Acute hepatitis C: High rate of both spontaneous and treatment-induced viral clearance
Acute hepatitis C: High rate of both spontaneous and treatment-induced viral clearance
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DOI：
10.1016/s0016-5085(03)00668-1
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发表时间：
2003-07-01
期刊：
影响因子：
29.4
通讯作者：
Pape, GR
中科院分区：
文献类型：
--
作者：
Gerlach, JT;Diepolder, HM;Pape, GR
背景与目的：急性丙型肝炎病毒感染约占急性肝炎病例的20%。本研究的目的是确定疾病的自然病程，并为急性丙型肝炎病毒的治疗策略的发展做出贡献。方法：60例急性丙型肝炎患者采用血清抗丙型肝炎病毒抗体转化或临床生化指标，首次血清标本检测丙型肝炎病毒RNA，诊断急性丙型肝炎病毒。结果：60例患者中有51例（85%）出现急性丙型肝炎病毒症状。在急性症状性丙型肝炎（n = 46）的自然（未经治疗）过程中，24例患者（52%）通常在症状出现后12周内自发清除，而所有无症状患者（n = 9）均发展为慢性丙型肝炎。在急性肝炎发病后3个月以上开始抗病毒治疗（干扰素- α加或不加利巴韦林）诱导80%的治疗患者持续清除病毒。结论：急性丙型肝炎患者出现症状后12周内病毒自行清除率高，治疗时应考虑到这一因素。仅对发病后3个月以上丙型肝炎病毒RNA呈阳性的患者进行治疗，91%的患者实现了总体病毒清除（自限性和治疗诱导），而对自发病毒清除的患者则避免了不必要的治疗。无症状急性丙型肝炎病毒感染患者不太可能自行清除感染，应尽早治疗。
Background & Aims: Acute hepatitis C virus infection accounts for approximately 20% of cases of acute hepatitis today. The aim of this study was to define the natural course of the disease and to contribute to the development of treatment strategies for acute hepatitis C virus. Methods: The diagnosis of acute hepatitis C virus in 60 patients was based on seroconversion to anti-hepatitis C virus antibodies or clinical and biochemical criteria and on the presence of hepatitis C virus RNA in the first serum sample. Results: Fifty-one of 60 (85%) patients presented with symptomatic acute hepatitis C virus. In the natural (untreated) course of acute symptomatic hepatitis C (n = 46), spontaneous clearance was observed in 24 patients (52%), usually within 12 weeks after the onset of symptoms, whereas all asymptomatic patients (n = 9) developed chronic hepatitis C. The start of antiviral therapy (interferon-alpha with or without ribavirin) beyond 3 months after the onset of acute hepatitis induced sustained viral clearance in 80% of treated patients. Conclusions: The management of acute hepatitis C has to take into account the high rate of spontaneous viral clearance within 12 weeks after the onset of symptomatic disease. Treatment of only those patients who remain hepatitis C virus RNA positive for more than 3 months after the onset of disease led to an overall viral clearance (self-limited and treatment induced) in 91% of patients, and unnecessary treatment was avoided in those with spontaneous viral clearance. Patients with asymptomatic acute hepatitis C virus infection are unlikely to clear the infection spontaneously and should be treated as early as possible.