Chu C M, Yeh C T, Liaw Y F
Liver Research Unit, Chang Gung Memorial Hospital and Medical College, Taipei, Taiwan.
Gut. 1999 Oct;45(4):613-7. doi: 10.1136/gut.45.4.613.
BACKGROUND/AIMS: The role of hepatitis C virus (HCV) in fulminant hepatitis remains controversial. This study was conducted to investigate the risk of fulminant hepatitis C in relation to HCV genotypes and concurrent infection of other viruses.
109 HCV RNA positive patients from 334 consecutive cases hospitalised to a medical centre in northern Taiwan for overt acute viral hepatitis were prospectively evaluated.
HCV RNA was detected by a combined reverse transcription-polymerase chain reaction assay. HCV genotypes were analysed using a genotype specific probe based assay in the 5' untranslated region.
39 patients tested positive for hepatitis B surface antigen but negative for IgM antibody to hepatitis B core antigen, indicating concurrent chronic hepatitis B virus (HBV) infection. Twelve patients were hepatitis G virus (HGV) RNA positive. Genotyping of HCV disclosed 1b in 93, 1b mixed with 2a/2c or 1b mixed with 2b in 11, and not classified in five. Serum titres of HCV RNA were <10(5) copies/ml in 77, 10(5)-10(7) copies/ml in 25, and >10(7) copies/ml in seven. Eleven patients (10.1%) had fulminant hepatitis as a complication. Development of fulminant hepatitis did not correlate with age and gender of the patients, concurrent HGV infection, HCV genotypes, or serum titre of HCV RNA. However, the incidence (95% confidence interval) of fulminant hepatitis in patients with underlying chronic HBV infection was 23. 1% (9.9 to 36.3%), which is significantly higher than in those without (2.9% (-1.0 to 6.8%)). In 39 patients with concurrent chronic HBV infection, the clinical and virological characteristics showed no significant difference between those with fulminant hepatitis and those without.
Acute hepatitis C in patients with concurrent chronic HBV infection is associated with a substantial risk of fulminant hepatitis.
背景/目的：丙型肝炎病毒（HCV）在暴发性肝炎中的作用仍存在争议。本研究旨在调查与HCV基因型及其他病毒合并感染相关的暴发性丙型肝炎风险。
对来自台湾北部某医疗中心因显性急性病毒性肝炎住院的334例连续病例中的109例HCV RNA阳性患者进行前瞻性评估。
采用逆转录-聚合酶链反应联合检测法检测HCV RNA。使用基于5'非翻译区基因型特异性探针的检测法分析HCV基因型。
39例患者乙型肝炎表面抗原检测呈阳性，但乙型肝炎核心抗原IgM抗体检测呈阴性，提示合并慢性乙型肝炎病毒（HBV）感染。12例患者庚型肝炎病毒（HGV）RNA检测呈阳性。HCV基因分型显示，93例为1b型，11例为1b型与2a/2c型混合或1b型与2b型混合，5例未分型。77例患者血清HCV RNA滴度<10⁵拷贝/ml，25例为10⁵-10⁷拷贝/ml，7例>10⁷拷贝/ml。11例患者（10.1%）并发暴发性肝炎。暴发性肝炎的发生与患者的年龄、性别、合并HGV感染、HCV基因型或HCV RNA血清滴度无关。然而，合并慢性HBV感染患者暴发性肝炎的发生率（95%置信区间）为23.1%（9.9%至36.3%），显著高于未合并慢性HBV感染的患者（2.9%（-1.0%至6.8%））。在39例合并慢性HBV感染的患者中，暴发性肝炎患者与未发生暴发性肝炎患者的临床和病毒学特征无显著差异。
合并慢性HBV感染的急性丙型肝炎患者发生暴发性肝炎的风险较高。
