慢性丙型肝炎患者不同感染途径的临床特点分析及自然病程

The clinical features and natural course of different routes of infection in patients with chronic hepatitis C

目的探讨慢性丙型肝炎(CHC)患者不同感染途径的临床特点及自然病程。方法收集2010-2016年在广西医科大学第一附属医院门诊确诊为CHC患者的临床资料,将疾病进展为肝硬化或肝癌统称为进展肝炎组(DH组),其余为慢性肝炎组(H组)。结果 (1)共收集CHC患者198例,其中输血感染115例,非输血感染83例。(2)2003年前以输血感染为主,2003年后以非输血感染为主。(3)共124例测基因分型,1b型66例(53.2%),3b型15例(12.1%),6a型16例(12.9%),3a型11例(8.9%),1a型10例(8.1%),2a型4例(3.2%),6a或6b型2例(1.6%)。输血感染以1b型为主,非输血感染以3b、6a为主。(4)病程进展:感染到首次诊断CHC的时间为(17.36±7.46)年。输血、非输血感染到确诊CHC的时间为(18.90±7.49)年、(14.00±6.25)年,差异有统计学意义(P=0.000)。(5)输血感染病程特点:感染进展至肝硬化时间平均(18.77±5.29)年,至肝癌平均(20.00±1.63)年。慢性肝炎组与进展肝炎组的TBIL、DBIL、IBIL、ALB、GLO、A/G、TBA、ALP、PA、CHE对比差异有统计学意义(P<0.05)。结论 CHC患者2003年前输血感染为主,2003年后以静脉药瘾、性接触感染途径为主。输血感染基因型以1b型为主,非输血感染3b、6a为主。CHC进展为肝硬化的平均时间为18年,至肝癌的平均时间约为20年,疾病进展后出现肝功能损害明显。

Objective To investigate the clinical features and natural course of different chronic hepatitisC（CHC）. Methods The clinical data of patients with CHC was collected in the department of infectious diseasesin the First Affiliated Hospital of Guangxi Medical University from 2010 to 2016. The cirrhosis or liver cancerreferred to as the development hepatitis group（DH group）,and the chronic hepatitis C called hepatitis group（H group）. Results（1）One hundred and ninety-eight CHC patients were enrolled,including 115 transfusion-transmitted infection（TTI）,and 83 non-transfusion infection（NTI）.（2）HCV patients were infected during 1989-2003,and were mainly infected with TTI before 2003,and were infected with NTI after 2003.（3）One hundredand twenty-four CHC were genotyped,included 66 cases（53.2%）of subtype 1 b,15 cases（12.1%）of subtype3 b,16 cases（12.9%）of subtype 6 a,11 cases（8.9%）of subtype 3 a,10 cases（8.1%）of subtype 1 a,4 cases（3.2%）of subtype 2 a and 2 cases（1.6%）of subtype 6 a or 6 b. The most common genotypes with TTI was type 1 b,the genotypes with NTI was 3 b and 6 a.（4）The TTI and NTI intervals between their transfusion and their initialdiagnoses of CHC were（18.90 ± 7.49）years,（14.00 ± 6.25）years（P = 0.000）.（5）The characteristics of TTI,the intervals between transfusion and initial diagnoses of CHC was（17.36 ± 7.46）years. The average time of hepa-titis to cirrhosis were（18.77 ± 5.29）years,to cancer were（20.00 ± 1.63）years. There were statistically signifi-cant difference among with the TBIL,DBIL,IBIL,ALB,GLO,A/G,TBA,ALP,PA and CHE in the H group andDH group（P〈0.05）. Conclusions HCV patients were mainly infected with blood transfusion before 2003,butwere injection drug use and sexual contact after 2003. The major infection mode of genotype 1 b was TTI,and theNTI were 3 b and 6 a.The average time of CHC to cirrhosis was 17 years,to cancer was 20 years,and the time ofliver damage after the progression of chronic hepatitis was advanced.