1018例丙型肝炎流行病学及临床特点分析

Analysis of epidemiology and clinical characteristics of 1018 cases of hepatitis C

目的了解丙型肝炎的流行病学及临床特点。方法对2010年7月至2018年12月在本院诊断为丙型肝炎的1018例患者采用回顾性调查的方式,记录性别、年龄、传播途径、临床表现、ALT、HCVRNA、基因分型等。将患者分为慢性丙型肝炎(无肝硬化)组846例和丙型肝炎肝硬化(肝硬化)组172例,比较两组年龄及HCVRNA。结果 1018例患者中,男518例,女500例。年龄<30岁者120例,年龄≥30岁者898例。经输血或有偿献血传播628例,占61.7%,ALT<3 ULN者716例,占70.3%。HCVRNA≥1×10^(7)copies/m L 932例,占91.5%。基因型1b 850例,占83.5%,2a 60例,占5.9%。临床症状多为乏力、纳差、肝区不适等,进展为肝硬化失代偿期症状有所加重。无肝硬化组平均年龄(45.4±13.5)岁,肝硬化组平均年龄(56.8±11.1)岁,组间比较差异有统计学意义(P<0.05);无肝硬化组HCVRNA(2.76×10^(7)±1.33×10^(7))copies/m L,肝硬化组(3.50×10^(7)±1.27×10^(7)) copies/m L,组间比较差异无统计学意义(P>0.05)。结论丙型肝炎感染者无性别差异,抗-HCV阳性率随年龄增长而逐渐上升。感染途径以经血液为主,常见的病毒基因型为1b和2a。丙型肝炎症状轻,ALT轻度异常,在临床上遇到症状轻、ALT反复异常者,即使无输血史也应行丙型肝炎相关检测。进展至肝硬化多见于年龄较大者,与HCVRNA载量高低无关,因此对于HCVRNA阳性的丙型肝炎患者,应尽早抗病毒治疗。

Objective To understand the epidemiology and clinical characteristics of hepatitis C. Methods A retrospective survey of 1018 patients diagnosed with hepatitis C in our hospital from July 2010 to December 2018 was used to record gender,age,route of transmission,clinical manifestations,ALT,HCVRNA,genotyping,etc.The patients were divided into the chronic hepatitis C(no cirrhosis)group(846 cases)and the hepatitis C cirrhosis(cirrhosis)group(172 cases).The age and HCVRNA of the two groups were compared. Results 518 cases were male and 500 cases were female among in 1018 patients,and 120 cases were <30 years old,898 cases were≥30 years old. A total of 628 cases spread through blood transfusion or paid blood donation,accounting for 61.7%.The ALT of 716 cases was less than 3 ULN,accounting for 70.3%.There were 932 cases with HCVRNA greater than or equal to 1 ×10^(7)copies/m L,accounting for91.5%.There were 850 cases with genotype 1 b,accounting for 83.5%,and 60 cases with 2 a,accounting for 5.9%.The clinical symptoms were mostly fatigue,anorexia,liver discomfort,etc.,and the symptoms of liver cirrhosis were aggravated in the decompensated stage.The age of the non-cirrhosis group was(45.4±13.5)years old,and the age of the cirrhosis group was(56.8±11.1)years old,there was a significant difference between the two groups(P<0.05).The HCVRNA in the cirrhosis group was(2.76×10^(7)±1.33×10^(7))copies/m L.And the HCVRNA in the liver cirrhosis group was(3.50×10^(7)±1.27×10^(7))copies/m L,there was no significant difference between the two groups(P>0.05).Conclusion There is no gender difference in hepatitis C infection,and the anti-HCV positive rate gradually increases with age.The main route of infection is through blood.The common virus genotypes are 1 b and 2 a. Hepatitis C symptoms are mild and ALT is mildly abnormal.Patients who have mild symptoms and repeated ALT abnormalities in the clinic should be tested for hepatitis C even without a history of blood transfusion.Progression to liver cirrhosis is more common in older people,and has nothing to do with the level of HCV RNA load.Therefore,for HCVRNA-positive hepatitis C patients,antiviral treatment should be given as soon as possible.