Clinical outcomes after hepatitis C infection from contaminated anti-D immune globulin
Clinical outcomes after hepatitis C infection from contaminated anti-D immune globulin
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DOI：
10.1056/nejm199904223401602
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发表时间：
1999-04-22
影响因子：
158.5
通讯作者：
Kenny-Walsh, E
中科院分区：
文献类型：
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作者：
Kenny-Walsh, E
背景和方法1994年2月，在爱尔兰1977年和1978年用于预防Rh同种免疫的抗D免疫球蛋白批次被发现被来自单个感染供体的丙型肝炎病毒（HCV）污染。1994年3月，对1970年至1994年期间接受过抗D免疫球蛋白治疗的所有妇女启动了一项全国筛查计划。在这项研究开始时接受筛查的62，667名妇女中，704名（1.1%）有过去或当前HCV感染的证据，其中390名（55%）在逆转录聚合酶链反应分析中血清HCV RNA检测呈阳性。所有390人都被转诊进行临床评估和治疗。我们评估了这390名妇女中的376名（96%）;其他14名未在指定的治疗中心之一就诊。结果376名妇女在筛查时的平均（+/-SD）年龄为45+/-6岁。他们已经感染丙型肝炎大约17年了。共有304名女性（81%）报告了症状，最常见的是疲劳（248名女性[66%]）。371名妇女中有176名（47%）血清丙氨酸转氨酶浓度略有升高（40至99 U/L），31名（8%）浓度为100 U/L或更高。363名女性中有356名（98%）的肝脏活检显示炎症;在大多数情况下，炎症是轻微的（41%）或中度的（52%）。尽管363名女性中有186名（51%）的活检样本显示纤维化证据，但只有7名女性（2%）可能或明确患有肝硬化。结论：大多数感染HCV的女性在接受HCV污染的抗D免疫球蛋白治疗17年后，肝活检显示有轻微或中度的肝脏炎症，约一半有纤维化，2%有可能或明确的肝硬化（N Engl J Med 1999;340：1228-33）。(C)1999年，马萨诸塞州医学会。
Background and Methods In February 1994, batches of anti-D immune globulin used in Ireland during 1977 and 1978 to prevent Rh isoimmunization were found to be contaminated with hepatitis C virus (HCV) from a single infected donor. In March 1994, a national screening program was initiated for all women who had received anti-D immune globulin between 1970 and 1994. Of the 62,667 women who had been screened when this study began, 704 (1.1 percent) had evidence of past or current HCV infection, and 390 of those 704 (55 percent) had positive tests for serum HCV RNA on reverse-transcription-polymerase-chain-reaction analysis. All 390 Were offered a referral for clinical assessment and therapy. We evaluated 376 of these 390 women (96 percent); the other 14 were not seen at one of the designated treatment centers.Results The mean (+/-SD) age of the 376 women was 45+/-6 years at the time of screening. They had been infected with hepatitis C for about 17 years. A total of 304 women (81 percent) reported symptoms, most commonly fatigue (248 women [66 percent]). Serum alanine aminotransferase concentrations were slightly elevated (40 to 99 U per liter) in 176 of 371 women (47 percent), and the concentrations were 100 U per liter or higher in 31 (8 percent). Liver biopsies showed inflammation in 356 of 363 women (98 percent); in most cases the inflammation was slight (41 percent) or moderate (52 percent). Although the biopsy samples from 186 of the 363 women (51 percent) showed evidence of fibrosis, only 7 women (2 percent) had probable or definite cirrhosis. Two of the seven reported excessive alcohol consumption.Conclusions Most of the women with HCV infection 17 years after receiving HCV-contaminated anti-D immune globulin had evidence of slight or moderate hepatic inflammation on liver biopsy, about half had fibrosis, and 2 percent had probable or definite cirrhosis, (N Engl J Med 1999;340:1228-33.) (C) 1999, Massachusetts Medical Society.