Martinot-Peignoux M, Boyer N, Cazals-Hatem D, Pham B N, Gervais A, Le Breton V, Levy S, Degott C, Valla D C, Marcellin P
Unité de Recherche INSERM U481, Centre de Recherche Claude Bernard sur les Hépatites Virales and Service d'Hépatologie, Hôpital Beaujon, Clichy, France.
Hepatology. 2001 Nov;34(5):1000-5. doi: 10.1053/jhep.2001.28458.
A significant proportion of patients with detectable antibodies to hepatitis C virus have normal serum alanine transaminase levels. Our aim was to study the outcome of this group. Between 1992 and 1999, 135 consecutive anti-HCV-positive patients with persistently normal ALT were followed for 3.6 +/- 2.3 years (0.5 to 8.5 years), 108 had a liver biopsy at inclusion, and 24 had a second liver biopsy 3.5 +/- 1.0 years later. Serum HCV RNA was detectable with PCR in 94 patients (69%) and not detectable in 41 patients (31%). Patients with and without detectable serum HCV RNA had similar epidemiological characteristics. Serum ALT levels and anti-HCV ratio were lower (P =.001), and histological lesions had lower grade and stage in patients without detectable serum HCV RNA (P =.001). Liver HCV RNA was not detectable with PCR in the 12-serum HCV RNA-negative patients tested. During follow-up, all patients without detectable serum HCV RNA remained HCV RNA-negative and kept normal serum ALT; all patients with detectable serum HCV RNA remained HCV RNA-positive, 20 (21%) had a slight fluctuation of serum ALT above the upper limit of normal. No significant changes were observed in the liver lesions of the 24 patients who underwent a second liver biopsy. In anti-HCV-positive patients with persistently normal serum ALT, histological lesions are significantly lower in HCV RNA-negative than in HCV RNA-positive patients. During follow-up, the HCV RNA status of patients remained unchanged; 21% of the patients with detectable serum HCV RNA had slight increase in serum ALT levels, but histological lesions remained stable.
相当一部分丙型肝炎病毒抗体可检测到的患者血清丙氨酸转氨酶水平正常。我们的目的是研究这组患者的转归。1992年至1999年，对135例连续的抗-HCV阳性且ALT持续正常的患者进行了3.6±2.3年（0.5至8.5年）的随访，108例患者在纳入时进行了肝活检，24例患者在3.5±1.0年后进行了第二次肝活检。94例患者（69%）通过PCR检测到血清HCV RNA，41例患者（31%）未检测到。血清HCV RNA可检测到和不可检测到的患者具有相似的流行病学特征。血清ALT水平和抗-HCV比值较低（P = 0.001），在血清HCV RNA不可检测的患者中，组织学病变的分级和分期较低（P = 0.001）。在检测的12例血清HCV RNA阴性患者中，PCR未检测到肝脏HCV RNA。随访期间，所有血清HCV RNA不可检测的患者仍为HCV RNA阴性，血清ALT保持正常；所有血清HCV RNA可检测到的患者仍为HCV RNA阳性，20例（21%）血清ALT有轻微波动超过正常上限。在接受第二次肝活检的24例患者中，肝脏病变未观察到显著变化。在抗-HCV阳性且血清ALT持续正常的患者中，HCV RNA阴性患者的组织学病变明显低于HCV RNA阳性患者。随访期间，患者的HCV RNA状态保持不变；21%血清HCV RNA可检测到的患者血清ALT水平略有升高，但组织学病变保持稳定。
