检测慢性丙型肝炎患者抗－HCVIgM的临床意义

对８２例输血后慢性丙型肝炎病人丙型肝炎病毒抗体（抗－ＨＣＶ）ＩｇＭ动态变化进行观察，８２例患者均检测到抗－ＨＣＶ抗体，其中５１例抗－ＨＣＶＩｇＭ阳性。抗－ＨＣＶＩｇＭ出现规律表现为４种类型：（１）持续检出型２４例（２９．２７％）；（２）间断检出型８例（９．７６％）；（３）短暂检出型１９例（２３．１７％）；（４）阴性型３１例（３７．８０％）。将８２例输血后慢性丙型肝炎抗－ＨＣＶＩｇＭ出现类型与丙氨酸转氨酶（ＡＬＴ）、ＨＣＶＲＮＡ消长情况比较，发现阴性型具有较低的ＡＬＴ峰值，而其它３型ＡＬＴ峰值较高（Ｐ＜０．０１）。８例经干扰素治疗的慢性活动性丙型肝炎患者，治疗前均有ＡＬＴ明显异常及ＨＣＶＲＮＡ、抗－ＨＣＶＩｇＭ阳性，治疗后１～３个月ＡＬＴ均转为正常，ＨＣＶＲＮＡ转为阴性，但其中只有３例伴抗－ＨＣＶＩｇＭ的阴转，随访１年发现，只有抗，ＨＣＶＩｇＭ阴转的３例病人得以痊愈，其余５例均在治疗后半年内病情复发。提示治疗中伴有抗－ＨＣＶＩｇＭ阴转的患者预后良好。

THE DIAGNOSTIC SIGNIFICANCE OF ANTI-HCV IgM IN CHRONIC HEPATITIS C VIRAL INFEC-TION

he significance of anti- HCV IgM testing in the diagnosis and evaluation of treatment of chronic hepa-titis C was studied.The serum samples from 82 patients with chronic hepatitisCwere tested for ALT,anti-HCv lgG and lgM and HCV RNA. All the 8 2 cases were positive for anti- HCV IgG and 5 1(62. 19%)positive for anti-HCV IgM. The emergence of anti-HCV IgM might be of four types: (1)persistent positive type,2.1(29. 26%)cases;( 2)intermittent positive type,8(9.75%)cases;(3) transient positive type, 19 (23. 17%)cases;(4)persistent negative type, 31 (37. 80%)cases,Usually there was progres-sive liver damage in type 1 and 2.If the patients were of transient positive type, they would usually reco-ver.There was a significant correlation between the levels of serum anti- HCV IGM and ALT,while no correlation existed between the levels of serum ALT anti-HCV IgG. It is suggested that in patients with chronic hepatitis C, detection of anti- HCV IgM may be useful for estimating the extent of progressive liver damage and guiding the antiviraI therapy.