不同感染途径的丙型肝炎患者血清HCV RNA及抗-HCV与ALT水平的分析

目的:探讨丙型肝炎(丙肝)患者感染途径与其肝脏病变程度的关系。方法:根据感染途径的不同将210例丙肝患者分输血后丙肝(PTHC组)102例和散发性丙肝(SHC组)108例,应用荧光定量聚合酶链反应(FQ-PCR)技术、酶联免疫吸附方法(ELISA)和自动生化速率法分别检测两组患者血清中HCV RNA含量、抗-HCV及ALT水平。结果:PTHC组HCV RNA阳性率和ALT的异常率均显著高于SHC组(χ2=23.39,P<0.01和χ2=13.73,P<0.01);HCV RNA阳性患者中,PTHC组的HCV DNA含量均值显著高于SHC组(t=4.29,P<0.01);ALT异常患者中,PTHC组的ALT水平均值显著高于SHC组(t=4.30,P<0.01)。HCV RNA的含量与ALT水平呈正相关(r=0.794,P<0.01)。结论:PTHC组患者病毒血症水平和肝脏功能损害的程度均显著高于SHC组,HCV不同的感染途径可导致患者不同的感染结果。     

丙型肝炎感染途径与肝损害程度的相关性

目的探讨丙型肝炎（丙肝）感染途径及其对肝脏病变程度的影响。方法应用荧光定量聚合酶链反应（FQ-PCR）技术、酶联免疫吸附方法（ELISA）和自动生化速率法分别检测90例输血后丙肝患者（PTHC组）和33例献血查体发现的丙肝患者（DHC组）血清丙型肝炎病毒HCV-RNA、抗·HCV及ALT水平。结果PTHC组HCV-RNA阳性率和ALT异常率均显著高于DHC组（P均〈0．01）;HCV-RNA阳性患者中,PTHC组HCV-RNA水平均显著高于DHC组（P〈0．01）;ALT异常患者中,PTHC组ALT水平均显著高于DHC组（P〈0．01）。HCV-RNA水平与ALT水平呈正相关（r=0．797,P〈0．01）。结论丙肝患者肝损害程度与感染途径有关,输血后丙肝患者肝损害程度重于其他途径感染的丙肝患者,原因为输衄后丙肝感染HCV量大。     

戊型肝炎及重叠乙型肝炎感染患者丙氨酸转氨酶变化

目的　观察戊型肝炎及重叠乙型肝炎感染患者丙氨酸转氨酶 (ALT)变化。方法　将戊型肝炎抗体阳性及重叠乙型肝炎感染患者 2 73例分为 5组。A组 12 7例 ,为戊型肝炎病毒 (HEV) IgG阳性 ;B组 9例 ,为HEV IgM阳性 ;C组 64例 ,为HEV IgM和HEV IgG均阳性 ;D组 3 2例 ,为HEV IgM和HEV IgG均阳性并重叠乙型肝炎感染 ;E组 41例 ,为HEV IgG阳性并重叠乙型肝炎感染。另选戊型肝炎抗体阴性的非乙型肝炎患者 5 0 0例作为对照组。用速率法测定各组ALT值。结果　各组ALT异常增高百分率及异常增高者ALT值分别为 :A组 2 1例 ( 16.5 %) ,ALT( 183± 89)U /L ;B组 3例 ,ALT( 2 0 3± 112 )U /L ;C组 16例 ( 2 5 .8%) ,ALT( 2 17± 119)U/L ;D组 11例 ( 3 4.4%) ,ALT( 2 3 4± 12 8)U/L ;E组 13例 ( 3 1.7%) ,ALT( 2 10± 98)U/L ;对照组 5 1例 ( 10 .2 %) ,ALT( 112± 68)U/L。戊型肝炎抗体阳性各组ALT异常增高率与对照组间差异有显著性 (P <0 .0 5 ) ,戊型肝炎抗体阳性各组ALT异常增高者ALT值与对照组间差异有显著性 (P <0 .0 5 )。结论　戊型肝炎抗体阳性组ALT异常增高率和增高者ALT值均较对照组有明显增高 ,HEV IgM阳性或重叠乙型肝炎感染较单纯HEV IgG阳性者 ,ALT增高明显     

慢性丙型肝炎患者外周血淋巴细胞亚群的特征及临床意义

目的 探讨外周血淋巴细胞亚群在慢性丙型肝炎患者中变化的特征及其临床意义。方法 选取2018年1月至2022年7月入院诊治慢性丙型肝炎患者138例，同期健康体检者72例。根据临床表现将患者分为单纯慢性丙型肝炎组58例，丙型肝炎肝硬化失代偿组31例和丙型肝炎早期肝硬化组49例，比较患者和健康对照组临床特征、淋巴细胞计数以及多种亚群所占的百分比。结果 慢性丙型肝炎组ALT、AST和总胆红素水平分别29.6(18.2,47.8)U/L、33.6(24.4,50.1)U/L和25.5(18.5,63.6)μmol/L,显著高于对照组的21.5(16.8,26.5)U/L、23.5(15.7,30.2)U/L和16.6(13.6,26.1)μmol/L,而Hb水平为78.2(64.2,105.3)g/L,显著低于对照组的97.3(78.1,118.9)g/L,(均P<0.05)。单纯慢性丙型肝炎组CD45⁺CD3⁺CD4⁺细胞的绝对值、CD45⁺CD3⁺CD8⁺...     

异甘草酸镁联合还原型谷胱甘肽治疗化疗药物性肝损伤临床疗效观察

目的：探讨异甘草酸镁联合还原型谷胱甘肽对化疗药物性肝损伤的临床疗效。方法80例符合化疗药物性肝损伤诊断标准的患者被随机分为联合治疗组45例,给予异甘草酸镁联合还原型谷胱甘肽治疗,和对照组35例,只给予还原型谷胱甘肽治疗;两组患者均治疗2 w,观察血ALT、AST水平变化。结果在治疗2 w结束时,对照组患者血ALT和AST分别为（88±45） U/L和（98±53） U/L,显著低于治疗前水平[分别为（130±60） U/L和（138±70） U/L,P〈0.05],而联合治疗组ALT和AST分别为（55±38） U/L和（56±43） U/L,显著低于治疗前水平[（125±47） U/L和（158±68） U/L,P〈0.05],后者也显著低于对照组治疗后水平（P〈0.05）;在小于60岁患者,27例联合治疗组治疗后ALT和AST水平分别为（45±23） U/L和（40±35） U/L,与20例对照组[（60±30） U/L和AST（65±34） U/L]相比,无显著性差异,而在＆gt;60岁患者,18例联合治疗组患者治疗后ALT和AST水平分别为（103±45） U/L和（99±50） U/L,明显低于15例对照组水平[（145±80） U/L和AST（151±65） U/L,P〈0.05]。结论异甘草酸镁联合还原型谷胱甘肽可显著降低化疗药物性肝损害患者血ALT和AST水平。     

干扰素诱发唇炎三例

门诊用干扰素治疗慢性病毒性肝炎中 ,发现 3例唇炎 ,现报道如下。例 1男 60岁。有输血史 ,ALT 2 0 0～ 40 0U/L、HCVRNA阳性、抗 HCV阳性 3年 ,诊断为慢性病毒性丙型肝炎。予α 1b干扰素 3 0 0万U肌注 ,1次 /隔日。治疗第 12周患者唇粘膜出现糜烂、出血 ,结痂逐渐加重 ,张口困难。口腔科按急性唇炎给予抗生素软膏涂抹、局部封闭等治疗无效 ,改用四环素可的松软膏涂抹 ,炎症时轻时重 ,伴有鳞屑、痒、干燥 ,追问既往无类似病史 ,考虑为丙型肝炎相关性唇炎 ,继续对症治疗。干扰素治疗 18周患者ALT正常 ,HCVRNA阴转 ,2 4周停药。停药…     

聚乙二醇化干扰素α-2a联合利巴韦林治疗代偿期丙型肝炎肝硬化患者临床疗效研究

目的探讨应用聚乙二醇化干扰素α-2a联合利巴韦林治疗代偿期丙型肝炎肝硬化患者的临床疗效。方法 2003年1月～2016年12月我院就诊的代偿期丙型肝炎肝硬化患者122例,采用随机数字表法分成两组,每组61例。给予对照组常规护肝治疗,给予观察组聚乙二醇化干扰素α-2a联合利巴韦林治疗24～48 w。随访两组24 w。采用实时荧光定量RT-PCR法检测血清HCV RNA,采用全自动生化分析仪检测血生化指标,采用化学发光法检测血清层粘连蛋白(LN)、Ⅲ型前胶原(PCⅢ)、透明质酸(HA),常规使用Fibroscan行肝脏硬度检测(LSM)。结果在治疗结束时,观察组血清HCV RNA水平为(2.0±0.4) lg IU/ml,显著低于对照组【(3.8±1.3)lg IU/ml,P0.05】;血清AST和ALT水平分别(46.03±24.05) U/L和(36.32±20.1) U/L,显著低于对照组【(78.7±21.1)U/L和(51.2±20.9) U/L,P0.05);观察组血清LN、PCⅢ和HA水平分别为(126.3±29.0)μg/L、(212.3±43.8)μg/L和(211.4±42.0)μg/L,均显著低于对照组【(140.3±32.1)μg/L、(267.5±39.8)μg/L和(329.6±68.4)μg/L,P0.05】;观察组LSM为(13.6±2.4) kPa,显著低于对照组【(17.6±5.2)kPa,P0.05】;在随访时发现,观察组血清ALT复常率和持续病毒学应答率(SVR)均显著高于对照组(分别为93.4%对45.9%和72.1%对9.8%,P0.05),而疾病进展发生率为3.3%,显著低于对照组的13.1%(P0.05)。结论应用聚乙二醇化干扰素α-2a联合利巴韦林抗病毒治疗代偿期丙型肝炎肝硬化患者可显著提高SVR,延缓肝纤维化进展,稳定肝功能指标。     

慢性丙型肝炎患者血清HCV RNA,ALT与肝脏病理间的关系

目的:探讨慢性丙型肝炎患者血清HCV-RNA 水平、ALT浓度及肝组织病理改变三者之间的关系．方法:采用荧光定量聚合酶链反应(FQ-PCR) 检测132例慢性丙型肝炎患者血清中HCV RNA的水平,用生化自动分析仪检测ALT值, 其中30例患者进行了肝脏活检,用HE染色,光学显微镜下观察肝脏病理改变．结果:在132例慢性丙型肝炎患者中有98例 HCV RNA水平超过1．0×106拷贝／L,阳性率为74．2％,有99例ALT水平超过正常值,异常率为75．0％．HCV-RNA水平与ALT浓度相关性不显著(r=0．40,P=0．695),与ALT异常率呈明显相关(r=1．00,P<0．01)．肝穿病理结果表明, HCV-RNA水平与肝脏的炎症活动度和纤维化程度均不相关(r=0．50,P=0．667;r=0．20,P= 0．80)．ALT浓度与肝脏的纤维化程度不相关(r =0．40,P=0．60),而与肝脏的炎症活动度呈明显相关(r=1．00,P<0．01)．结论:慢性丙型肝炎患者血清HCV RNA水平与ALT浓度无关,也不能反映肝组织病理损伤程度;ALT浓度与肝脏的纤维化程度无关,但可在一定程度上反映肝脏的炎症改变．     

丙型肝炎病毒感染的自然演变规律分析

目的　了解我国人群丙型肝炎病毒 (HCV)感染的自然演变规律。方法　 2 0 0 1- 12～ 2 0 0 2 - 0 7对河北省固安县和赵县 2 83例因单采血浆而感染丙型肝炎者进行调查分析 ,男性 137例 ,女性 14 6例。行腹部超声检查及丙氨酸氨基转移酶 (ALT)、天冬氨酸氨基转移酶 (AST)、谷氨酰转肽酶 (GGT)采用速率法检测 ,HCVRNA的测定采用荧光定量PCR方法。转化生长因子 - β1(TGF - β1)、组织金属蛋白酶抑制因子 - 1(TIMP - 1)、三型前胶原肽(PⅢP)、四型胶原 (PC -Ⅳ )、透明质酸 (HA) ,采用ELISA方法。结果　 (1)非侵入性诊断 (包括临床诊断、超声诊断、血清学诊断 )为慢性肝炎轻度者 14 6例 ,占 5 1 .6 % ;中度 97例 ,占 34. 3% ;重度 15例 ,占 5 . 3% ;肝硬化 4例 ,占1 .4 % ;脂肪肝 2 1例 ,占 7 .4 %。(2 ) 2 83例感染者中 2 5 8例测定了HCVRNA ,阴性率 2 3. 3% ,表明该组人群感染HCV后 12～ 2 5年有较高的HCV自发阴转率。 (3)慢性肝炎重度和肝硬化组的ALT、AST、GGT均值明显高于其他组 ,慢性肝炎重度组ALT值异常率为 5 3 .3% (8/ 15 ) ,AST值异常率为 5 3 .3% (8/ 15 )。肝硬化组ALT值异常率为10. 0 % (4/ 4 ) ,AST值异常率为 10. 0 % (4/ 4 ) ,差异有显著性。 (4)慢性肝炎重度和肝硬化组肝纤维化血清学诊断指     

急性丙型肝炎血清HCV RNA含量相关性及与α干扰素疗效的关系

目的了解急性丙型肝炎血清中丙型肝炎病毒(HCV)RNA含量与ALT的相关性与α干扰素疗效的关系。方法采用荧光定量聚合酶链反应(PCR)检测153例急性丙型肝炎患者HCVRNA含量,用α干扰素肌注联合利巴韦林口服抗病毒。治疗前作基因分型,并在治疗前、治疗后4周、12周用PCR法检测HCVRNA含量、每月检测肝功能。判断α干扰素肌注联合利巴韦林治疗的应答情况。结果动态结果显示,血清HCVRNA含量与ALT水平呈正相关。HCVRNA含量显示≤1×105拷贝/mL的4周病毒学应答率高于1×105拷贝/mL,二组P0.05。预测干扰素疗效的关键是治疗前HCVRNA在血清中的水平及ALT水平。结论急性丙型肝炎患者的治疗过程中,HCVRNA含量是预测干扰素疗效的重要指标之一;急性丙肝ALT增高幅度高,HCVRNA病毒复制快速,予α干扰素联合利巴韦林治疗后RVR、EVR均较高。     

Alpha-interferon therapy in chronic hepatitis due to active dual infection with hepatitis B and C viruses

BACKGROUND: Nearly 14% of non-alcoholic chronic liver disease in India is related to hepatitis B virus (HBV) and hepatitis C virus (HCV) dual infection. There are no clear data available from the literature on the therapeutic management of these patients who often suffer an unfavourable course. METHODS: Fourteen consecutive cases of biopsy-proven chronic liver disease fulfilling the following criteria were included: Child's A or B liver disease, hepatitis B surface antigen positive, HBV-DNA positive, antibody to HCV positive and HCV-RNA positive. Seven patients had chronic liver disease (group I), while the remaining seven patients (group II) had additional disorders (non-Hodgkin's lymphoma (two), acute leukaemia (two), thalassaemia (two), chronic renal failure (one). Interferon alpha-2b (IFN) was given in a dose of 6 MIU thrice weekly for 6 months. Complete response was defined as loss of HBV-DNA and HCV-RNA at 6 months and sustained response (SR) as the sustained loss of HBV-DNA and HCV-RNA for more than 6 months during the follow-up period. RESULTS: At the end of 6 months, alanine aminotransferase (ALT) levels remained unchanged (120 +/- 40 vs 136 +/- 64 IU/L), but six of the seven (86%) patients in group I lost HBV-DNA. All three hepatitis Be antigen (HBeAg)-positive patients lost HBeAg with an early flare of ALT (at 45 +/- 12 therapy days). Two of these patients (29%) lost HCV-RNA. Thus, SR was seen in 29%, while HBV-DNA loss was found in 100% during the follow-up period. In group II patients, there was a significant decrease in ALT (308 +/- 14 vs 65 +/- 25 IU/L, P < 0.001), but only three (43%) patients lost HBV-DNA and two (29%) lost HCV-RNA. One patient with acute leukaemia and another with renal failure had a complete response to IFN, but none of the lymphoma patients showed any antiviral response. CONCLUSIONS: In chronic hepatitis due to dual infection with HBV and HCV, interferon therapy is: (i) safe; (ii) effective (more so in clearing HBV); (iii) often associated with early ALT flare; and (iv) may be less effective if non-Hodgkin's lymphoma is present.     

持续丙氨酸氨基转移酶正常乙型肝炎肝硬化的临床分析

目的探讨持续ALT正常乙型肝炎肝硬化患者的肝组织病理特征及其相关因素,为临床诊断及治疗提供参考。方法选取2005年1月-2012年12月住院的乙型肝炎肝硬化患者68例,对所有患者进行肝组织病理学检查,分析肝组织病理改变程度与患者年龄、HBV DNA载量、ALT水平的相关性。结果 30岁的肝组织病变以轻度为主,≥30岁且40岁者以中度病变为主,≥40岁者以重度病变为主(P0.05);当HBV DNA载量5×105拷贝/ml时,以重度改变为主(P0.05);ALT水平为0~20 U/L时肝组织以轻度病理改变为主,20~30 U/L以中度病理改变为主,30~40 U/L以重度病理改变为主(P0.05)。结论对ALT持续正常的肝硬化患者,应结合其年龄、HBV DNA载量及ALT水平综合评估,40岁以上、HBV DNA载量5×105拷贝/ml、ALT水平在30~40 U/L的患者,应行肝组织活检以明确疾病有无进展,即使不做肝组织活检,也应予以合理的抗病毒治疗。     

Procollagen-III Peptide and Chronic Viral C Hepatitis

Chronic hepatitis develops in at least half of persons acutely infected with hepatitis C virus (HCV). Ten to 25% of these patients will develop cirrhosis. Serum pro-collagen-III peptide (PIIIP) may be of value in predicting the development of chronic active fibrogenic liver disease. It has been reported that in chronic viral C hepatitis, the levels of hepatitis C virus-RNA (HCV-RNA) correlate directly with the severity of hepatic histology and inversely with response to interferon therapy. Objectives: The aims of this study were to correlate the level of PIIIP with HCV-RNA concentrations, ALT values, and histological severity in patients with chronic viral C hepatitis. Methods: Eighty-six patients with chronic C hepatitis were divided into three groups: group I (n = 34), mild chronic active hepatitis, group II (n = 25), moderate to severe chronic active hepatitis, and group III (n = 27), cirrhosis. HCV-RNA was measured by Quantiplex, and PIIIP was measured by radioimmunoassay-gnostic assay. Results: Mean ± SD level of ALT in group I was 114 ± 48 U/L, group II was 169 ± 115 U/L, and group III was 160 ± 94 U/L. The mean ± SD level of HCV-RNA in group I was 110 ± 130 × 10⁵ Eq/ml, in group II was 140 ± 140 × 10⁵ Eq/ml, and in group III was 70 ± 80 × 105 Eq/ml. The mean ± SD level of PIIIP in group I was 0.6 ± 0.2 U/ml, in group II was 0.9 ± 0.4 U/ml, and in group III was 1.2 ± 0.6. There was a significant difference in the levels of PIIIP among the three groups ( p = 0.0001). There was no correlation among ALT, HCV-RNA, and PIIIP in any of the three groups. Conclusions: PIIIP peptide determinations in patients with chronic viral C hepatitis are reflective of histological severity and may provide relatively nonin-vasive means of following disease progression.     

Clinical significance of activity of ALT enzyme in patients with hepatitis C virus

AIM： TO investigate serum alanine aminotransferase （ALT） levels in relation to the clinical, biochemical, ultrasonographic and histological characteristics of patients with hepatitis C virus.
METHODS： Duration of disease, HCV-RNA, liver steatosis, and the hepatitis activity index （HAI） were correlated with serum ALT in 36 patients with HCV. ALT values were also investigated in 16 control subjects without any liver diseases.
RESULTS： In bivariate analyses, ALT levels correlated with duration of HCV infection （P 〈 0.01）, HCV-RNA （P 〈 0.05）, and the HAI （P 〈 0.01）. Among the components of the HAI, ALT concentrations were significantly associated with periportal bridging/necrosis （P 〈 0.01） and fibrosis （P 〈 0.05）. In multivariate analysis, periportal bridging/ necrosis （β = 0.508; P 〈 0.01）, duration of HCV infection （β = 0.413; P 〈 0.01）, and HCV-RNA （β = 0.253; P 〈 0.05） were independently associated with ALT activity. The normal ALT activity for men and women was 〈 23 IU/L and 〈 22 IU/L, respectively.
CONCLUSION： In patients with HCV, alterations in the liver tissue as reflected by ALT elevation are mainly associated with periportal bridging/necrosis, viral load and duration of disease. A cut-off value 〈 23 IU/L distinguished with high diagnostic accuracy healthy controls from patients with HCV.     

丙氨酸氨基转移酶轻度升高慢性乙型肝炎患者肝组织病理学改变

目的分析ALT轻度升高的慢性乙型肝炎患者肝组织病理学改变情况,以探讨ALT水平与肝脏炎症及纤维化分期的关系。方法选择216例ALT轻度升高的慢性乙型肝炎患者及83例慢性HBV携带者,进行肝活检,分析肝脏炎症分级（G）及纤维化分期（S）与ALT及年龄的关系。结果在肝炎组中,炎症分级≥G2者占55.6%,明显高于对照组（31.3%）;肝炎组纤维化分期≥S2者占62.1%,也明显高于对照组（28.9%,P〈0.01）,均有显著性差异;在慢性肝炎组中年龄大于40岁者,肝组织炎症分级≥G2及纤维化分期≥S2者分别为69.5%及75.0%,均明显高于年龄〈40岁组,差异具有统计学意义（P〈0.01）;在年龄大于40岁的患者中,ALT〉60U/L者G3＋4比例（52.9%）高于ALT〈60U/L者（31.7%,P〈0.05）;ALT〉60U/L者纤维化分级高（S3＋4）者比例也明显高于ALT〈60U/L者,差异具有统计学意义（P〈0.05）,ALT〉60U/L组有84.3%纤维化分级≥S2,明显高于ALT〈60U/L组（63.4%,P〈0.05）。结论部分ALT轻度升高的慢性乙型肝炎患者肝组织病变也处于活动期,其中年龄大于40岁而ALT又大于60U/L者,应开始抗病毒治疗,达不到这个标准的患者应行肝组织活检来决定是否需要抗病毒治疗。     

Significance of hepatitis B core antigen in the liver in patients with chronic hepatitis B and its relation to hepatitis B virus DNA

Liver biopsies from 52 patients with chronic hepatitis B were investigated for the presence and distribution of HBcAg and the results were compared with the status of hepatitis B virus deoxyribonucleic acid (HBV-DNA). The patients consisted of 37 men and 15 women, aged 16-55 years (mean = 34 years). Serum alanine aminotransferase (ALT) was elevated in 50 patients (range: 18-969 U/L; mean = 290 U/L). Serological testing showed HBsAg in all, HBeAg in 45 (87%), and HBV-DNA in 28 (54%). Liver biopsies demonstrated HBcAg in 35 (67%) patients. HBcAg was not only present in 31 of 45 (69%) patients who were seropositive for HBeAg, but also in four of seven (57%) with antibody to HBeAg (anti-HBe). In 28 of 35 (80%) patients with HBcAg in the liver, serum HBV-DNA was detected. However, no serum HBV-DNA was detected in 17 patients who had no detectable HBcAg in the liver. The distribution of HBcAg in the liver was rather cytoplasmic and nuclear than nuclear alone. Among 33 patients with cytoplasmic HBcAg in the liver, 15 (45%) had an evidence of acute exacerbation of hepatitis with marked ALT elevation (range: 168-894 U/L; mean = 385 U/L) and nine patients showed severe chronic active hepatitis and confluent necrosis, histologically. These results indicate that the presence of HBcAg in the liver correlates with the amount of circulating hepatitis B virus as quantified by serum level of HBV-DNA. The predominant cytoplasmic HBcAg in the liver may suggest the possibility of multiple episodes of acute exacerbation and more severe ongoing hepatitis during the clinical course.     

输血后丙型肝炎患者的临床特点及自然病程

目的了解输血后慢性丙型肝炎病毒(HCV)感染者的临床特点及自然病程。方法采用回顾性调查与前瞻性研究相结合的方法,进行定群随访观察。结果(1)在99例HCV感染病例中,输血时间主要集中于1989—1994年,其中1990—1992年最为多见。(2)99例随访患者中,90例临床诊断为慢性丙型肝炎,9例诊断为丙型肝炎肝硬化(代偿期)。(3)99例患者自输血距首次诊断丙型肝炎的时间为(7．4± 6．6)年,其中9例患者首次诊断丙型肝炎肝硬化距输血时间为(12．7±5．8)年。(4)在63例男性患者中, 慢性丙型肝炎59例,丙型肝炎肝硬化4例；36例女性患者中,慢性丙型肝炎31例,丙型肝炎肝硬化5例；按男女分组比较丙型肝炎与肝硬化的构成比,差异无统计学意义(P＞0．05)。(5)丙型肝炎肝硬化组患者病程中均有反复肝功能异常,并且两氨酸氨基转移酶异常时波动的幅度较大。(6)本组病例在观察期间未发现肝癌的发生。结论(1)在广州地区,目前经输血感染HCV的可能性较1995年前大幅度降低。(2)9．1％ (9／99)的慢性丙型肝炎感染者在HCV感染13(12．7±5．8)年左右已进展为肝硬化(代偿期)。(3)对于反复出现肝功能异常的慢性丙型肝炎患者,应尽可能采用干扰素联合利巴韦林进行抗病毒治疗。     

应用索磷布韦/维帕他韦治疗门诊和住院筛查的丙型肝炎患者疗效研究

目的 调查真实世界丙型肝炎病毒感染情况,并探讨应用索磷布韦/维帕他韦治疗慢性丙型肝炎(CHC)患者病毒学应答情况。方法 2017年9月～2019年9月行血清抗-HCV检测的3966例住院和门诊患者,应用索磷布韦/维帕他韦治疗CHC患者12 w。结果 在3966例患者中,检出血清抗-HCV阳性80例(2.0%);在80例抗-HCV阳性者中,同期进行了血清HCV RNA检测者42例,结果40例(95.2%)血清HCV RNA阳性;在40例CHC患者中,12例无明显症状和体征,18例有腹胀、乏力、纳差,10例有蜘蛛痣、肝病面容、肝掌、脾肿大;35例血清AST＞90 U/L,4例AST轻度异常,1例AST正常;3例存在HBV/HCV混合感染;B超检查14例正常,26例提示肝内光点增粗;40例CHC患者接受索磷布韦/维帕他韦治疗,结果RVR、EVR、ETVR、SVR、NR和复发率分别为75.0%、80.0%、82.5%、72.5%、10.0%和10.0%;在治疗12 w末,血清TBIL水平为(30.7±4.3)μmol/L,显著低于治疗前【(80.4±15.6)μmol/L,P＜0.05】,血清AST水平为(72.5±18.6)U/L,显著低于治疗前【(247.7±110.4) U/L,P＜0.05】,血清ALB水平为(49.2±11.5)g/L,显著高于治疗前【(35.9±9.2)g/L,P＜0.05】;不良反应发生率为22.5%。结论 真实世界丙型肝炎发病率较高,对患者进行HCV感染筛查很有必要。应用索磷布韦/维帕他韦治疗CHC患者疗效显著,血清病毒学应答率高,能显著改善肝功能,且具有一定的安全性。     

Stability of HCV-RNA level and its lack of correlation with disease severity in asymptomatic chronic hepatitis C virus carriers

This study examines the relationship between HCV-RNA levels and disease severity in 60 individuals with chronic hepatitis C virus infection. HCV-RNA levels were quantified by the branched DNA (bDNA) assay in 445 samples (median: eight samples per patient) obtained over a median of 40.4 months (95% confidence interval (CI): 37.0–42.5). The median log HCV-RNA level was 6.77 (95% CI: 6.62–6.92) molecular equivalents/mL (MEQ/mL). The median log range of HCV-RNA levels in individual patients over the course of the study was 0.89 (95% CI: 0.69–1.16). HCV-RNA level varied over time by less than one log in 62% of patients, by 1–1.5 logs in 22% and by greater than 1.5 logs in only 17%. Univariate analysis, revealed an inverse association between HCV-RNA levels and ALT levels ( P =0.037). Univariate and logistic regression analysis showed no significant association between HCV-RNA levels and either the degree of inflammation or fibrosis. In contrast, there was a significant positive association between alanine aminotransferase (ALT) levels and histological activity especially in individuals with ALTs>  100 IU/L. Hence, HCV-RNA levels: (i) almost always fell within the dynamic range of the bDNA assay; (ii) were stable in asymptomatic chronically infected patients, with only a small proportion of patients exceeding a range of 1.5 logs; (iii) did not correlate with either the extent of inflammation or degree of fibrosis. In contrast, there was a strong association between ALT level and the histological severity of liver disease.     

Relationships between serum aminotransferase levels, liver histologies and virological status in patients with chronic hepatitis C in Taiwan

In patients with chronic hepatitis C, the relationships between serum alanine aminotransferase (ALT) levels, histological liver injury and serum hepatitis C virus (HCV) RNA titres remain controversial. To evaluate these relationships, 93 Chinese patients with histological diagnosis of chronic hepatitis C were enrolled for this study. Serum ALT levels, HCV-RNA titres and HCV genotypes were examined. The histology was evaluated according to a modified histological activity score based on the degree of periportal necro-inflammation, intralobular necro-inflammation, portal inflammation, total necro-inflammation and fibrosis. The mean serum ALT level was significantly higher in patients with severe intralobular necro-inflammation activity than in patients with mild or no activity (P= 0.013). However, scores of intralobular activity were only weakly correlated with serum ALT levels (r= 0.27) and could not be used to adequately predict ALT values. Serum ALT levels showed no significant correlation with the scores of portal inflammation, periportal necro-inflammation, total necro-inflammation and fibrosis. Also, there was no significant difference in the mean serum ALT level among different serum HCV-RNA levels and HCV genotypes. Serum HCV-RNA titres and genotypes showed no significant correlation with liver histology and serum HCV-RNA titres were only weakly correlated with the total necro-inflammatory score (r= 0.27). In conclusion, although serum ALT levels were higher in patients with more severe intralobular necro-inflammatory activity, the correlation was not strong enough to adequately predict ALT values. Serum HCV-RNA titres and genotypes also showed no significant correlation with serum ALT levels and liver histologies.