河北省赵县某农村单采血浆还输血细胞献血员丙型肝炎病毒感染的追踪调查

目的　调查我国输血后丙型肝炎病毒 (HCV)感染的自然史及其影响预后的因素。方法　河北省赵县某农村单采血浆还输血细胞献血员 (简称献浆员 ) ,于 1993年 8月经现场调查及血清学检测被诊断为HCV感染者 172例 ,未进行任何抗病毒治疗 ,2 0 0 2年 7月对其HCV感染 9年后的转归以及影响转归的因素进行调查分析。结果　在 172例HCV感染者中 ,9年后 2例死于晚期肝病 ,4例死于脑出血 ,1例意外死亡 ,9年后实际追踪到 14 2例 ,失访率为 13 9% (2 3/ 16 5 ) ,肝病的病死率为 1 2 % (2 / 172 )。该组HCV感染者的慢性化率为 91 5 % (130 / 14 2 ) ,自然阴转率为 8 4 % (12 /14 2 )。在持续性HCV感染者中 ,经B型超声检查提示 ,肝硬化率为 3 1% (4/ 130 ) ;重度肝炎占 6 9%(9/ 130 ) ;中度肝炎 36 2 % (47/ 130 ) ;轻度 5 3 1% (6 9/ 130 ) ;另有 10 0 % (13/ 130 )诊断为脂肪肝。HCVRNA阳性组的丙氨酸氨基转移酶、天冬氨酸氨基转移酶、和γ谷氨酸转肽酶的平均水平显著高于阴性组 (P <0 0 0 1)。HCV/HBV混合感染者肝硬化进程显著快于单独HCV感染 (P <0 0 5 )。结论　输血后HCV感染者的慢性化率远远高于乙型肝炎病毒 (HBV)感染者 ,HCV/HBV混合感染者较单一感染者预后差。

Nine-year follow-up of hepatitis C virus infection in a rural area of Hebei province, China

OBJECTIVE: To investigate natural history of hepatitis C virus infection and related factors among plasma donors in China. METHODS: 172 plasma donors in a rural area of Hebei province had been diagnosed as HCV infection in 1993. No antiviral treatment was applied to them during the period of infection. In the present study, we investigated the outcome of HCV infection nine years later and related factors affecting the outcome. In fact, only 142 cases were followed up in the investigation. The mean age of 142 cases of blood donors was 46 +/- 9 and the mean age of infection was 37 +/- 9 years old. RESULTS: After nine-year follow-up, 1.2% died of end-stage liver disease. 130 (91.6%) of 142 cases under investigation were still positive for HCV RNA or anti-HCV in their blood and 12 cases (8.4%) were negative for both HCV RNA and anti-HCV. 3.1% developed liver cirrhosis among the patients with persistent infection. The mean level of ALT, AST, GGT among HCV RNA positive cases were significantly higher than that of HCV RNA negative cases (P < 0.001). The abnormal rates of ALT and/or AST in male patients were significantly higher than those of female patients (P = 0.005). The rate of progression to liver cirrhosis from chronic hepatitis C virus was significantly higher in patients co-infected with HCV/HBV than that of the cases of single HCV infection. CONCLUSION: Higher chronic rate was observed in this research. Superinfection of HBV/HCV may have worse clinical outcomes.