意大利北部丙型肝炎病毒（HCV）感染的十年发病率及病毒自发清除率
Ten year incidence of HCV infection in northern Italy and frequency of spontaneous viral clearance.
作者信息
Mazzeo C, Azzaroli F, Giovanelli S, Dormi A, Festi D, Colecchia A, Miracolo A, Natale P, Nigro G, Alberti A, Roda E, Mazzella G
机构信息
Dipartimento di Medicina Interna e Gastroenterologia, Università degli Studi di Bologna, and CRBA (Centro di Ricerca Biomedica Applicata), Policlinico S Orsola-Malpighi, Bologna, Italy.
出版信息
Gut. 2003 Jul;52(7):1030-4. doi: 10.1136/gut.52.7.1030.
BACKGROUND
Little is known of the incidence of hepatitis C virus (HCV) infection, and the frequency of spontaneous viral clearance in the general population is unknown. We conducted an epidemiological study in two Apennine towns in northern Italy.
METHODS
Anti-HCV (ELISA and RIBA third generation) and HCV-RNA by polymerase chain reaction were tested in thawed sera from an adult general population of Loiano-Monghidoro in 1986 and 1996, obtained in the context of the MICOL (Multicenter Italian Study on Cholelithiasis). In 1999, anti-HCV positive subjects and sex and age matched controls were recalled in order to identify risk factors for acquiring HCV infection and to assess the family composition of anti-HCV+ subjects.
RESULTS
For 1646 subjects, sera were available from both 1986 and 1996 (mean age in 1986 43 (0.39) years). In 1986, 57 (3.46%) subjects were HCV antibody positive (HCV-Ab+). Eight new cases were recorded in 1996: adult incidence was 50.3 cases/100 000 inhabitants/year. Fifty three of 63 (84.1%) HCV-Ab+ sera were also HCV-RNA+. Genotype 2a/2c accounted for 44% and 1b for 47.0% of cases. HCV-Ab+ subjects had higher serum levels of alanine aminotransferase with respect to controls (p<0.005), as did subjects infected with genotype 1 with respect to those with genotype 2 (p<0.05). Eleven of 65 (16.9%) HCV-Ab+ subjects spontaneously cleared HCV-Ab; 7/11 also lost HCV-RNA- in both serum and leucocytes. Sixteen anti-HCV+ subjects belonged to families containing more than one infected member. Married couples accounted for 10 of these 16 subjects. In four of these five married couples, HCV genotype was identical in the two spouses.
CONCLUSIONS
In rural northern Italy, the adult incidence of HCV is approximately 50 cases/100 000 inhabitants/year. Our findings suggest that as many as 17% of infected subjects may spontaneously clear HCV-Ab. Interfamilial transmission seems to have a role in the spread of infection.
背景
丙型肝炎病毒（HCV）感染的发病率鲜为人知，普通人群中病毒自发清除的频率也不清楚。我们在意大利北部的两个亚平宁城镇进行了一项流行病学研究。
方法
对1986年和1996年从洛亚诺 - 蒙吉多罗成年普通人群中获取的解冻血清进行抗HCV检测（酶联免疫吸附测定法和第三代重组免疫印迹法）以及聚合酶链反应检测HCV - RNA，这些血清是在意大利胆结石多中心研究（MICOL）的背景下获得的。1999年，召回了抗HCV阳性受试者以及性别和年龄匹配的对照组，以确定感染HCV的危险因素，并评估抗HCV阳性受试者的家庭构成。
结果
对于1646名受试者，1986年和1996年的血清均可用（1986年平均年龄43（0.39）岁）。1986年，57名（3.46%）受试者HCV抗体阳性（HCV - Ab +）。1996年记录到8例新病例：成人发病率为50.3例/10万居民/年。63例HCV - Ab +血清中有53例（84.1%）HCV - RNA也呈阳性。2a/2c基因型占病例的44%，1b基因型占47.0%。与对照组相比，HCV - Ab +受试者的血清丙氨酸转氨酶水平更高（p<0.005），与基因型2的受试者相比，感染基因型1的受试者也是如此（p<0.05）。65例HCV - Ab +受试者中有11例（16.9%）自发清除了HCV - Ab；其中7/11的血清和白细胞中也失去了HCV - RNA。16名抗HCV +受试者属于家庭成员中有不止一人感染的家庭。这16名受试者中有10对是已婚夫妇。在这5对已婚夫妇中的4对中，夫妻双方的HCV基因型相同。
结论
在意大利北部农村地区，HCV成人发病率约为50例/10万居民/年。我们的研究结果表明，多达17%的感染受试者可能会自发清除HCV - Ab。家庭间传播似乎在感染传播中起作用。
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