台湾丙型肝炎病毒感染检测呈阳性的无偿献血者的临床特征与结局：一项前瞻性研究

Clinical aspects and outcomes of volunteer blood donors testing positive for hepatitis-C virus infection in Taiwan: a prospective study.

作者信息

Liu Chun-Jen, Chen Pei-Jer, Shau Wen-Yi, Kao Jia-Horng, Lai Ming-Yang, Chen Ding-Shinn

机构信息

Department of Internal Medicine, National Taiwan University College of Medicine, National Taiwan University Hospital, 1 Chang-Te Street, Taipei 100, Taiwan.

出版信息

Liver Int. 2003 Jun;23(3):148-55. doi: 10.1034/j.1600-0676.2003.00820.x.

DOI:10.1034/j.1600-0676.2003.00820.x

PMID:12955877

Abstract

BACKGROUND/AIM: The natural history of hepatitis-C virus (HCV) infection has been explored in volunteer blood donors, but not yet in hepatitis-B endemic areas. Whether previous or concurrent hepatitis-B virus (HBV) infection influences the natural history of HCV infection remains unknown. Thus, we followed the anti-HCV-positive blood donors who had past or concurrent HBV infection in Taiwan.

METHODS

From 1992 to 1993, 1588 anti-HCV reactive volunteer blood donors were referred to us from the Taipei Blood Center and 879 (55%) repeatedly reactive for anti-HCV were enrolled. Two hundred and forty-three donors (HCV RNA seropositive rate 49% by polymerase chain reaction (PCR)) received regular follow-ups (mean period: 4.9 years) with their liver disease status determined mainly by clinical and biochemical parameters, serum alpha-fetoprotein level and imaging studies. Hepatitis-C virus genotype and occult HBV infection were determined by PCR-based assays.

RESULTS

Of the initial 879 subjects, 250 (28%) had chronic hepatitis, nine (1%) had liver cirrhosis (LC) and two (0.2%) had hepatocellular carcinoma (HCC) already. In the 243 regularly followed donors, 30% had repeatedly normal serum alanine aminotransferase (ALT) and 70% had more than once elevated ALT. Cirrhosis developed in four (1.6%; follow-up period range: 2-6 years) and HCC in two (0.8%; follow-up period: 3 and 4 years, respectively). Distribution of HCV genotype and hepatitis-B surface antigen (HBsAg) did not differ between those with and those without elevation of ALT. Of the 15 donors with LC and/or HCC, only 1(7%) was positive for both HBsAg and HBV DNA and the other 14 were negative for both HBsAg and serum HBV DNA.

CONCLUSIONS

Incidentally detected hepatitis-C was progressive in a small proportion of anti-HCV-positive volunteer blood donors in Taiwan. Occult HBV infection played a minimal role in the development of LC in this donor population.

摘要

背景/目的：丙型肝炎病毒（HCV）感染的自然史已在志愿献血者中进行了探索，但尚未在乙型肝炎流行地区进行。既往或同时感染乙型肝炎病毒（HBV）是否会影响HCV感染的自然史仍不清楚。因此，我们对台湾既往或同时感染HBV的抗HCV阳性献血者进行了随访。

方法

1992年至1993年，台北血液中心将1588名抗HCV反应性志愿献血者转介给我们，其中879名（55%）抗HCV反复反应阳性者被纳入研究。243名献血者（聚合酶链反应（PCR）检测HCV RNA血清阳性率为49%）接受了定期随访（平均随访期：4.9年），其肝病状况主要通过临床和生化参数、血清甲胎蛋白水平及影像学检查来确定。通过基于PCR的检测方法确定HCV基因型和隐匿性HBV感染情况。

结果

在最初的879名受试者中，250名（28%）患有慢性肝炎，9名（1%）患有肝硬化（LC），2名（0.2%）已患有肝细胞癌（HCC）。在243名接受定期随访的献血者中，30%的人血清丙氨酸氨基转移酶（ALT）反复正常，70%的人ALT不止一次升高。4人（1.6%；随访期范围：2至6年）发展为肝硬化，2人（0.8%；随访期分别为3年和4年）发展为HCC。ALT升高者与未升高者之间HCV基因型和乙型肝炎表面抗原（HBsAg）的分布无差异。在15名患有LC和/或HCC的献血者中，只有1名（7%）HBsAg和HBV DNA均为阳性，其他14名HBsAg和血清HBV DNA均为阴性。