丙型肝炎病毒感染患者13～14年后病毒组织学随访观察

目的了解丙型肝炎病毒(HCV)感染后持续活动者的临床转归和肝脏组织学情况。方法5例因输血而感染丙型肝炎者,为女性,4例因单采血浆还输血球而感染丙型肝炎者,为男性,总共9例,所有感染者感染时间、感染途径清楚。采用炎症分级纤维化分期以及修正的Knodell评分对肝脏活检组织的炎症和纤维化程度进行评价,超声检查,血清丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)采用速率法,抗HCV采用酶联免疫吸附试验(ELISA)方法,HCVRNA定性检测采用RocheCobasHCV聚合酶链反应(PCR)试剂盒,HCVRNA定量采用BayerHCV分枝DNA(bDNA)试剂盒,HCVRNA基因型采用BayerLiPA基因型分析方法。结果(1)9例慢性丙型肝炎感染者共随访13～14年,其间于诊断时、1992、1995、1999、2003、2004年共检测6次ALT水平,均高于正常上限值(ULN)。(2)2004年检测9例慢性丙型肝炎感染者HCVRNA定性均为阳性,定量从3.57×108拷贝/L～7.21×109拷贝/L,大于2.00×109拷贝/L者5例。3例感染者为基因2型,其余6例为基因1b型。(3)9例慢性丙型肝炎感染者超声诊断为慢性炎症轻度者3例(3/9),占33.3%;中度6例(6/9),占66.7%;重度0例;脂肪肝1例(1/9),占11.1%。未发现失代偿性肝硬化和原发性肝癌。(4)9例慢性丙型肝炎感染者的肝组织炎症活动度(HAI)分数为5～8.5分,纤维

Thirteen to fourteen years' follow-up of patients with hepatitis C

OBJECTIVE: To investigate the clinical outcomes and hepatic histology of patients with hepatitis C. METHODS: Nine patients with hepatitis, 4 males and 5 females, aged 44 +/- 7, who were infected during transfusion or blood donation underwent follow-up for 13 approximately 14 years: liver histological examination by biopsy, ultrasonography, biochemical examination of alanine transaminase (ALT), apartate aminotransferase (AST), and total bilirubin (TBIL), serum anti-HCV by ELISA, and HCV RNA quantification by PCR. RESULTS: ALT were higher than the normal value at every time point and HCV RNA remained positive (3.57 x 10(8) approximately 7.21 x 10(9) copies/L) in all patients. Ultrasonography showed mild and moderate hepatitis (3 and 6 cases respectively). The modified histological activity indices (HAI) were 5.0 approximately 8.5 and the fibrosis scores were 1 approximately 4. The ALT value was higher in the moderate cases than in the mild cases, and higher in those with higher HAI. The viral load was higher in the patients infected by the virus of the genotype 1b than in the patients infected by the virus of the genotype 2. CONCLUSION: The clinical outcomes and hepatic histology of patients with hepatitis C seem not very severe.