Hepatitis C: Controversies, strategies and challenges
Hepatitis C: Controversies, strategies and challenges
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DOI：
10.1080/11024159850191472
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发表时间：
1998-12-01
期刊：
影响因子：
--
通讯作者：
Gitnick, G
中科院分区：
文献类型：
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作者：
Gitnick, G
丙型肝炎感染的危险因素包括静脉注射药物(42%)、输血史(6%)、与多个异性伴侣接触(6%)、与家庭接触(3%)、从事保健工作(2%)或血液透析(1%)。40%的患者没有可识别的危险因素。丙型肝炎病毒是一种单链、阳性的RNA病毒。已经确定了六种主要的基因类型；每一种都包含一系列的亚型。在美国，患病率为1型(74%)、2型(15%)、3型(6%)和4型(1%)。在感染者体内，丙型肝炎病毒也以一种被称为准种的密切相关的基因型谱存在，更复杂的准种与较长的病程、较高水平的病毒血症、较高的1型感染和较差的干扰素治疗反应相关。诊断是通过EIA检测抗-丙型肝炎病毒，并经RIBA或丙型肝炎病毒RNA确认。慢性丙型肝炎病毒感染者，无论是否有转氨酶升高，均可通过聚合酶链式反应检测到血清RNA。标准治疗方法是干扰素α2b(Intron A)，剂量为300万个单位，每周3次，共6个月。这会导致治疗结束时40%-50%的完全应答(转氨酶正常，检测不到丙型肝炎病毒RNA)，但在接下来的6个月内，60%-80%的病例会复发。现在普遍提倡较长的课程(12个月到18个月)。更好的患者选择，例如，那些血清丙型肝炎病毒RNA水平较低且没有肝硬变的患者，以及延长治疗时间可能会导致更好的应答率。与利巴韦林等其他抗病毒药物的联合治疗大大降低了复发率。
Risk factors for hepatitis C infection include I.V. drug use (42%); history of blood transfusion (6%); exposure to multiple heterosexual partners (6%); exposure to a household contact (3%); health care employment (2%); or hemodialysis (1%). Forty percent of patients have no identifiable risk factors. The HCV is a single-stranded, positive-sense RNA virus. Six major genotypes have been identified; each contains a series of subtypes. In the U.S., prevalences are type 1 (74%); type 2 (15%); type 3 (6%); and type 4 (1%). Within an infected individual, HCV also exists as a spectrum of closely related genotypes referred to as a quasispecies, and more complex quasispecies correlate with longer duration of disease, higher levels of viremia, genotype 1 infection, and poorer response to interferon therapy.Diagnosis is made by measuring anti-HCV by EIA, with confirmation by RIBA or HCV RNA. Patients with chronic HCV infection, with or without aminotransferase elevation, have detectable serum RNA by PCR. Standard therapy is interferon alfa 2b (Intron A) at a dosage of 3 million units 3 times a week for 6 months. This results in a 40%-50% complete response at the end of treatment (normal aminotransferases and undetectable HCV RNA), but relapse occurs in 60%-80% of cases over the next six months. Longer (12 month to 18 month) courses are now widely advocated. Better patient selection, e.g., those with low serum HCV RNA levels and absence of cirrhosis, and increased duration of therapy may lead to better response rates. Combination therapy with other antiviral agents, such as ribavirin, has dramatically reduced relapse rates.