输血后乙型和丙型肝炎病毒感染的前瞻性调查

目的 了解输血所致ＨＢＶ和ＨＣＶ感染现状及ＨＢｓＡｇ抗ＨＣＶ和ＡＬＴ筛检供血的效果。方法 对１３８例输血者输血前，后１，３，６，９个月血清标本及其供血检测ＨＢｓＡｇ，抗ＨＢｓ，抗ＨＢｃ，抗ＨＣＶ和ＡＬＴ，并对部分血清标本用ＰＣＲ及巢式ＲＴ－ＰＣＲ法检测ＨＢＶＤＮＡ和ＨＣＶＲＮＡ，结果和结论 输血后ＨＢＶ和ＨＣＶ感染率分别为１．４％（２／１３８）和３４．８％（４８／１３８），输血后乙型和丙型肝炎发生     

庚型肝炎病毒（GBV—C／HGV）与HBV和HCV联合或重叠感染的初步研究

目的 研究庚型肝炎病毒（ＧＢＶ－Ｃ／ＨＧＶ）与ＨＢＶ和ＨＣＶ联合或重叠感染的情况，方法 采用ＥＬＩＳＡ的方法检测血液制剂和血源乙肝疫苗原料血浆中的ＨＢｓＡｇ和抗－ＨＣＶ；并用５′非编码区的引物，用逆转录聚合酶链反应（ＲＴ－ＰＣＲ）法检测ＧＢＶ－Ｃ／ＨＧＶＲＮＡ。结果 ＨＢｓＡｇ和抗ＨＣＶ均阴性血浆的ＧＢＶ－Ｃ／ＨＧＶＲＮＡ阳性率为１８．８％（１５／８０）；ＨＢｓＡｇ阳性而抗ＨＣＶ阴性血浆的ＧＢＶ－     

肝细胞癌患者乙、丙和丁型肝炎病毒感染状况

为探讨乙型、丙型和丁型肝炎病毒（ＨＢＶ，ＨＣＶ和ＨＤＶ）感染对肝细胞癌（肝癌）发生的意义，本文作者采用ＥＬＩＳＡ和聚合酶链反应法对７２例广东籍肝癌患者ＨＢＶ、ＨＣＶ和ＨＤＶ血清标志以及血浆ＨＢＶＤＮＡ和ＨＣＶＲＮＡ进行了检测。ＨＢｓＡｇ和抗－ＨＣＶ阳性率分别为８４．７％和１８．１％，显著高于１２８名健康对照者。ＨＢｓＡｇ和／或ＨＢＶＤＮＡ总阳性率为９３．１％，抗－ＨＣＶ和／或ＨＣＶＲＮＡ阳性率为２７．８％，ＨＢＶ和ＨＣＶ重叠感染率为２２．２％。其中６１例ＨＢｓＡｇ阳性肝癌的ＨＤＶ血清标志检出率为１４．８％，明显高于６１例ＨＢｓＡｇ阳性的肝炎对照者。结果表明，广州地区肝癌的发生，主要与ＨＢＶ和ＨＣＶ感染密切相关外，且可能与ＨＤＶ感染有关。     

血液透析患者血液中丙型及乙型肝炎病毒的检测

为了解血液透析患者血液中丙型肝炎病毒（ＨＣＶ）及乙型肝炎病毒（ＨＢＶ）的感染情况，对２２例维持性血液透析患者应用逆转录聚合酶链反应及酶联免疫吸附实验，检测了血清中ＨＣＶＲＮＡ及其抗体水平；同时采用斑点杂交及固相放射免疫法检测了血清中ＨＢＶＤＮＡ及其血清标志物。结果显示，２７％的血液透析患者血清ＨＣＶ抗体阳性，其中３３％的患者血清存在ＨＣＶＲＮＡ。在血清ＨＣＶ抗体阴性的１６例患者中，也有１例（６％）血清ＨＣＶＲＮＡ阳性。在２２例血液透析患者中，３例（１４％）血清ＨＢＶＤＮＡ阳性（ＨＢｅＡｇ也均阳性）。其余１９例ＨＢＶＤＮＡ阴性患者（ＨＢｅＡｇ均阴性），有１２例（６３％）血清抗－ＨＢｃ阳性。在７例血清ＨＣＶＲＮＡ或（和）抗－ＨＣＶ阳性者，５例有既往或现在ＨＢＶ感染的证据，但未见ＨＣＶＲＮＡ与ＨＢＶＤＮＡ同时存在者。提示在相当数量的血液透析患者体内存在肝炎病毒血症，应加强对血液透析患者肝炎病毒感染的监测及预防工作     

66例慢性非甲非乙型肝炎患者的丙型肝炎病毒感染研究

以ＨＣＶ－Ｔ３序列为引物，结合ＲＴ－ＰＣＲ和寡聚核甘酸探针Ｓｏｕｔｈｅｒｎ杂交，检测６６例慢性非甲非乙型肝炎（ＮＡＮＢＨ）患者的血浆ＨＣＶ－ＲＮＡ，阳性４２例（６３．６％）。同样病例以相当于ＨＣＶＣ区基因编码和ＮＳ３区编码的人工合成肽抗原检测抗ＨＣＶ，阳性４９例（７４．２％）。这６６例慢性ＮＡＮＢＨ病例，抗ＨＣＶ和ＨＣＶ－ＲＮＡ双阳性者３８例（５７．６％）；抗ＨＣＶ阴性而ＨＣＶ－ＲＮＡ阳性者４例（６．１％）；抗ＨＣＶ阳性而ＨＣＶ－ＲＮＡ阴性者１１例（１６．７％）。其中诊断为散发型ＮＡＮＢＨ者３５例，检出ＨＣＶ－ＲＮＡ者１７例（４８．６％），为输血后ＮＡＮＢＨ者３１例，检出ＨＣＶ－ＲＮＡ者２５例（８０．７％）。     

肾移植患者丙型肝炎病毒感染的临床研究

目的：了解肾移植患者丙型肝炎病毒（ＨＣＶ）的感染情况及ＨＣＶ感染后的临床影响。 方法：对６７例肾移植患者进行至少１年的随访，用第二代ＥＬＩＳＡ法和Ｎｅｓｔ－ＰＣＲ测定血清中抗ＨＣＶ和ＨＣＶ ＲＮＡ。 结果：抗ＨＣＶ的阳性率５０．７％（３４例），ＨＣＶ ＲＮＡ的阳性率为４７．８％（３２例）。ＨＣＶ ＲＮＡ阳性组术前血透时间和输血量及丙氨酸转移酶（ＡＬＴ）水平明显高于ＨＣＶ ＲＮＡ阴性组，ＨＣＶ ＲＮ     

HGV-RNA阳性与阴性慢性乙型肝炎患者的对比研究

目的 研究慢性乙型肝炎（ＣＨＢ）患者庚型肝炎病毒（ＨＧＶ）感染的意义。方法 ＲＴ＿ＰＣＲ法对１４６例ＣＨＢ患者血清进行了ＨＧＶ－ＲＮＡ检测,并将ＨＧＶ－ＲＮＡ阳性与阴性患者进行临床与病理学对比。结果 ＨＧＶ－ＲＮＡ阳性２３例（１５．７５％）。ＨＧＶ－ＲＮＡ阳性与阴性２肝功能等生化指标水平,肝脏病理损害程度、ＨＢＶ－ＤＮＡ阳性率均无显著性差异。５例ＨＧＶ－ＲＮＡ阳性、１６例ＨＧＶ－ＲＮＡ阴性ＣＨＢ患     

周围血白细胞的复制型丙型肝炎病毒RNA的检测及临床意义

用简并引物作套式反转录。聚合酶链反应检测正、负链丙型肝炎病毒（ＨＣＶ）ＲＮＡ。显示３０例急、慢性丙型肝炎患者的血清及血浆中，７例无症状抗－ＨＣＶ阳性者的血清、血浆及周围血白细胞（ＰＢＬ／Ｃ）中，均未检出负链ＨＣＶＲＮＡ。慢性丙型肝炎者ＰＢＩ（中正、负链ＨＣＶＲＮＡ的检出率高于急性丙型肝炎及无症状抗－ＨＣＶ阳性者（Ｐ＜０．０５～０．００１）。１７例经肝组织学检查的患者中，急性肝炎（ＡＨ）者ＰＢＬ／Ｃ的正、负链ＨＣＶＲＮＡ检出率低于慢性活动性肝炎（ＣＡＨ）者（Ｐ＜０．０５）。１例ＡＨ及６例ＣＡＨ患者肝组织内正、负链ＨＣＶＲＮＡ全部阳性。证实丙型肝炎患者的ＰＢＬ／Ｃ确可被ＨＣＶ感染，病程越长，被ＨＣＶ感染的可能性越大；病情活动者，ＰＢＬ／Ｃ中负链ＨＣＶＲＮＡ的检出率越高。提示ＨＣＶ不仅可以感染ＰＢＬＣ，而且可在其中复制；负链ＨＣＶＲＮＡ的出现与病情活动有关。     

多重和套式聚合酶链反应检测血液,腹膜透析患者血清中HBV D…

利用免疫学和聚合反应（ＰＣＲ）方法，对３５例血液透析（血透），１４例腹膜透析（腹透）患者的８４份血清进行了检测。血透组抗－ＨＣＶ阳性率８２．９％，ＨＣＶ ＲＮＡ ＰＣＲ阳性率５１．４％；腹透组抗－ＨＣＶ阳性率仅７．１％，ＨＣＶ ＲＮＡ ＰＣＲ均阴性。ＨＢｓＡｇ和（或）ＨＢｅＡｇ在二组的阳性率分别为２５．７％和２１．４％；ＨＢＶＤＮＡＰＣＲ阳性率分别为４５．７％和６４．２％。透析患者ＨＣＶ和ＨＢＶ感     

抗HCV阳性慢性肝病患者HBV感染及前C／C区基因变异

探讨ＨＢＶ基因变异在ＨＢｓＡｇ阴性抗ＨＣＶ阳性慢性肝病中的意义。方法用巢式聚合酶链反应（ＰＣＲ）与限制片段长度多态性相结合，对５６例慢性肝病患者６例ＨＢｓＡｇ阴性抗ＨＣＶ阳性（Ａ组）．１９例ＨＢｓＡｇ阳性抗ＨＣＶ阳性（Ｂ组）及３１例单独ＨＢＶ成染（Ｃ组）进行前Ｃ区密码２８终止变异（Ａ８３）和Ｃ区密码９７异亮氨酸亮氨酸变异（Ｌ９７）分析。结果Ａ组和Ｂ组Ａ８３和Ｌ９７变异检出率分别为３３％和４２％显著低于Ｃ组８１％（Ｐ值＜０．００１）：而Ａ组和Ｂ组间无统计学差异（Ｐ值＞０．０５）。结论ＨＢＶ和ＨＣＶ双重感染ＨＢｓＡｇ阴性与Ａ８３和Ｌ９７变异无相关。     

输血后丙型肝炎的回顾性研究

用酶免疫法（ＥＩＡ）检测１９８４年１０月至１９８５年２月在我院接受输血的９２例患者冻存血清中的抗ＨＣＶ，结果发现输血后丙型肝炎（临床型ＨＣＶ感染）３例，亚临床ＨＣＶ感染１１例，故ＨＣＶ总感染率为１５．２％，临床型ＨＣＶ感染占总ＨＣＶ感染的２１．４％；这１４例受血者抗ＨＣＶ的检出率在受血后１～２个月，３～４个月和５～６个月分别为２８．６％，５７．２％和１００％。用巢式逆转录－聚合酶链反应（ＲＴ－ＰＣＲ）的方法检测这１４例受血者抗ＨＣＶ阳转前１个月的血清，发现有８例ＨＣＶ－ＲＮＡ阳性（５７．１％），ＨＣＶ－ＲＮＡ最早可在受血者输血第一个月的血清中检测到。用ＥＩＡ法检测同期献血员冻存血清标本４００份，发现抗ＨＣＶ阳性者１１份（２．７５％）。这些结果提示我国献血员中ＨＣＶ感染率较高，受血者发生ＨＣＶ感染的危险性较大。因此，今后对献血员要进行抗ＨＣＶ的检测，以减少ＨＣＶ的传播。     

Hepatitis GB virus C genome in the serum of aplastic anaemia patients receiving frequent blood transfusions

GB virus C (GBV-C) RNA was detected in five of 18 patients with aplastic anaemia who had received blood transfusions, whereas it was not detected in eight patients who had not received any transfusions. Antibody against hepatitis C virus (anti-HCV) was detected in nine patients in the transfusion group, compared with one of eight who had not received any transfusions. Therefore, the route of transmission of both GBV-C and HCV in these patients appeared to have been multiple blood transfusion. Since all of the GBV-C RNA-positive patients harboured anti-HCV, GBV-C seems to frequently superinfect with HCV. Neither GBV-C nor HCV is likely to have been a causative agent of the anaemia in the cases examined.     

Anti-HCV in post-transfusion hepatitis: deductions from a prospective study

Stored sera from 52 patients who developed post-transfusion hepatitis (PTH) during a prospective study of PTH in Toronto in 1984/85, sera from 111 donors whose blood was transfused into these patients and sera from 50 patients with chronic active hepatitis with a remote history of blood transfusion were tested for anti-HCV. In patients with PTH seroconversion occurred relatively early. Ten converted in less than 14 weeks after transfusion. Only three of the 34 patients (9%) whose hepatitis resolved developed anti-HCV compared to 11 of 18 (61%) whose hepatitis became chronic. Patients who seroconverted had higher alanine aminotransferase (ALT) values during the phase of acute hepatitis than those who did not seroconvert. Most of the patients who developed PTH received blood that was negative for anti-HCV. Four donors whose blood was positive for anti-HCV transmitted hepatitis. Three of the patients developed anti-HCV and chronic hepatitis. One of the recipients did not seroconvert and the hepatitis resolved. Forty-two of the 50 patients (84%) with chronic hepatitis and a remote history of blood transfusion were positive for anti-HCV. We conclude that anti-HCV-positive donors may transmit hepatitis C; that if anti-HCV is diagnostic of hepatitis C, most cases of acute PTH are either not due to hepatitis C or may represent cases of hepatitis C in which the anti-HCV test was undetectable. On the other hand, most cases of PTH which progress to chronic hepatitis are caused by HCV.(ABSTRACT TRUNCATED AT 250 WORDS)     

Natural course of progression of liver fibrosis in Japanese patients with chronic liver disease type C--a study of 527 patients at one establishment

Patients with chronic hepatitis C infection show a gradual progression of fibrosis to liver cirrhosis and hepatocellular carcinoma (HCC). We studied whether the progression of liver fibrosis differed among Japanese subjects who were infected with different hepatitis C virus (HCV) genotypes. In 527 patients we examined whether there was a relationship between gender, age, history of blood transfusion, interval between date of blood transfusion and date of liver biopsy or date of diagnosis of HCC, serum alanine aminotransferase level, platelet count or HCV genotype, with the extent of liver fibrosis, classified into four stages (F1–F4). Moreover, we compared the mean rate of liver fibrosis progression per year in patients with each HCV genotype. Patients who had a higher fibrosis score tended to be older, have a lower platelet count and a longer interval since blood transfusion than those who had a lower fibrosis score. The mean rate of liver fibrosis progression was 0.12 ± 0.15 stages per year after the blood transfusion. However, the progression rate of liver fibrosis in patients who had received a blood transfusion when they were ≥ 30 years of age was 0.19 ± 0.22, while the progression rate of liver fibrosis in the patients who had received a blood transfusion when they were < 30 years was 0.09 ± 0.09. In conclusion, chronic hepatitis C is a progressive disease, and patients with genotype 1b, 2a and 2b have a similar rate of progression of liver fibrosis. Particular attention should be paid to patients who are infected with HCV when ≥ 30 years of age, because intrahepatic fibrosis rapidly progresses in these patients.     

Frozen Blood and Transfusion-Transmitted Hepatitis C Virus

The purpose of the present study was to evaluate the impact of frozen red cell transfusion on the transmission of hepatitis C virus (HCV) before the introduction of blood donor screening. Anti-HCV antibodies were detected in 59 patients with sickle-cell disease who required chronic transfusions and had exclusively received frozen red blood cells (RBC). The files were reviewed for clinical signs of chronic hepatitis C. Anti-HCV antibodies were detected in 2 adult patients; both also had clinical evidence of HCV infection. No other patient showed signs of acute or chronic HCV hepatitis. In a control group of 28 patients who had received nonfrozen RBC transfusions, the prevalence of anti-HCV antibodies was 25%. So, our study seems to indicate that the use of frozen RBC had reduced the risk of HCV contamination.     

Incidence of Post-Transfusion Hepatitis before and after Screening for Hepatitis C Virus Antibody

To evaluate the effectiveness of screening test for antibody to hepatitis C virus (anti-HCV), the incidence of acute post-transfusion HCV infection in patients who underwent cardiovascular surgery and received blood transfusion was studied. All patients were followed prospectively with serum biochemistry tests and viral hepatitis markers before and periodically for at least 6 months after cardiovascular surgery. None of them had history of liver disease and none tested positive for anti-HCV prior to blood transfusion. Before blood donors were screened for anti-HCV with a second-generation HCV diagnostic kit, 28 (12.4%) of 226 patients or 0.49% of 5,690 unit transfusion had seroconverted to anti-HCV during a 6-month follow-up. The incidence of post-transfusion hepatitis (PTH) C in 91 patients who had received 1–12 units transfusion was significantly lower than in 135 patients who had received more than 12 units transfusion (6.6 vs. 16.3%, p<0.05). However, none of the 87 transfused patients, since anti-HCV screening in July 1992, developed PTH C (p<0.05). The result demonstrates that screening for anti-HCV by a more sensitive second-generation HCV diagnostic assay may protect the patients studied from PTH C. It further provides a firm argument for the necessity of a nation-wide blood donor screening.     

No Significant Changes in Levels of Hepatitis C Virus (HCV) RNA by HCV Infection Competitive Polymerase Chain Reaction in Blood Samples from Patients with Chronic

To determine if levels of hepatitis C virus(HCV) RNA change over a several-year period, wequantified the amount of HCV RNA by competitivepolymerase chain reaction. The population studiedincluded 44 residents of a rural area with chronic HCVinfection, 39 had chronic hepatitis C and 37 werepatients on hemodialysis. All these Japanese patientshad HCV RNA of genotype II. Blood samples were collected once a year from 1992 to 1995. From 1993 to1995 between the groups, there was no significantdifference in change of HCV RNA levels of 44 residentswith chronic HCV infection, with and without liverdysfunction, nor was there any change in the 31 hemodialysispatients from 1992 to 1995. The HCV RNA levels in the 25with chronic hepatitis who did not respond tointerferon-alpha during 1992-1993 returned topretreatment levels after the cessation of interferontreatment. In two of six hemodialysis patients who wereinfected with HCV during this observation period, HCVRNA was eliminated within one year, and the remaining four became HCV carriers. HCV RNA levels in thelatter rose rapidly after infection and were sustainedat a high level throughout the study period. Thus, HCVRNA level did not change remarkably during a three-year period, a finding which supportsthat it does not correlate with deterioration of liverdamage and aging of HCV carriers.     

Anti-Hepatitis C Virus Screening Will Reduce the Incidence of Post-Transfusion Hepatitis C Also in Low-Risk Areas

The incidence of post-transfusion hepatitis non-A, non-B (PTH-NANB) was prospectively assessed in two areas in the southeast region of Sweden. Patients undergoing hip arthroplasty were studied with blood sampling for alanine aminotransferase analysis before and at 2, 3, and 4 months after transfusion. Of the patients 97% and 82% were transfused and received a mean of 5.5 and 3.4 units in Linköping and Oskarshamn, respectively. None of 38 patients in Oskarshamn but 4 of 144 patients (2.8%) in Linköping contracted PTH-NANB. Two of these four patients developed antibodies against hepatitis C virus (HCV) by the first-generation anti-HCV enzyme-linked immunosorbent assay (ELISA) (C100). The other two patients remained negative by this test. HCV infection was, however, indicated in all four patients by positive second-generation anti-HCV ELISA confirmed by positive second-generation recombinant immunoblot assay (4-RIBA). Three of the patients were positive by polymerase chain reaction (PCR). Serum from one blood donor to the four hepatitis patients (altogether three donors) was found positive by first- and second-generation anti-HCV ELISA and 4-RIBA and was also PCR-positive. Three other blood donors, who did not transmit hepatitis, were anti-HCV ELISA (C100)-positive. This study shows that if anti-HCV ELISA had been available at the start of the trial, all cases of PTH would have been avoided at the expense of only 0.7% transfusion units discarded. Routine anti-HCV ELISA testing of all transfusion units will reduce the incidence of PTH-C even in low-risk areas.     

Anti-hepatitis C virus screening will reduce the incidence of post-transfusion hepatitis C also in low-risk areas.

The incidence of post-transfusion hepatitis non-A, non-B (PTH-NANB) was prospectively assessed in two areas in the southeast region of Sweden. Patients undergoing hip arthroplasty were studied with blood sampling for alanine aminotransferase analysis before and at 2, 3, and 4 months after transfusion. Of the patients 97% and 82% were transfused and received a mean of 5.5 and 3.4 units in Link?ping and Oskarshamn, respectively. None of 38 patients in Oskarshamn but 4 of 144 patients (2.8%) in Link?ping contracted PTH-NANB. Two of these four patients developed antibodies against hepatitis C virus (HCV) by the first-generation anti-HCV enzyme-linked immunosorbent assay (ELISA) (C100). The other two patients remained negative by this test. HCV infection was, however, indicated in all four patients by positive second-generation anti-HCV ELISA confirmed by positive second-generation recombinant immunoblot assay (4-RIBA). Three of the patients were positive by polymerase chain reaction (PCR). Serum from one blood donor to the four hepatitis patients (altogether three donors) was found positive by first- and second-generation anti-HCV ELISA and 4-RIBA and was also PCR-positive. Three other blood donors, who did not transmit hepatitis, were anti-HCV ELISA (C100)-positive. This study shows that if anti-HCV ELISA had been available at the start of the trial, all cases of PTH would have been avoided at the expense of only 0.7% transfusion units discarded. Routine anti-HCV ELISA testing of all transfusion units will reduce the incidence of PTH-C even in low-risk areas.     

Hepatitis C virus antibodies, viral RNA and genotypes in sera from patients on maintenance haemodialysis

SUMMARY. Patients on maintenance haemodialysis in four dialysis centres were tested for markers of hepatitis C virus (HCV) infection. Antibody to HCV (anti-HCV) was detected by the second-generation enzyme immunoassay in 142 (26%) of the 543 patients and HCV RNA in 117 (22%) of whom four were without detectable anti-HCV in serum. Seventy-seven (66%) were infected with HCV of genotype II/1b, 31 (27%) with genotype III/2a and eight (7%) with genotype IV/2b. in a distribution similar to that in blood donors who carried HCV asymptomatically. Haemodialysis patients had high HCV RNA titres comparable to those of patients with chronic hepatitis C. HCV RNA was detected in 96 (26%) of the 365 patients with a history of transfusion more frequently than in 21 (12%) of the 178 without previous transfusion ( P <0.001). In transfused patients, frequencies of anti-HCV and HCV RNA increased in parallel with the duration of haemodialysis. The frequency of anti-HCV in non-transfused patients, however, did not change appreciably with the duration of haemodialysis up to 22 years. The patients with anti-HCV had a higher frequency of HCV RNA in serum than symptom-free blood donors with anti-HCV (113/142 or 80% vs 109/166 or 66% P <0.01) and the patients with HCV RNA had a lower frequency of elevated aminotransferase levels than blood donors with HCV RNA (5/113 or 4% vs 27/109 or 25%, P <0.00l). These results indicate that transfusion is a significant cause of HCV infection in patients on maintenance haemodialysis, and that these patients are prone to establish the HCV carrier state after infection.