Jain A, Kar P, Madan K, Das U P, Budhiraja S, Gopalkrishna V, Sharma J K, Das B C
Department of Medicine, Maulana Azad Medical College, New Delhi, India.
Eur J Gastroenterol Hepatol. 1999 Nov;11(11):1231-7. doi: 10.1097/00042737-199911000-00008.
The role of hepatitis C virus (HCV) infection in fulminant hepatitis (FH) is poorly understood and the available data are conflicting. We have examined the aetiological role of HCV in 50 consecutive patients with sporadic FH by employing serology and reverse transcription-polymerase chain reaction (RT-PCR).
A total of 50 consecutive patients with sporadic FH were included. After an initial clinical and biochemical assessment, tests were performed for detection of HBsAg, IgM anti-HBc, IgM anti-HAV, IgM anti-HEV and anti-HCV. RT-PCR was carried out for detection of HCV RNA in sera of all the patients and in post mortem liver biopsy tissue of 20 subjects, using primers selected from the conserved 5' non-coding region of the HCV genome.
Hepatitis E virus (HEV) was found to be the most common viral infection (21/50; 42%) followed by HBV (14/50; 28%), HCV (7/50; 14%) and HAV (2/50; 4%). No viral markers could be detected in nine patients (18%) and multiple infections were seen in seven (14%). Of the seven subjects who tested positive for HCV-related markers, two had both anti-HCV and HCV RNA, three had HCV RNA alone and the remaining two had anti-HCV alone. Interestingly, all the HCV-infected subjects were co-infected with other hepatotropic viruses and the most common co-infecting agent was found to be HBV (5/7). Liver tissue was available in 20 cases and HCV RNA was detected in three of them. All of these patients were also positive for the viral genome in their serum samples. Comparison of the biological attributes of HCV-positive and HCV-negative cases revealed that haemorrhagic symptomatology (haematemesis, melaena and purpurae) was significantly more common, prothrombin time more deranged and mortality was much higher in the former group. The overall mortality was 68% and the most common cause of death was cerebral oedema (70.6%). No significant correlation was observed between mortality and the duration of the icterus-encephalopathy interval. The study included a total of 21 pregnant females; HEV infection was found to be significantly greater in this group and was associated with a higher mortality rate.
The results clearly suggest that HCV is not an important aetiological factor for FH in North India. However, it may act as a co-factor in the development of FH leading to a higher mortality. HEV appears to contribute substantially to the causation of sporadic FH in India and advanced stage pregnancy is a potential risk factor for HEV-induced FH and high rate of mortality. Our study also suggests that the length of the icterus-encephalopathy period may not have significant prognostic implications in Indian patients with FH.
丙型肝炎病毒（HCV）感染在暴发性肝炎（FH）中的作用尚不清楚，现有数据相互矛盾。我们通过血清学和逆转录聚合酶链反应（RT-PCR）研究了50例连续性散发性FH患者中HCV的病因学作用。
纳入50例连续性散发性FH患者。在初步临床和生化评估后，进行检测HBsAg、IgM抗-HBc、IgM抗-HAV、IgM抗-HEV和抗-HCV的试验。使用从HCV基因组保守的5'非编码区选择的引物，对所有患者的血清以及20例受试者的尸检肝活检组织进行RT-PCR以检测HCV RNA。
戊型肝炎病毒（HEV）是最常见的病毒感染（21/50；42%），其次是HBV（14/50；28%）、HCV（7/50；14%）和HAV（2/50；4%）。9例患者（18%）未检测到病毒标志物，7例（14%）出现多重感染。在7例HCV相关标志物检测呈阳性的受试者中，2例同时有抗-HCV和HCV RNA，3例仅有HCV RNA，其余2例仅有抗-HCV。有趣的是，所有HCV感染的受试者均合并感染其他嗜肝病毒，最常见的合并感染病原体是HBV（5/7）。20例患者有肝组织，其中3例检测到HCV RNA。所有这些患者的血清样本中病毒基因组也呈阳性。HCV阳性和HCV阴性病例生物学特性的比较显示，出血症状（呕血、黑便和紫癜）在前一组中明显更常见，凝血酶原时间更紊乱，死亡率更高。总体死亡率为68%，最常见的死亡原因是脑水肿（70.6%）。未观察到死亡率与黄疸-脑病间隔时间之间存在显著相关性。该研究共纳入21例孕妇；该组中HEV感染明显更多，且与更高的死亡率相关。
结果清楚地表明，在印度北部，HCV不是FH的重要病因学因素。然而，它可能作为FH发展的一个辅助因素导致更高的死亡率。HEV似乎在很大程度上促成了印度散发性FH的病因，晚期妊娠是HEV诱导的FH和高死亡率的一个潜在危险因素。我们的研究还表明，黄疸-脑病期的长短可能对印度FH患者没有显著的预后意义。
