慢性丙型肝炎患者人巨细胞病毒感染及肝脏损害状况的研究

Study of human cytomegalovirus infections and hepatic impairment in chronic hepatitis C patients

目的探讨慢性丙型肝炎患者人巨细胞病毒（HCMV）感染及合并感染者的肝脏损害状况。方法选取95例慢性丙型肝炎患者（病例组）及95例健康体检者（对照组），应用荧光定量聚合酶链反应（FQ-PCR）法检测两组HCMV．DNA含量，比较两组HCMV-DNA阳性率。应用FQ-PCR法检测慢性丙型肝炎患者HCV—RNA含量，进一步分析病例组中高病毒含量（〉10^4拷贝/ml）患者和低病毒含量（≤104拷贝／m1）患者HCMV．DNA阳性率的差异。采用速率法检测血清丙氨酸氨基转移酶（ALT）和天冬氨酸氨基转移酶（AST）水平，分析不同患者肝脏损害状况。结果病例组HCMV-DNA阳性25例，阳性率为26．3％（25／95），对照组HCMV-DNA阳性5例，阳性率为5．3％（5，95），两组比较差异有统计学意义（χ2=14．29，P〈0．01）。病例组中高病毒含量患者（43例）HCMV．DNA阳性21例，阳性率为48．8％（21／43），低病毒含量患者（52例）HCMV．DNA阳性4例，阳性率为7．7％（4／52），两者比较差异有统计学意义（r=19．90，P〈0．01）。病例组血清ALT、AST水平显著高于对照组（P〈0．01），病例组HCMV．DNA阳性患者血清ALT、AST水平显著高于HCMV．DNA阴性患者（P〈0．01）。结论慢性丙型肝炎患者更易合并HCMV的活动性感染；慢性丙型肝炎患者合并HCMV活动性感染时，进一步加重肝脏损害。

Objective To explore the infections of human eytomegalovirus （HCMV） in chronic hepatitis C patients and the hepatic impairment in chronic hepatitis C patients co-infected with HCMV. Methods HCMV-DNA was determined by fluorescence quantitative-PCR （FQ-PCR） in 95 patients with chronic hepatitis C （observation group） and 95 healthy controls（control group） and HCMV active infections were analyzed. HCV-RNA was determined by FQ-PCR in observation group, and the difference of HCMV-DNA positive rate between high HCV-RNA（ 〉 10^4 copies/ml） and low HCV-RNA（ ≤ 10^4 copies/ml） was analyzed. Alanine aminotransferase （ALT）, aspartate aminotransferase （AST） were determined by rate method in two groups and the hepatic impairment was analyzed. Results Twenty-five cases with positive HCMV-DNA in observation group, the positive rate was 26.3%（25/95 ）. Five cases with positive HCMV-DNA in control group, the positive rate was 5.3% （5/95）. There was significant difference between two groups for HCMV-DNA （X2 = 14.29,P 〈0.01）. Twenty-one cases with positive HCMV-DNA in 43 cases of high HCV-RNA patients, the positive rate was 48.8%（21/43 ）. Four eases with positive HCMV-DNA in 52 cases of low HCV-RNA patients,the positive rate was 7.7%（4/52）. There was significant difference between the two （ χ2 = 19.90,P 〈 0.01 ）. ALT,AST in observation group was higher than that in control group （P 〈 0.01 ）. ALT, AST in chronic hepatitis C patients positive for HCMV-DNA was higher than that in chronic hepatitis C patients negative for HCMV-DNA significantly （P 〈 0.01 ）. Conclusions HCMV in chronic hepatitis C patients becomes active again and co-infects easily. When chronic hepatitis C patients co-infect HCMV actively, hepatic is further injured.