Course and outcome of hepatitis C
Course and outcome of hepatitis C
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DOI：
10.1053/jhep.2002.36227
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发表时间：
2002-11-01
期刊：
影响因子：
13.5
通讯作者：
Hoofnagle, JH
中科院分区：
文献类型：
--
作者：
Hoofnagle, JH
丙型肝炎病毒（HCV）是一种小包膜RNA病毒，属于黄病毒科和肝炎病毒属。HCV RNA基因组长度为9，600个核苷酸，编码一个单一的多聚蛋白，该多聚蛋白在切割后被切割成10个多肽，包括t3结构蛋白（C、E1和E2）和多种非结构蛋白（[NS] NS 2至NS 5）。NS蛋白包括蛋白质加工（蛋白酶）和病毒复制（RNA聚合酶）所必需的酶。该病毒在肝脏中以高速率复制，并且具有显著的序列异质性。HCV有6种基因型和90多种亚型，在美国最常见的是1a和1b（约75%），2a和2b（约15%）和3（约7%）。急性丙型肝炎的标志是在接触1至2周内血清中出现HCV RNA，随后血清丙氨酸氨基转移酶（ALT）升高，然后出现症状和黄疸。抗HCV抗体（anti-HCV）往往出现较晚。在急性缓解型肝炎中，HCV RNA被清除，血清ALT水平降至正常。然而，55%~ 85%的患者并没有清除病毒，而是发展为慢性丙型肝炎。慢性丙型肝炎通常无症状，但通常与ALT水平持续或波动性升高有关。丙型肝炎的慢性后遗症包括进行性肝纤维化、肝硬化和肝细胞癌。肝外表现包括干燥综合征、冷球蛋白血症、肾小球肾炎和迟发性皮肤卟啉病。了解丙型肝炎的病程和转归对于制定管理和治疗方法非常重要。
The hepatitis C virus (HCV) is a small enveloped RNA virus belonging to the family flaviviridae and genus hepacivirus. The HCV RNA genome is 9,600 nucleotides in length and encodes a single polyprotein that is post-translationally cleaved into 10 polypeptides including t3 structural (C, E1, and E2) and multiple nonstructural proteins ([NS] NS2 to NS5). The NS proteins include enzymes necessary for protein processing (proteases) and viral replication (RNA polymerase). The virus replicates at a high rate in the liver and has marked sequence heterogeneity. There are 6 genotypes and more than 90 subtypes of HCV, the most common in the United States being 1a and 1b (approximately 75%), 2a and 2b (approximately 15%), and 3 (approximately 7%). Acute hepatitis C is marked by appearance of HCV RNA in serum within 1 to 2 weeks of exposure followed by serum alanine aminotransferase (ALT) elevations, and then symptoms and jaundice. Antibody to HCV (anti-HCV) tends to arise late. In acute resolving hepatitis, HCV RNA is cleared and serum ALT levels fall to normal. However, 55% to 85% of patients do not dear virus, but develop chronic hepatitis C. Chronic hepatitis C is often asymptomatic, but is usually associated with persistent or fluctuating elevations in ALT levels. The chronic sequelae of hepatitis C include progressive hepatic fibrosis, cirrhosis, and hepatocellular carcinoma. Extra-hepatic manifestations include sicca syndrome, cryoglobulinemia, glomerulonephritis, and porphyria cutanea tarda. Knowledge of the course and outcome of hepatitis C is important in developing approaches to management and therapy.