Hepatitis C infection in children with hemophilia A and B.
Hepatitis C infection in children with hemophilia A and B.
复制标题
患有甲型和乙型血友病的儿童感染丙型肝炎。
作者：
V. Blanchette;E. Vorstman;Allyson Shore;Elaine Wang;M. Petric;B. Jett;H. Alter
从选定的血友病儿童组（小于或等于18岁）的储存血清中定量丙型肝炎病毒（抗HCV）抗体。1987至1989年期间，血清阳性率如下：未输血的血友病患者0%（0/11例），仅用蒸汽加热的因子VIII或IX浓缩物治疗血友病患者，0%（9例中0例），仅用冷沉淀或单一供体血液制品治疗的血友病患者0%（0/9例），血友病患者定期接受未加热或干热处理的因子VIII或IX浓缩物95%（21/22例）。相应的丙氨酸氨基转移酶（ALT）结果相似：在未输血的血友病患者、用蒸汽加热因子浓缩物治疗的血友病患者或仅接受冷沉淀或单一供体血液制品的患者中，ALT值始终低于实验室正常值上限（40 U/L）。相比之下，82%（22例中的18例）的血友病儿童定期输注未加热或干热处理的因子浓缩物的ALT值大于40 U/L。从这些数据中得出三个结论：（1）HCV是多次输血血友病儿童慢性肝炎的主要原因，（2）未加热和干热处理的凝血因子浓缩物传播HCV感染的风险非常高，（3）蒸汽加热灭活的凝血因子浓缩物传播HCV感染的风险非常低，甚至可能为零。这些发现对于既往未输血的血友病患者易感染HCV具有治疗意义。
Antibodies to hepatitis C virus (anti-HCV) were quantitated in stored sera from selected groups of hemophilic children (less than or equal to 18 years of age). During the period 1987 to 1989, seropositivity rates were as follows: untransfused hemophiliacs 0% (0 of 11 cases), hemophiliacs treated exclusively with vapor-heated factor VIII or IX concentrates 0% (0 of 9 cases), hemophiliacs treated only with cryoprecipitate or single donor blood products 0% (0 of 9 cases), and hemophiliacs regularly treated with unheated or dry heat-treated factor VIII or IX concentrates 95% (21 of 22 cases). Corresponding alanine aminotransferase (ALT) results were similar: values were always below the upper limit of laboratory normal (40 U/L) in untransfused hemophiliacs, hemophiliacs treated with vapor-heated factor concentrates, or those who received only cryoprecipitate or single donor blood products. By contrast ALT values were greater than 40 U/L in 82% (18 of 22 cases) of hemophilic children regularly infused with unheated or dry heat-treated factor concentrates. Three conclusions are drawn from this data: (1) HCV is a major cause of chronic hepatitis in multitransfused hemophilic children, (2) unheated and dry heat-treated clotting factor concentrates carry a very high risk of transmitting HCV infection, and (3) clotting factor concentrates inactivated by vapor heating carry a very low and perhaps zero risk of transmitting HCV infection. These findings are of therapeutic significance for previously untransfused hemophiliacs susceptible to HCV infection.