丙型肝炎病毒感染的献血者10年追踪观察

目的　追踪观察发生HCV感染的献血者的疾病进程和健康状况。方法　从 1993年 10月～ 2 0 0 4年 2月 ,对 30名HCV感染的献血者定期抽取血液标本 ,观察所得到的 4 4 2份系列标本的血清ALT、抗 HCV和HCV RNA的动态变化 ,并进行HCV分型测定 ,重点分析了其中 10名自愿者肝组织的病理检查结果和血清ALT、抗 HCV与HCV RNA的动态变化。结果　① 30名HCV感染者系列标本中 ,ALT异常率 37.6 % (16 6 / 4 4 2 ) ;抗 HCV阳性率97.1% (42 9/ 4 4 2 ,ELISA法 ) ;HCV RNA阳性率 74 .9% (331/ 4 4 2 )。② 10名HCV感染的献血者 10年系列血清中抗 HCV大多数持续存在 (94 4 % ,15 1/ 16 0 ) ,其HCV RNA时有间隙性阴性 ,阳性率 6 7 5 % (10 8/ 16 0 )其血清ALT水平异常率 33 6 % (5 0 / 14 9)。③HCV分型测定 :HCVⅡ / 1b型占 85 % (2 2 / 2 6 ) ,Ⅲ / 2a型占 15 % (4/ 2 6 )。④ 10名HCV感染者肝组织检查显示均为轻度慢性肝炎。结论　肝组织的病理变化同血清抗 HCV、HCV RNA和ALT的异常有明显相关性。虽然HCV感染后 10年的疾病进程大多是缓慢的 ,但应采取适当治疗措施以控制慢性肝炎的发展。

Follow-up observation on blood donors infected with HCV for 10 years

Objective To follow up the disease course and health condition of blood donors infected with HCV. Methods To collect blood specimens from 30 HCV-infected subjects periodically, observe the dynamic changes of serum ALT levels, anti-HCV and HCV-RNA, perform HCV typing, liver biopsy. Results In 10 years, 442 serial sera from HCV-infected subjects were collected and analyzed, and liver biopsy was performed in 10 voluntary subjects. The results were as follows: ①The abnormal ALT rate in these HCV-infected subjects was 37.6%(166/442), demonstrating fluctuation of ALT among HCV infected persons; the anti-HCV positive rate was 97.1%(429/442); the HCV-RNA positive rate was 74.9%(331/442). ②Anti-HCV in HCV-infected blood donors' sera existed almost persistently; sometimes HCV-RNA testing in some of the HCV-infected subjects was negative; the HCV RNA positive rate was 67.5% (108/160). ③HCV typing showed that the HCV type Ⅱ/1b was 85%(22/26), and type Ⅲ/2a was 15%(4/26). ④Liver biopsies of 10 HCV-infected blood donors showed that all of them had mild chronic hepatitis. Conclusion Liver biopsies showed that all infected donors progressed to chronic hepatitis C within 10 years. The pathological changes of the liver were consistent with the detection of anti-HCV antibodies, HCV-RNA and the increased ALT levels. Although the disease progress was slow, measures needed to be taken to prevent the development of chronic hepatitis.