Bellentani S, Pozzato G, Saccoccio G, Crovatto M, Crocè L S, Mazzoran L, Masutti F, Cristianini G, Tiribelli C
Fondo Studi Fegato, University of Trieste, Trieste, Italy.
Gut. 1999 Jun;44(6):874-80. doi: 10.1136/gut.44.6.874.
The severity, clinical course, and risk of hepatitis C virus (HCV) related chronic liver disease are still rather poorly defined.
To investigate the prevalence, risk factors, and severity of HCV related liver disease in the general population, and investigate whether infection with a specific genotype is associated with an increased risk of cirrhosis or hepatocellular carcinoma.
HCV RNA determination by polymerase chain reaction (PCR) and HCV genotyping were performed in all anti-HCV positive subjects belonging to the Dionysos study (6917 subjects). Diagnosis of cirrhosis and hepatocellular carcinoma was established by liver biopsy in all cases. All the data were analysed by univariate and multivariate statistics in all the cohort. To investigate the natural history of HCV infection, anti-HCV positive subjects were followed up every six months for three years with liver function tests and ultrasonograms.
The overall prevalence of HCV RNA positivity was 2.3%. Positivity increased progressively with age, and was higher in women (ratio of men to women = 0.7). Genotypes 1b and 2a were the most frequent (42 and 24% of HCV RNA positive patients), with a prevalence of 1 and 0.6% respectively. Intravenous drug use, blood transfusions received before 1990, history of previous hepatitis among the cohabiting, and history of animal (mainly dogs) bites were significantly (p<0.05) associated with HCV infection, independently of age and sex. Multivariate analysis showed that, independently of age, sex, and alcohol intake, genotype 1b infection, with or without coinfection with other genotypes, is the major risk factor associated with the presence of cirrhosis and/or hepatocellular carcinoma. During the three years of follow up, 57 (35%) of the HCV RNA positive subjects had consistently normal alanine aminotransferase and gamma-glutamyltransferase values. Two of the 22 HCV RNA positive cirrhotic patients, all drinking more than 90 g of alcohol a day, developed hepatocellular carcinoma (incidence rate = 3.0% per year).
In the general population of Northern Italy, HCV infection is widespread, but only less than 50% of the anti-HCV positive subjects, particularly those infected with genotype 1b, are associated with a more severe liver disease. Alcohol consumption greater that 30 g a day significantly aggravates the natural course of the disease.
丙型肝炎病毒（HCV）相关慢性肝病的严重程度、临床病程及风险仍未明确界定。
调查普通人群中HCV相关肝病的患病率、危险因素及严重程度，并研究特定基因型感染是否与肝硬化或肝细胞癌风险增加相关。
对属于狄俄尼索斯研究的所有抗-HCV阳性受试者（6917名）进行聚合酶链反应（PCR）检测HCV RNA及HCV基因分型。所有病例均通过肝活检确诊肝硬化和肝细胞癌。对所有队列的数据进行单因素和多因素统计分析。为研究HCV感染的自然史，对抗-HCV阳性受试者每六个月进行一次随访，为期三年，检查肝功能和超声检查。
HCV RNA阳性的总体患病率为2.3%。阳性率随年龄逐渐升高，女性更高（男女比例=0.7）。1b型和2a型是最常见的基因型（分别占HCV RNA阳性患者的42%和24%），患病率分别为1%和0.6%。静脉吸毒、1990年前接受输血、同居者既往肝炎病史以及动物（主要是狗）咬伤史与HCV感染显著相关（p<0.05），与年龄和性别无关。多因素分析表明，与年龄、性别和酒精摄入量无关，1b型基因型感染，无论是否合并其他基因型感染，是与肝硬化和/或肝细胞癌存在相关的主要危险因素。在三年的随访期间，57名（35%）HCV RNA阳性受试者的丙氨酸转氨酶和γ-谷氨酰转移酶值一直正常。22名HCV RNA阳性肝硬化患者中有两名，均每天饮酒超过90克，发展为肝细胞癌（发病率=每年3.0%）。
在意大利北部的普通人群中，HCV感染普遍存在，但抗-HCV阳性受试者中只有不到50%，特别是那些感染1b型基因型的患者，与更严重的肝病相关。每天饮酒超过30克会显著加重疾病的自然病程。
