输血后丙型肝炎病人10年前瞻性研究

A Prospective Study on Blood-Transfused Hepatitis C Patients for Ten Years

目的 研究26例丙肝病人的演变过程。方法 采用前瞻性的研究方法,以26例已跟踪10年以上的丙肝病人作为研究对象,对所采集到的输血前及输血后血清,进行ALT和抗HCV检测及HCV RNA检测。结果 对该26例输血后丙肝病人跟踪时间平均128个月,输血后抗HCV最早于第15天被检测到,最晚出现于第80天,平均窗口期为42d,至第11年时其抗HCV阳性率仍维持在约70％。大多数病人在输血后的30d内其ALT即出现异常,随后其ALT的变化大致可分为3种类型:短期异常后转为正常并维持至今;ALT维持较长时间异常;ALT呈波浪式反复异常。笔者所跟踪的26例输血后丙肝病人中,24例病人的ALT或只有一个异常峰,但维持时间较长(平均16个月),或呈现波浪式多次的高异常,其抗HCV在第11年时仍绝大多数维持阳性,说明丙肝病毒在人体内引起的免疫反应较弱而持久。2例病人在ALT异常5个月后转为正常,随后其抗HCV及HCV RNA亦转为阴性,至今已超过10年未发现肝炎症状,HCV感染人体以后能引起较快、较强的免疫反应,该被感染者又能通过免疫系统将病毒清除掉。结论 大多数丙型肝炎病人转为慢性化,少数丙型肝炎病人则存在自愈。

Objective To study the course of blood-transfused hepatitis C patients. Methods 26 blood-transfused hepafitis C patients were followed from 1990, when the commercial anti-HCV ELISA kit was not available in China, to now for more than ten years.The serial sera of these patients were tested for anti-HCV, HCV RNA and ALT. Results The average first time of Anti-HCV positive conversion were 42 days (15-80) after blood transfusion and the window time of abnormal ALT were 42 days (21-73).In 11 years, the positive rate of anti-HCV was about 70%.In 6, 12 and 24 month, the abnormal ALT rate were more than 50%.From 3F6 months after, the abnormal ALT rate decreased signitieantly. There are three ALT figures in these patients: (1) ALT become abnormal quickly after blood transfused, keep short time, then return normal till now. (2) Long time ALT abnormal(average 16 months, 6-47 months). (3) Wave-like ALT abnormal. Conclusion Most blood-transfused hepatitis C patients become chronic and fewer of them can recover from HCV infection.