Natural history of hepatitis C virus carriers with persistently normal aminotransferase levels
Natural history of hepatitis C virus carriers with persistently normal aminotransferase levels
复制标题
DOI：
10.1016/s0016-5085(00)70145-4
复制
发表时间：
2000-04-01
期刊：
影响因子：
29.4
通讯作者：
Torella, R
中科院分区：
文献类型：
--
作者：
Persico, M;Persico, E;Torella, R
背景和目标：一些血清丙型肝炎病毒（HCV）患者的转氨酶（ALT）水平持续正常，并受到肝硬化的影响。本研究前瞻性评估了一组ALT水平持续正常的抗HCV阳性患者的疾病进展。方法：对37名受试者进行研究。每例受试者在基线和5年随访后接受肝活检，基线时检测血清样本的基因型和HCV RNA载量。每隔一个月和每6个月分别检测ALT水平和血清HCV RNA。ALT升高的患者退出研究，并接受IFN治疗。IFN治疗结束后5年，进行肝活检。结果如下：基线时肝活检显示34例慢性肝炎，3例组织学正常，其中2例HCVRNA阴性，1例阳性。HCV基因型分布如下：2a，56%; Ib，41%;和Ia，3%。在7年随访结束时，73%的患者的ALT值仍然正常。5年后的肝组织学与进入研究时观察到的结果相当。结论：大多数ALT血清水平持续正常的患者具有非常轻微的慢性肝炎。然而，存在健康的抗-HCV阳性受试者。在与持续正常ALT水平相关的HCV相关慢性肝炎患者中，疾病活动度多年不增加，并且进展为肝硬化缓慢或不存在。
Background & Aims: Some patients with serum hepatitis C virus (HCV) have persistently normal aminotransferase (ALT) levels and are affected by cirrhosis. This study prospectively evaluated progression of the disease in a group of anti-HCV-positive patients with persistently normal ALT levels. Methods: Thirty-seven subjects were studied. Each subject underwent liver biopsy at baseline and after 5 years of follow-up, At baseline, serum samples were tested for genotypes and HCV RNA load. ALT levels and serum HCV RNA were tested every other month and every 6 months, respectively. Patients with increased ALT were discharged from the study and treated with IFN. Five years after the end of IFN therapy, a liver biopsy was performed. Results: Liver biopsy at baseline showed chronic hepatitis in 34 patients and normal histology in 3 patients, 2 of whom were negative for HCV RNA and 1 positive. HCV genotypes were distributed as follows: 2a, 56%; Ib, 41%; and la, 3%, At the end of 7-year follow-up, 73% of the patients still had normal ALT values, Liver histology after 5 years was comparable to that observed at entry to study. Conclusions: Most patients with persistently normal ALT serum levels have very mild chronic hepatitis. However, healthy anti-HCV-positive subjects exist, In patients with HCV-related chronic hepatitis associated with persistently normal ALT levels, the grade of disease activity does not increase over years and progression to cirrhosis is slow or absent.