Di Tommaso L, Macchia S, Morandi L, Leoncini S, Pession A, Dal Monte P R, Foschini M P
Department of Oncology, Section of Anatomic Pathology Marcello Malpighi, University of Bologna, Italy.
Int J Surg Pathol. 2003 Jul;11(3):197-204. doi: 10.1177/106689690301100306.
Genome heterogeneity may be related to the wide variability of clinical and pathological features in hepatitis C virus (HCV)-related chronic liver disease. This paper addresses the possible association between HCV subtypes and clinical and histological features of chronically infected patients. Sixty-eight consecutive liver biopsies of chronic hepatitis constituted the basis of the study. HCV genotyping was performed on frozen tissue. Grading of necroinflammatory activity and staging of fibrosis were histologically assessed. Serologic HCV-RNA and liver function were assessed at the same time. All information was compared with clinical data including age, sex, HCV serology, and probable data and route of infection. Two cases were excluded as inadequate tissue was available. Five cases were negative to HCV-RNA in both serum and tissue. In 61 cases HCV RNA was present at the same time in serum and liver tissue. Forty-four patients were men (72%) and 17 (28%) were women. Two peaks of age were observed: 1 in the 4th decade of life, the 2nd in the 7th. The 2 groups had different HCV genotypes. Patients with genotypes 1b (mean age 50.7 years), 2c (mean age 61.3 years), and a subgroup of coinfections (mean age 60 years) were older than patients with genotypes 1a (mean age 35.5 years), 3 (mean age 36 years), and a subgroup of coinfections (mean age 33 years). Patients with genotypes 1b, 2, or 2c and a subgroup of coinfections more frequently had a history of blood transfusion and or surgical intervention dating up to 49 years previously. Patients with HCV 1a, 3, and a subgroup of coinfections frequently admitted a period of intravenous drug abuse. Patients with advanced liver disease, i.e., severe fibrosis and cirrhosis, showed the same 2 peaks of incidence: in the 4th and 7th decades of life, the first group mainly comprising patients with HCV types 1a and 3, the second, patients with HCV types 1b and 2c. Both these groups shared a clinical history of a long-standing infection. Two profiles of patients emerged. The largest group was composed of elderly patients, infected by HCV genotypes 1b or 2c, with a history of blood transfusion and/or surgery, presenting an advanced stage of liver disease (namely, severe fibrosis or cirrhosis). The second group was composed of younger patients, mainly in the 4th decade of life, infected by HCV types 3 or 1a, often presenting with chronic hepatitis in the stage of severe fibrosis or cirrhosis. The latter could be the profile of HCV infection in the near future.
基因组异质性可能与丙型肝炎病毒（HCV）相关慢性肝病临床和病理特征的广泛变异性有关。本文探讨了HCV亚型与慢性感染患者临床及组织学特征之间的可能关联。68例连续的慢性肝炎肝活检样本构成了本研究的基础。对冷冻组织进行HCV基因分型。通过组织学评估坏死性炎症活动分级和纤维化分期。同时评估血清学HCV-RNA和肝功能。将所有信息与临床数据进行比较，包括年龄、性别、HCV血清学以及可能的感染数据和途径。因组织样本不足排除2例。5例血清和组织中的HCV-RNA均为阴性。61例血清和肝组织中同时存在HCV RNA。44例患者为男性（72%），17例（28%）为女性。观察到两个年龄高峰：一个在生命的第4个十年，另一个在第7个十年。两组具有不同的HCV基因型。基因型为1b（平均年龄50.7岁）、2c（平均年龄61.3岁）的患者以及一个合并感染亚组（平均年龄60岁）比基因型为1a（平均年龄35.5岁）、3（平均年龄36岁）的患者以及一个合并感染亚组（平均年龄33岁）年龄更大。基因型为1b、2或2c的患者以及一个合并感染亚组更频繁地有输血和/或手术史，时间可追溯至49年前。HCV 1a、3基因型的患者以及一个合并感染亚组经常承认有一段静脉药物滥用时期。患有晚期肝病（即重度纤维化和肝硬化）的患者也出现了相同的两个发病高峰：在生命的第4个和第7个十年，第一组主要包括HCV 1a和3型患者，第二组主要包括HCV 1b和2c型患者。这两组都有长期感染的临床病史。出现了两种患者类型。最大的一组由老年患者组成，感染HCV 1b或2c基因型，有输血和/或手术史，呈现晚期肝病（即重度纤维化或肝硬化）。第二组由年轻患者组成，主要在生命的第4个十年，感染HCV 3或1a型，常表现为重度纤维化或肝硬化阶段的慢性肝炎。后者可能是不久的将来HCV感染的特征。
