HEPATITIS-C INFECTION IN PATIENTS WITH PRIMARY HYPOGAMMAGLOBULINEMIA AFTER TREATMENT WITH CONTAMINATED IMMUNE GLOBULIN
HEPATITIS-C INFECTION IN PATIENTS WITH PRIMARY HYPOGAMMAGLOBULINEMIA AFTER TREATMENT WITH CONTAMINATED IMMUNE GLOBULIN
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DOI：
10.1056/nejm199412153312402
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发表时间：
1994-12-15
影响因子：
158.5
通讯作者：
HAALAND, T
中科院分区：
文献类型：
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作者：
BJORO, K;FROLAND, SS;HAALAND, T
背景在斯堪的纳维亚，许多原发性低丙种球蛋白血症患者在静脉注射免疫球蛋白后感染了非甲非乙型肝炎，后来发现该产品含有非甲非乙型肝炎病毒。我们研究了一组55名挪威原发性低丙种球蛋白血症患者的丙型肝炎病毒（HCV）感染的患病率和临床病程，并调查了其与使用污染的免疫球蛋白的关系。我们用聚合酶链反应检测HCV RNA并进行HCV基因分型。我们还分析了干扰素治疗的反应。在20例接受污染免疫球蛋白治疗的患者中，17例血清HCVRNA阳性，另外，在35例未接受污染免疫球蛋白治疗的患者中，1例血清HCVRNA阳性。在所有12例进行基因分型的患者中发现HCV基因型V，但8例患者也有基因型II或III，或两者兼而有之。所有HCV RNA阳性患者的生化肝脏检查结果异常。所有肝活检标本（来自15例患者）均异常，伴有门静脉炎症、胆管损伤和局灶性坏死。6例患者出现肝硬化。两名患者死于肝功能衰竭。在10例接受干扰素治疗的患者中，有4例出现了完全的，尽管是短暂的生化反应，但随访活检标本显示组织学进展的证据。对干扰素的反应最差的是具有多种HCV基因型的患者。除1例患者外，其余患者HCV RNA均为阳性。在原发性低丙种球蛋白血症患者中，用污染的免疫球蛋白治疗后HCV感染率很高。在这些免疫功能低下的患者中，HCV感染具有严重和快速进展的过程，并且对干扰素的反应很差。
Background. In Scandinavia many patients with primary hypogammaglobulinemia contracted non-A, non-B hepatitis after intravenous treatment with an immune globulin product that was later found to contain a non-A, non-B hepatitis virus.Methods. We studied the prevalence and clinical course of hepatitis C virus (HCV) infection in a group of 55 Norwegian patients with primary hypogammaglobulinemia and investigated its association with the use of contaminated immune globulin. We used the polymerase chain reaction to detect HCV RNA and performed HCV genotyping. We also analyzed the responses to treatment with interferon.Results. Of 20 patients who received the contaminated immune globulin, 17 were seropositive for HCV RNA, In addition, 1 of 35 patients not exposed to the contaminated immune globulin was HCV RNA-positive. HCV genotype V was found in all 12 patients for whom genotyping was performed, but 8 patients also had genotype II or III, or both. All HCV RNA-positive patients had abnormal results on biochemical liver tests. All liver-biopsy specimens (from 15 patients) were abnormal, with portal inflammation, bile-duct damage, and focal necrosis. In six patients there was cirrhosis. Two patients died of liver failure. In 4 of the 10 patients treated with interferon there were complete, though transient, biochemical responses, but the follow-up biopsy specimens showed evidence of histologic progression. The poorest responses to interferon were among the patients with multiple HCV genotypes. All but one patient remained positive for HCV RNA.Conclusions. In patients with primary hypogammaglobulinemia there was a high rate of HCV infection after treatment with contaminated immune globulin. In these immunocompromised patients HCV infection has a severe and rapidly progressive course, and responses to interferon are poor.