Outbreak of hepatitis C virus infection in patients with hematologic disorders treated with intravenous immunoglobulins: different prognosis according to the immune status.
Outbreak of hepatitis C virus infection in patients with hematologic disorders treated with intravenous immunoglobulins: different prognosis according to the immune status.
复制标题
静脉注射免疫球蛋白治疗的血液系统疾病患者爆发丙型肝炎病毒感染：根据免疫状态不同预后不同。
DOI：
10.1182/blood.v90.3.1309.1309_1309_1314
复制
发表时间：
1997
期刊：
影响因子：
20.3
通讯作者：
E. Radaeli
中科院分区：
文献类型：
--
作者：
G. Rossi;A. Tucci;E. Cariani;A. Ravaggi;A. Rossini;E. Radaeli
免疫缺陷对丙型肝炎病毒(HCV)感染过程的影响仍然存在争议，尽管已经提出了恶化的影响。我们比较了两组免疫活性不同的血液病患者在使用受污染的静脉免疫球蛋白(IVIG)治疗后获得相同病毒株后丙型肝炎的特征。IVIG治疗的适应症是6例特发性血小板减少性紫癜(ITP)患者和7例免疫缺陷(ID)的各种血液疾病患者的低丙种球蛋白血症。感染率为100%。5名ID患者尽管血清丙型肝炎病毒RNA阳性，但从未出现过丙型肝炎病毒抗体。10例患者显示相同的丙型肝炎病毒基因。此外，在四名患者中进行的E1-E2基因部分核苷酸测序显示，氨基酸序列相同或密切相关，从而有力地支持了共同感染源的假说。临床急性感染在两组之间没有显著差异，但在7名ID患者中有5名患者发生了随后的肝功能衰竭，而在ITP患者中没有一名发生肝功能衰竭(P=0.04)。在三个病例中进行的肝脏活检证明，丙型肝炎病毒是导致肝脏损害的唯一原因。6名ID患者死亡，其中4例死亡的主要原因是肝脏疾病，2例是促成原因。IVIG治疗后患者的中位生存期为12个月，明显低于ITP患者(P=0.0028)。我们得出结论，在血液病患者中，免疫缺陷显著恶化IVIG获得性丙型肝炎病毒感染的病程。
The influence of immunodeficiency on the course of hepatitis C virus (HCV) infection is still debated, although a worsening effect has been suggested. We compared the characteristics of hepatitis C in two groups of hematologic patients with different levels of immunocompetence who acquired the same virus strain after treatment with contaminated intravenous immunoglobulins (IVIG). Indications for IVIG therapy were idiopathic thrombocytopenic purpura (ITP) in six patients and hypogammaglobulinemia in 7 patients with various hematologic disorders, who were defined immunodeficient (ID). Infection rate was 100%. Five ID patients never developed HCV antibodies despite serum HCV-RNA positivity. The same HCV genotype was shown in 10 patients tested. Moreover, E1-E2 gene partial nucleotide sequencing, performed in four patients, showed identical or closely related amino acid sequences, thus strongly supporting the hypothesis of a common source of infection. Clinical acute infection did not differ significantly between the two groups, but subsequent liver failure developed in five of the seven ID patients and in none of the ITP patients (P = .04). Liver biopsy, performed in three cases, documented HCV as the only cause of liver damage. Six ID patients died, with liver disease being the primary cause of death in four cases and a contributory cause in two cases. Their median survival after IVIG was 12 months, significantly worse than that of ITP patients (P = .0028). We conclude that immunodeficiency markedly worsens the course of IVIG-acquired HCV infection in hematologic patients.
多次输血血友病患者丙型肝炎病毒感染的自然史：与人类免疫缺陷病毒共感染的影响。
DOI：
--
发表时间：
1993
期刊：
Journal of acquired immune deficiency syndromes
影响因子：
--
作者：
Eyster,ME;Diamondstone,LS;Lien,JM;Ehmann,WC;Quan,S;Goedert,JJ
通讯作者：
Goedert,JJ
影响因子：
29.4
作者：
Que, FG;Gores, GJ
通讯作者：
Gores, GJ