重型肝炎患者丙型肝炎病毒抗体的存在状态及其意义

THE REVALENCE AND SIGNIFCANCE 0F ANT1BODY To HEPATITISCvINPATIENT SWITH SEVERE VIRAL HEPATIS

采用合成肽酶免疫分析法（ｓｐＥＬＩＳＡ）和美国Ｏｒｔｈｏ公司第２代ＥＬＩＳＡ（２ｎｄＥＬＩＳＡ）检测重型肝炎患者血清丙型肝炎病毒抗体（抗ＨＣＶ），阳性率分别为２２％（２３ｌ／１０３）和１９％（１７／８９）；阳性血清经重组免疫印迹法（４·ＲＩＢＡ）鉴定仅５９％阳性，用逆转录聚合酶链反应检测ＨＣＶＲＮＡ阳性率仅６０％；动态观察，约１／３抗ＨＣＶ阳性患者抗体持续２～４周消失。血清抗ＨＣＶ阳性和（或）ＨＣＶＲＮＡ阳性患者均合并乙型肝炎病毒感染，但合并ＨＣＶＲＮＡ阳性患者预后较差。结果提示，单独ＨＣＶ感染不是本地区重型肝炎发生的主要原因，检测ＨＣＶＲＮＡ对于确切了解重型肝炎患者ＨＣＶ感染状况和判断预后有一定的意义。

The study was designed to reevaluate the prevalence and significance of antibody to hepatitisC virus(anti HCV) in sera from patients with severe viral hepatitis. Serum anti HCV in l03 cases of Severe viral hepatitis was detected by enzyme linked-immunosorbent assay based on synthetic peptides(SpELISA ) and the second generation ELISA(2nd ELISA ) (Ortho Co, UsA ),The positive rates of serumantiHCV detected by spELISA and the 2nd ELISA were 22%(23l103 ) and l9%(17/89)respectively. OnlY 59%(13/22) of sera positive with antiHCV by ELISA were shown to be positive by the second generation recotnbinant immunoblot assay(4.RIBA ) and 60%was positive with HCV RNA by reverse tran-scription-polymerase chain reaction(RT-pCR)。 After 2-4 weeks, disapparance of serum antiHVC happened in about one third of the patients with positive antiHCV, AlI the patients with positive antiHCVand/or positive HCV RNA were coinfected with hepatitis B virus,but those with positive HCV RNAshowed poor prognosis。 These resuIts suggest that HCV infection alone seems not to be the major cause ofsevere viral hepatitis。 It is valuable to detect HCV RNA for finding out the prevalence of HCV infectionand estimating the prognosis of patients with severe viral hepatitis。