河北省固安县某农村单采浆献血员丙型肝炎病毒感染的追踪研究

12-25-year follow-up of hepatitis C virus infection in a rural area of Hebei province, China

目的 :了解我国输血后丙型肝炎病毒 (HCV)感染的慢性化规律和影响因素。方法 :对河北省固安县某农村 137例单采浆献血员HCV感染 12～ 2 5年的现状进行调查 ,包括临床表现 ,血清丙氨酸氨基转移酶 (ALT)、天门冬氨酸氨基转移酶 (AST)、γ 谷氨酰转肽酶 (γ GT)、碱性磷酸酶 (ALP)、血清总胆红素 (TBil)、直接胆红素 (DBil)、总蛋白(TP)、白蛋白 (ALB)测定和αFP检测 ,病毒学标志检测以及B型超声检查 ,其中 ,HCVRNA的测定采用荧光定量PCR方法 ,抗 HCV和HBsAg测定采用酶联免疫吸附试验。结果 :该组HCV感染的慢性化率为 70 .99% ,自然阴转率为2 9 .0 1%。 137例感染者目前几乎均无症状 ,总的ALT和 /或AST异常率为 37.4 0 % ,6例为中度 ,其余均为轻度 ,无重度。但B型超声检查发现 ,轻度者占 5 7.72 % ,中度占 38.2 1% ,重度占 4 .0 7%。重度者距感染发生时间分别为 13、14、2 1、2 5和 2 5年。HCVRNA阳性组的ALT、AST和γ GT平均水平显著高于阴性组 ,抗 HCV阳性组的ALT/AST的异常率显著高于阴性组 ,抗 HCV滴度与HCVRNA水平的对数呈正相关 (r=0 .74 7,P <0 .0 1)。男性感染者的慢性化率高于女性感染者 (78.6 9%比 6 4 .2 9% )。结论 :本组输血后HCV感染自然阴转率较高 ,慢性HCV感染表现隐匿 ,肝酶学检查指标?

Objective: To investigate natural histor y of hepatitis C virus (HCV) inf ection and related factors in China. Methods: We enrolled 137 cases infected with HCV 12-25 years ago in this research Their clinical manifestations were rec orded and sera detected for alanine aminotransferase (ALT), aspartate amino transferase (AST), γ-glutamyltransferase (γ-GT), alkaline phosphatase (ALP ), t otal bilirubin(TBil), direct bilirubin(DBil), total protein (TP), a lbumin (ALB) and α-fetoprotein (αFP) , as well as virus markers. The B-type ultra so und detecting was performed for examination of liver, gall bladder, spleen and p ancreas. In virus markers, HCV RNA was detected with fluorogenic-quantitative p o lymerase-chain-reaction, HBsAg and anti-HCV antibody, with enzyme-linked immu-no-absorbed assay (ELISA). Results: 12-25 years after infection,93(70.99%) of the 1 31 cases who were detected for HCV RNA still had detectable HCV RNA in their blo od and the infection had cleared spontaneously in 38 cases (29.01%). No case com plained of any sign at present, abnormal ALT and/or AST was observed in 37.40% c ases , in which 6 cases were with moderate ALT and/or AST elevation,and all remaining cas es were with mild ALT and/or AST elevation. With ultrasound examination, however , 57.72% mild degree, 38.21% moderate degree and 4.07% severe degree were found in these cases. The intervals after infection for cases with severe degree were 13, 14, 21, 25 and 25 years re spectively. The levels of liver enzymes were significantly higher in HCV RNA pos i tive cases than in HCV RNA negative cases ( P <0.01),and abnormal rate of live r enzym es was higher in anti-HCV positive cases than in anti-HCV negative cases ( P <0.01). Positive relation was observed between anti-HCV titer and virus load ( r =0.747, P <0.01), and male gender had higher chronic infection rate than female (infection rate at present, 78.69% vs 64.29%, P =0.070). Conclusion: Higher spontaneous HCV clear rate after infection was observed in this research. The clinical course of chronic HCV infection seems obscure and is often accompanied with mild to moder a te elevated ALT/AST, therefore, the clinical manifestations and liver enzymes ca n not betray its severity.Instead, ultrasound examination plays an impor tant role in clinical evaluation. Male gender may have worse clinical outcomes.