283例慢性丙型肝炎患者感染12至25年后肝脏超声检查变化的特点

Clinical outcomes of 283 patients of transfusion-related hepatitis C in the northern areas of China

目的 了解我国人群HCV感染的慢性化经过和临床转归。方法 2 83例因单采血浆而感染丙型肝炎者 ,男性 137例 ,女性 14 6例。超声检查 ,ALT、AST、GGT采用速率法 ,抗 HCV采用ELISA方法。统计学方法采用 χ2 检验、u检验、秩和检验。结果 (1)超声诊断为重度慢性肝炎 15例 ,占5 3% ;肝硬化 4例 ,占 1 4 % ;共计 6 7%。 (2 )重度慢性肝炎和肝硬化组感染年龄 <4 0岁的发生率为6 72 % ,感染年龄 >4 0岁的发生率为 6 6 6 % ,两组发病率差异无显著意义。 (3)重度慢性肝炎和肝硬化的发生率在男性为 12 4 % ,女性为 1 3% ,男性的发生率明显高于女性 ,差异有显著意义。 (4) 2 83例感染者中 2 6 6例测定了抗 HCV ,阳性率 84 5 8% ,抗 HCV阳性组的慢性肝炎重度、肝硬化的发生率分别为 6 6 %、1 7% ,共计 8 3%。 (5 )重度慢性肝炎和肝硬化组的ALT、AST、GGT均值明显高于其他组。结论 HCV感染极易慢性化 ,但肝硬化的发生率没有国外文献报道的那么高。未发现失代偿性肝硬化、肝癌的病例。HCV感染者中男性的病情重于女性。感染时的年龄对HCV感染的预后影响不大。HCV感染者较易发生脂肪肝 ,HCV感染导致的肝硬化多为活动性肝硬化。在缺乏肝活检的情况下 ,超声检查有助于病情的判断。

Objective To investigate the natural history and clinical outcomes in a cohort of transfusion-related hepatitis C in northern areas of China. Methods The authors studied 283 patients (137 males,146 females,mean age 45.79±9.92 age) who became infected with HCV while donating plasma 12-25 years ago. These cases were subjected to ultrasonography and liver biochemical tests and serologic anti-HCV assays. Statistical analyses were performed using the SPSS software. Results Ultrasonographic findings suggestive of liver cirrhosis were 8.3% of cases. No decompensated cirrhosis or HCC was detected. The value of ALT was higher in severe chronic hepatitis (mean 62.07±50.87 IU/L) and cirrhosis (mean 115.50±108.41 IU/L) patients than in the other groups (mean 32.30±29.10 IU/L). The abnormal rate of ALT was 53.3% in severe group,100% in cirrhosis group. Conclusion The natural history of transfusion-related hepatitis C in the areas seemed to be relatively mild when compared with previous data. Our cases showed relatively low rate of positive findings in ultrasonography. None of this cohort had the decompensated cirrhosis or HCC. The factor of sex but not the age at time of infection was found being related to the outcomes. In the absence of liver biopsy,ultrasonography was a suitable and sensitive method for the diagnosis of the progressive hepatitis and cirrhosis.