The natural course of hepatitis C virus infection after 22 years in a unique homogenous cohort: spontaneous viral clearance and chronic HCV infection
The natural course of hepatitis C virus infection after 22 years in a unique homogenous cohort: spontaneous viral clearance and chronic HCV infection
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DOI：
10.1136/gut.49.3.423
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发表时间：
2001-09-01
期刊：
影响因子：
24.5
通讯作者：
Crowe, J
中科院分区：
文献类型：
--
作者：
Barrett, S;Goh, J;Crowe, J
背景/目的：1977年通过污染的抗D免疫球蛋白感染丙型肝炎病毒（HCV）基因型1b的爱尔兰妇女队列代表了一个独特的同质组，以调查HCV感染的自然病程。随访5年（接种后21/22年）。调查的其他功能包括：组织学状态/进展，HCV感染的心理社会影响，肝外表现，和HLA II类associations.Results-The最常见的症状是疲劳和关节痛。此外，77%的妇女属于心理困扰的临床范围。接种后，20.6%的PCR阴性和3.4%的PCR阳性女性报告了黄疸性肝炎史（p=0.002）。PCR阳性和阴性女性的平均组织学活动指数/纤维化评分在诊断时分别为4.1（1.4）、11.1（1.3）和2.1（1.5）/0.15（0.36），44例PCR阳性女性在5年随访后为4.1（1.2）/1.0（1.0）。未观察到肝硬化或肝细胞癌。DRB 1 *01等位基因存在于28.8%的PCR阴性和8.7%的PCR阳性女性中（p=0.004）。混合性冷球蛋白血症，干燥综合征，阳性甲状腺自身抗体，抗核抗体，类风湿因子，抗线粒体抗体在PCR阳性的妇女的患病率分别为12.7%，7.6%，13.9%，5.1%，3.8%，和3.8%.Conclusions-一个良性的过程中，HCV感染的慢性HCV感染的妇女，22年后接种观察到的疾病进展不足。急性黄疸型肝炎和HLA-DRB 1 *01等位基因与病毒清除相关。尽管有这种有利的结果，但仍存在严重的心理困扰和生活质量差。
Background/aims-The cohort of Irish women infected with hepatitis C virus (HCV) genotype 1b via contaminated anti-D immunoglobulin in 1977 represent a unique homogenous group to investigate the natural course of HCV infection.Methods-The clinical status of 87 polymerase chain reaction (PCR) positive and 68 PCR negative women was investigated at diagnosis (1994/95) and after 4-5 years of follow up (21/22 years after inoculation). Other features investigated included: histological status/progression, psychosocial impact of HCV infection, extrahepatic manifestations, and HLA class II associations.Results-The most common symptoms reported were fatigue and arthralgia. Furthermore, 77% of women fell within the clinical range for psychological distress. A history of icteric hepatitis was reported in 20.6% of PCR negative and 3.4% of PCR positive women after inoculation (p=0.002). The mean histological activity index/fibrosis scores of PCR positive and negative women were 4.1 (1.4)11.1 (1.3) and 2.1 (1.5)/0.15 (0.36) at diagnosis and 4.1 (1.2)/1.0 (1.0) in 44 PCR positive women after five years of follow up. Cirrhosis or hepatocellular carcinoma was not observed. The DRB1*01 allele was present in 28.8% of PCR negative and 8.7% of PCR positive women (p=0.004). The prevalence rates of mixed cryoglobulinaemia, sicca complex, positive thyroid autoantibodies, antinuclear antibody, rheumatoid factor, and antimitochondrial antibody in PCR positive women were 12.7%, 7.6%, 13.9%, 5.1%, 3.8%, and 3.8%.Conclusions-A benign course of HCV infection with lack of disease progression was observed in women with chronic HCV, 22 years after inoculation. Acute icteric hepatitis and the HLA DRB1*01 allele were associated with viral clearance. Despite this favourable outcome, high levels of psychological distress and poor quality of life were present.