输血后丙型肝炎患者的临床特点及自然病程

The clinical features and natural history of post-transfusiou hepatitis C

目的了解输血后慢性丙型肝炎病毒(HCV)感染者的临床特点及自然病程。方法采用回顾性调查与前瞻性研究相结合的方法,进行定群随访观察。结果(1)在99例HCV感染病例中,输血时间主要集中于1989—1994年,其中1990—1992年最为多见。(2)99例随访患者中,90例临床诊断为慢性丙型肝炎,9例诊断为丙型肝炎肝硬化(代偿期)。(3)99例患者自输血距首次诊断丙型肝炎的时间为(7．4± 6．6)年,其中9例患者首次诊断丙型肝炎肝硬化距输血时间为(12．7±5．8)年。(4)在63例男性患者中, 慢性丙型肝炎59例,丙型肝炎肝硬化4例；36例女性患者中,慢性丙型肝炎31例,丙型肝炎肝硬化5例；按男女分组比较丙型肝炎与肝硬化的构成比,差异无统计学意义(P＞0．05)。(5)丙型肝炎肝硬化组患者病程中均有反复肝功能异常,并且两氨酸氨基转移酶异常时波动的幅度较大。(6)本组病例在观察期间未发现肝癌的发生。结论(1)在广州地区,目前经输血感染HCV的可能性较1995年前大幅度降低。(2)9．1％ (9／99)的慢性丙型肝炎感染者在HCV感染13(12．7±5．8)年左右已进展为肝硬化(代偿期)。(3)对于反复出现肝功能异常的慢性丙型肝炎患者,应尽可能采用干扰素联合利巴韦林进行抗病毒治疗。

Objective To study the clinical features and natural history of post-transfusion hepatitis C （PTHC）. Methods Ninety-nine post-transfusion hepatitis C patients were analyzed using retrospective and prospective study and follow-up. Results （1） Ninety-nine post-transfusion HCV patients were infected during 1989-1994, mostly between 1990-1992. （2） Ninety patients were diagnosed as chronic hepatitis C, and 9 as hepatic cirrhosis （period of compensation）. （3） The intervals between their transfusions and their initial diagnoses of PTHC were 7.4 ± 6.6 years in all 99 patients, and the intervals in 9 cirrhosis patients were 12.7± 5.8 years . （4） Among 63 male patients, 59 cases were chronic hepatitis C and 4 were cirrhosis while among 36 female patients, 31 were chronic hepatitis C and 5 were cirrhosis. There was no significant difference of the ratio for hepatitis C and cirrhosis between the male and female patients （P 〉 0.05）. （5） Repeat abnormal liver function occurred accompanied with a fluctuation of ALT elevation in those patients with cirrhosis. （6） No patient developed hepatic carcinoma during the study period. Condusions （1） The possibility of HCV infection by transfusion has declined greatly since 1995 in Guangzhou. （2） Nine of the 99 （9.1%） chronic HCV-infected patients developed a compensated cirrhosis after 12.75.8 years. （3） For those PTHC patients with repeat abnormal liver functions, interferon combined with ribavirin is recommended to prevent the development of cirrhosis.