Pagliaro L, Peri V, Linea C, Cammà C, Giunta M, Magrin S
Institute of General Medicine and Pneumology, University of Palermo, Italy.
Ital J Gastroenterol Hepatol. 1999 Jan-Feb;31(1):28-44.
A comprehensive overview on the course of hepatitis C is not available despite the many studies published. The aim was to review the course and prognostic variables of untreated hepatitis C.
English-language articles published between January 1989 and December 1997 were identified and data extracted to answer predefined relevant questions.
Median chronicization rate, mostly assessed in transfusion-associated hepatitis, was 67%. In retrospective studies, the interval between date of infection and diagnosis of cirrhosis or hepatocellular carcinoma was 20-40 years. Median progression rate from chronic hepatitis to cirrhosis was 27.9% after 8-12 years. Studies obtaining this figure included selected groups of patients and could reflect the worst prognostic segment of the disease. The course of hepatitis C virus infection may be more favourable: cirrhosis rarely or never occurred in young females infected by con-taminated anti-D-immunglobulins; hepatitis was histologically mild in most hepatitis C virus-RNA positive subjects with normal or near normal transminases, predicting non-progressive or very slowly progressive disease; in a population survey from Italy, among 170 infected subjects only 4% had raised transaminases, and none overt liver disease. Increasing age, histological severity, alcohol, possibly male sex and liver iron content were predictors of cirrhosis or increased fibrosis.
Chronicization rate of hepatitis C virus infection is very high. Hepatitis C virus infection can result in a wide prognostic spectrum of liver disease, ranging from cirrhosis and hepatocellular carcinoma to subclinical, nonprogressive disease. Cofactors such as alcohol excess are important in determining the outcome of hepatitis C virus-related chronic liver disease.
尽管已发表了许多研究，但尚无关于丙型肝炎病程的全面综述。目的是回顾未经治疗的丙型肝炎的病程及预后变量。
识别1989年1月至1997年12月发表的英文文章，并提取数据以回答预先设定的相关问题。
慢性化率中位数（大多在输血相关丙型肝炎中评估）为67%。在回顾性研究中，从感染日期到肝硬化或肝细胞癌诊断的间隔为20 - 40年。慢性肝炎发展为肝硬化的进展率中位数在8 - 12年后为27.9%。得出这一数据的研究纳入了特定患者群体，可能反映了该疾病预后最差的部分。丙型肝炎病毒感染的病程可能更乐观：受污染的抗D免疫球蛋白感染的年轻女性很少或从未发生肝硬化；在大多数丙型肝炎病毒RNA阳性且转氨酶正常或接近正常的受试者中，肝炎在组织学上较轻，预示疾病无进展或进展非常缓慢；在意大利的一项人群调查中，170名受感染受试者中只有4%的转氨酶升高，且无明显肝病。年龄增长、组织学严重程度、饮酒、可能还有男性性别和肝脏铁含量是肝硬化或纤维化加重的预测因素。
丙型肝炎病毒感染的慢性化率非常高。丙型肝炎病毒感染可导致肝病预后范围广泛，从肝硬化和肝细胞癌到亚临床、无进展性疾病。诸如过量饮酒等协同因素在决定丙型肝炎病毒相关慢性肝病的结局方面很重要。
