丙型肝炎患者外周血单个核细胞中HCV-RNA含量检测的临床意义

Clinical Significance of Detection of HCV RNA Concentration in Peripheral Blood Mononuclear Cells of Patients with HCV Infection

目的:了解丙型肝炎(丙肝)患者外周血单个核细胞(PBMC)中丙肝病毒核酸(HCV-RNA)的存在情况并探讨其临床意义。方法:应用荧光定量聚合酶链反应(FQ-PCR)方法,对65例丙肝患者的血清和PBMC中HCV-RNA进行检测。结果:65例丙肝患者血清和PBMC中HCV-RNA阳性分别为41例(63.1%)和35例(53.8%),其中34例急性丙肝患者血清、PBMC中HCV-RNA阳性分别为21例(61.8%)、13例(38.2%),31例慢性丙肝患者血清、PBMC中HCV-RNA阳性分别为20例(64.5%)、22例(71.0%),慢性丙肝患者PBMC中HCV-RNA检出率与急性相比,差异有统计学意义(2χ=5.74,P<0.05)。3例(2例慢性、1例急性)丙肝患者PBMC中HCV-RNA阳性,但血清HCV-RNA阴性。9例(全为急性)丙肝患者PBMC中HCV-RNA阴性,但血清HCV-RNA阳性。32例(12例急性、20例慢性)丙肝患者血清和PBMC中HCV-RNA均阳性,且PBMC中HCV-RNA的含量均低于血清,两者含量呈正相关。结论:PBMC为HCV肝外贮存场所,其HCV含量依赖血清中HCV的含量;PBMC中HCV在丙肝患者的病情慢性化过程中可能起一定作用;实验室可以通过浓聚血液中PBMC的浓度来提高其HCV-RNA的检出率,故临床医生在对丙肝患者进行血清HCV-RNA定量检测的同时开展PBMC中HCV-RNA检测可以减少漏诊,可作为慢性丙肝患者的选择治疗及预后判断的重要指标。

Objective： To investigate the existence of hepatitis C virus （HCV） RNA in peripheral blood mononuclear ceils （PBMCs） of patients with hepatitis C and to explore its clinical significance. Methods： Fluorescent quantitative polymerase chain reaction（FQ-PCR） was applied to detect HCV-RNA both in serum and in PBMCs of 65 patients with hepatitis C. Results： It was found that of total 65 cases, 41 were HCV RNA positive in serum, and 35 were HCV RNA positive in PBMCs. And of patients with acute hepatitis C, 134（38. 2%） were HCV RNA positive in PBMCs, meanwhile, 22（71.0%） were HCV RNA positive in PBMC among chronic hepatitis C. The incidence of HCV infection in PBMCs was significantly higher in chronic hepatitis C than in acute hepatitis C（x^2 =5.74,P〈0.05）. Three patients with HCV RNA negative in their sera showed HCV RNA positive in PBMC, and nine patients with HCV RNA positive in their sera showed HCV RNA negative in PBMCs. Thirty-two patients were detected HCV RNA both in their sera and in PBMCs, the HCV RNA concentration in PBMC was lower than of their sera, and correlation of their concentrations was significantly positive. Concision： PBMC is the extra-hepatic resort for HCV storage. The detectability of HCV RNA in PBMC seems to depend on the HCV concentration in serum. The HCV infection of PBMCs might paly certain roles in chronicity and long-term liver damage of hepatitis C. The detection of PBMC HCV RNA might have important significance in the diagnosis and choosing treatment and prognosis of hepatitis C.