝病患者抗－ＨＣＶ的检出率与ＡＬＴ活性无关（Ｐ＞０．０５）。在受血者中，抗－ＨＣＶ的检出率与受血次数、ＡＬＴ活性关系非常密切。因此，加强对ＨＣＶ的检测是当前预防输血后肝炎的紧迫任务。     

筛查抗—HCV对单采浆献血员保护作用的评价

３１５名单采浆还输血细胞献血员（简称单采浆献血员）在实行筛查血清丙型肝炎病毒抗体（抗－ＨＣＶ）后献血浆１．０￣１．５年时ＨＣＶ感染率为１０．１６％，与未筛查抗－ＨＣＶ时的单采浆献血员比较，ＯＲ＝０．２３（９５％ＣＩ＝０．１６￣０．３４）；与筛查抗－ＨＣＶ后的全血献血员比较，ＯＲ＝１２．２７（９５％ＣＩ＝４．１０￣３６．７６）。表明筛查抗－ＨＣＶ对单采浆献血员虽然有重要的保护作用，但也有很大的局限性     

筛查抗－HCV对单采浆献血员保护作用的评价

３１５名单采浆还输血细胞献血员（简称单采浆献血员）在实行筛查血清丙型肝炎病毒抗体（抗－ＨＣＶ）后献血浆１．０～１．５年时ＨＣＶ感染率为１０．１６％，与未筛查抗－ＨＣＶ时的单采浆献血员比较，ＯＲ＝０．２３（９５％ＣＩ＝０．１６～０．３４）；与筛查抗－ＨＣＶ后的全血献血员比较，ＯＲ＝１２．２７（９５％ＣＩ＝４．１０～３６．７６）。表明筛查抗－ＨＣＶ对单采浆献血员虽然有重要的保护作用，但也有很大的局限性。     

阳泉市重点人群HCV感染状况调查

我们于１９９４年首次对阳泉市２０８７名食品及公共场所从业人员进行丙肝抗体检测。结果显示：食品从业人员抗－ＨＣＶ阳性率为０．９３％，公共场所从业人员抗－ＨＣＶ阳性率为０．８５％，总阳性率为０．９１％；ＨＣＶ感染以２０岁以上的中、青年为主；输血是导致ＨＣＶ感染的重要危险因素。     

输血后丙型肝炎和献血员抗—HCV的动态观察

对输血后丙型肝炎（丙肝）和献血员抗－ＨＣＶ进行随访。结果：１９９１年７月至１９９３年６月输血后丙肝的发病率为４６．６６％，明显高于１９８９年５月至１９９０年１１月输血后丙肝的发病率（５．８１％）。献血员抗－ＨＣＶ阳性率分别为：１９８７年１．１６％、１９９０年６．９７％、１９９２￣１９９３年３６．８０％，这一特点与输血后丙肝发病趋势一致，亦与本地单采血浆量增加有关。     

乙型和丙型肝炎病毒重叠感染的研究

目的　为了解乙型肝炎患者重叠感染丙型肝炎病毒（ＨＣＶ） 的状况,并探讨乙型肝炎病毒（ＨＢＶ） 、ＨＣＶ 重叠感染时ＨＣＶ 对ＨＢＶ 复制的影响。方法　应用ＥＬＩＳＡ 法对７１２ 例乙型肝炎患者进行了血清抗－ ＨＣＶ 检测和乙型肝炎病毒标志检测。结果　７１２ 例乙型肝炎患者血清抗－ ＨＣＶ阳性率为１４ ．４７ ％ ,其中重型肝炎患者血清抗－ ＨＣＶ 阳性率最高（４８ ．９８ ％ ） ,急性肝炎患者最低（３．２５ ％ ） 。在不同临床类型的乙型肝炎患者之间,血清抗－ ＨＣＶ 阳性率存在显著性差异（ Ｐ＜ ０ ．００１）,显示病情越重,病程越长,血清抗－ ＨＣＶ 阳性率越高;在ＨＢＶ 和ＨＣＶ 重叠感染的患者中,血清ＨＢｓＡｇ、ＨＢｅＡｇ 和抗－ ＨＢｃＩｇＭ 阳性率低于乙型肝炎患者（ Ｐ＜ ０ ．００１ ,Ｐ＜ ０ ．００１ 和Ｐ＜０ ．０５） ,而血清抗－ ＨＢｅ 阳性率高于乙型肝炎患者（ Ｐ＜ ０ ．０１）,均有显著的统计学意义。结论　乙型肝炎患者重叠感染ＨＣＶ 与病情加重和慢性化的形成有关,并使ＨＢＶ 的复制受到抑制。     

降低输血后HCV感染的临床研究

目的：探讨输血后ＨＣＶ感染高发的原因并提出降低发生率的可行措施。方法：对１３８例定期筛检供血及６８例献血前筛检供血的受血者进行了前瞻性调查。用定量ＰＣＲ试剂盒,通过荧光检测仪对１０份供血进行ＨＣＶ ＲＮＡ定量分析;对４１例血清进行ＨＣＶ ＲＮＡ定量、ＡＬＴ用抗－ＨＣＶ检测;用ＲＴ－ＰＣＲ法对３４份抗－ＨＣＶ（－）供血作ＨＣＶ ＲＮＡ定性分析。结果：两种方法筛检供血所致的输血后ＨＣＶ感染率分别为３４     

肝病患者肝炎病毒感染状况的血清学调查

应用第二代抗ＨＣＶ试剂对我国不同地区肝病患者血清抗ＨＣＶ进行了检测，同时调查了ＨＢＶ和 ＨＡＶ感染状况。 ２０１６例肝病患者血清中抗 ＨＣＶ检出率为 １２． ２５％，ＨＢＶｍ 检出率为 ７４． ５５％，抗 ＨＡＶ－ＩｇＭ检出率为２９．３１％。各型肝病患者抗ＨＣＶ检出情况分别是：急性肝炎６２／７５２（８．２４％）；慢迁肝４８／５４１（８．８７％）；慢活肝９３／５２３（１７．７８％），慢性重症肝炎５／３２（１５．６３％）；肝硬化３４／１４３（２３．７８％）；肝癌５／２５（２０． ００％）。对不同年龄组肝病患者抗 ＨＣＶ检出率的比较表明，抗 ＨＣＶ检出率随患者年龄增加而增高。受血史及其他经血液暴露史与 ＨＣＶ感染密切相关，但仍有近半数肝病患者 ＨＣＶ感染途径不明。各型肝病患者中仅４７／２０１６（２．１３％）为单纯ＨＣＶ感染，其他ＨＣＶ感染者则为重叠感染。不同地区肝病患者血清抗ＨＣＶ检出率间差异较大（２．１５％～３０．９５％），北方地区较高，对其影响因素进行了探讨。     

沙市地区某些人群抗-HCV调查

用第二代抗－ＨＣＶ试剂检测沙市地区２０８４名献血员与８９０名肝病患者。结果献血员抗－ＨＣＶ阳性率为０．２９％，肝病患者为１．３５％，表明沙市地区存在ＨＣＶ感染，其感染率相对较低。４３２名甲肝与８名急性乙肝病人未检出阳性，而４４３名慢性乙肝中有１１例阳性，阳性率为２．４８％，５例肝硬化病人中有１例阳性。提示混合或重叠ＨＣＶ感染，对ＨＢＶ感染的慢性化、肝硬化起一定促进作用。最后作者慎重提出试验结果的假     

High prevalence of hepatitis C virus infection in a southern Italian rural region. Clinical aspects and evidence of inapparent parenteral exposure

AIM: Infection by hepatitis C virus (HCV) generally determines an asymptomatic acute hepatitis which becomes chronic in about 90% of cases. In order to contribute data on the prevalence and the transmission of HCV infection and its associated conditions, anti-HCV seropositivity records in a large sample of a population living in a rural area in Southern Italy were collected and examined. METHODS: Data were obtained from the registers of local general practitioners operating in 4 neighbouring countries which make up the region analysed. Information on established or potential risk factors for HCV transmission was obtained by means of a questionnaire. RESULTS: More than half of the entire population of the examined region (19,800 subjects, 60%) had a record for an anti-HCV blood testing. Out of these 19,800 subjects, 2,213 were found to be seropositive, with a resulting overall anti-HCV prevalence higher than that reported for the whole country (11.1% vs 3%). Genotype 1b was the most commonly detected (86%). Anti-HCV prevalence was significantly higher in the 50-59 and 60-69 year age groups than in other age groups. The results of multiple regression analysis showed that blood transfusion, use of glass syringes, surgical interventions, promiscuous use of tooth-brush, promiscuous use of sharp-edged instruments and lowest number of years of schooling were all independent predictors of anti-HCV positive. No association was found with family history of liver disease and alcohol consumption. A total 46.6% of the subjects had chronic hepatitis, 24.4% had cirrhosis, 1.8% had hepatocellular carcinoma and cirrhosis and 27.2% were "asymptomatic" (with normal serum ALT levels and no histological features of chronic hepatitis despite HCV viremia). CONCLUSION: The most striking result of the study was that the high levels of HCV endemicity was not frequently associated with apparent evidence of parenteral exposure, suggesting that HCV spread in the community can even occur mostly through inapparent parenteral routes.     

Examination of hepatitis c virus antibody seropositive blood donors and their relatives

INTRODUCTION: 239 anti-HCV seropositive blood donors (132 male, 107 female, age: 19-61, mean: 40.59 y.) and 174 family members of them (74 male, 100 female, age: 4-65, mean: 23.67 y.) were studied for chronic hepatitis C virus infection and chronic liver disease. Detailed virus serology, ultrasonography, and 6 months follow-up and--in patients with HCV RNA--liver biopsy were made. RESULTS: HCV RNA was determined in 165 patients. 70% of them were HCV RNA positive. The ALT level was normal in 95 cases (57%), and lower, than twice of the normal was in 34 cases (20%) among them. Liver biopsy was made in 79 patients; chronic C hepatitis was proven in 75 cases (steatosis in 3 cases, alcoholic liver disease in 1 case was observed). Inflammatory activity was minimal (HAI < 3) in 17, mild (HAI: 3-6) in 41, moderate (HAI: 7-9) in 7, and severe (HAI > 9) in 10 cases. There was no correlation between the serum ALT levels and the severity of the histological activity of chronic C hepatitis. Authors stress the importance of the fact, that 2 patients had normal ALT and 5 patients ALT levels were lower, than the twice of the normal of the 17 patients with significant inflammatory activity (HAI < 6). Chronic C hepatitis need for antiviral therapy was occurred in 45% of patients who known themselves previously healthy. CONCLUSIONS: The necessity of the systematic examination of anti-HCV seropositive patients and of the importance of the liver biopsy in patients with HCV RNA positivity is stressed. 3 anti-HCV seropositive cases of 174 family members of the blood donors were observed, but none of them was HCV RNA positive. It seems to be, family members of the HCV infected patients have no increased risk for HCV infection.     

Association of hepatitis C virus with liver cirrhosis and hepatocellular carcinoma compared with hepatitis B virus in Egyptian patients

Hepatocellular carcinoma (HCC) is an aggressive malignancy and carries a poor prognosis. Documentation of the wide geographical variation in its incidence has led to clear identification of several risk factors. These include hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in endemic areas. The present study investigated the association of HBV with HCV and cirrhosis, the latter is regarded as a premalignant lesion and underlies most cases with HCC. Serum samples from 94 patients with HCC (n=25) and cirrhosis (n=69) were tested for hepatitis C virus antibody (anti-HCV), hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc) and serum alphafetoprotein (AFP). Of the 94 patients, 71 (75.5%) had anti-HCV, 6 (6.4%) were positive to HBsAg, while 64 (68.1%) were positive to anti-HBc. These viral markers were more prevalent among HCC patients, 19 (76.0%) had hepatitis C antibody, 3 (12.0%) were positive to HBsAg and 22 (88.0%) were positive to anti-HBc compared with 52 (75.4%), 3 (4.3%) and 42 (60.9%), respectively in patients with cirrhosis. Regarding serum AFP measurement, 14 (56%) of patients with carcinoma and 35 (50.7%) of patients with cirrhosis demonstrated levels above 7 ng/ml. In patients with cirrhosis, elevated serum AFP and presence of anti-HCV in serum were significantly associated. In conclusion, this study shows that viral hepatitis is strongly associated with the development of cirrhosis and HCC in Egyptian patients. Hepatitis C virus seems to play a predominant role compared with hepatitis B virus.     

献血感染丙型肝炎人群转归分析

目的研究献血感染丙型肝炎病毒（HCV）人群16年后的转归。方法对该人群问卷收集一般情况,肝脏B超检查;采集5ml静脉血,进行丙型肝炎病毒抗体、RNA、谷丙转氨酶（ALT）和血清生化指标（透明质酸、Ⅲ型前胶原肽、Ⅳ型胶原）检测。结果162名研究对象尚未出现晚期肝病患者。抗-HCV阳性率95.68%,RNA阳性率77.78%,ALT异常率20.37%。不同急性期症状感染者,16年后抗-HCV阳性率、ALT异常率和RNA阳性率差异无统计学意义。经性别分层分析,女性感染年龄〉40岁抗体较易阴转（χMH^2=8.26,P=0.04）。结论HCV感染16年后,不同急性期症状感染者转归无差异,病毒清除与性别和初始感染年龄有关。