THE NATURAL-HISTORY OF COMMUNITY-ACQUIRED HEPATITIS-C IN THE UNITED-STATES
THE NATURAL-HISTORY OF COMMUNITY-ACQUIRED HEPATITIS-C IN THE UNITED-STATES
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DOI：
10.1056/nejm199212313272702
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发表时间：
1992-12-31
影响因子：
158.5
通讯作者：
BEACH, MJ
中科院分区：
文献类型：
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作者：
ALTER, MJ;MARGOLIS, HS;BEACH, MJ
背景。超过一半的输血后丙型肝炎患者会发生慢性肝病，但对社区获得性丙型肝炎的自然史知之甚少。在1985年和1986年，我们在美国的四个县发现了患有急性非甲、非乙型肝炎的成年人，并对他们进行了前瞻性随访。我们使用三种标记物检测保存的血清样本中的丙型肝炎病毒（HCV）感染：第二代血清学检测HCV抗体（抗HCV）；聚合酶链反应法检测HCV RNA；荧光抗体阻断法检测HCV抗原抗体（抗hcvag）。在130例非甲、非乙型肝炎患者中，106例（82%）有HCV感染，93例抗HCV阳性，13例仅HCV RNA或抗hcvag阳性。97名hcv感染患者中有60名（62%）发展为慢性肝炎，随访9至48个月，与感染的危险因素无关。30例肝活检患者中有10例为慢性活动性肝炎。在肝炎发病后42至48个月收集的样本中，在13名接受检测的慢性肝炎患者中有12名检测到HCV RNA，在所有15名接受检测的肝炎消退患者中检测到HCV RNA。除两名初始阳性患者外，抗- hcv在所有患者中持续存在，抗体损失率为0.6 / 100人年。社区获得性丙型肝炎患者的慢性肝炎发病率很高。在美国，HCV可能是慢性肝病的主要原因，并且在大多数患者中，即使没有活动性肝病，HCV感染似乎也会持续至少数年。
Background. Chronic liver disease develops in more than half of patients with post-transfusion hepatitis C, but little is known about the natural history of community-acquired hepatitis C.Methods. In 1985 and 1986 we identified adults with acute non-A, non-B hepatitis in four counties in the United States and followed them prospectively. We used three markers to detect hepatitis C virus (HCV) infection in stored samples of serum: antibody to HCV (anti-HCV) detected by second-generation serologic assays; HCV RNA detected by polymerase-chain-reaction assay; and antibody to HCV antigen (anti-HCVAg) detected by fluorescent-antibody-blocking assay.Results. Of 130 patients with non-A, non-B hepatitis, 106 (82 percent) had HCV infection, 93 were positive for anti-HCV, and 13 were positive only for HCV RNA or anti-HCVAg. Chronic hepatitis developed in 60 (62 percent) of 97 HCV-infected patients followed for 9 to 48 months, with no relation to the risk factors for infection. Ten of the 30 patients who had liver biopsies had chronic active hepatitis. In samples collected 42 to 48 months after the onset of hepatitis, HCV RNA was detected in 12 of 13 tested patients with chronic hepatitis and in all 15 tested patients with hepatitis that had resolved. Anti-HCV persisted in all but two of the initially positive patients, for a rate of antibody loss of 0.6 per 100 person-years.Conclusions. Patients with community-acquired hepatitis C have a high rate of chronic hepatitis. HCV may be a major cause of chronic liver disease in the United States, and in most patients HCV infection seems to persist for at least several years, even in the absence of active liver disease.