Alberti A, Morsica G, Chemello L, Cavalletto D, Noventa F, Pontisso P, Ruol A
Second Department of Internal Medicine, University of Padova, Italy.
Lancet. 1992 Sep 19;340(8821):697-8. doi: 10.1016/0140-6736(92)92234-7.
There is controversy about clinical management of patients who persistently have antibodies to hepatitis C virus (anti-HCV) but who have no symptoms and signs of liver disease. We have taken liver biopsy samples from 23 such patients (16 of whom had normal alanine aminotransferase [ALT] values) to assess prevalence of liver disease and to see whether anti-HCV and HCV-RNA correlated with histological findings. 16 patients had histological evidence of chronic hepatitis, which was not predicted by serum ALT or by the pattern of specificity of anti-HCV. All 16 cases with hepatitis C viraemia (HCV-RNA detected by polymerase chain reaction), including 9 with normal ALT, had chronic hepatitis on biopsy (p less than 0.001), whereas 7 HCV-RNA-negative cases had normal liver histology. These findings indicate that serum HCV-RNA is a sensitive and specific marker of liver disease in anti-HCV-positive subjects, independent of ALT values, and challenge the idea of the existence of "true" healthy carriers of HCV.
对于持续存在丙型肝炎病毒抗体（抗-HCV）但无肝脏疾病症状和体征的患者，其临床管理存在争议。我们从23例此类患者中采集了肝活检样本（其中16例丙氨酸氨基转移酶[ALT]值正常），以评估肝脏疾病的患病率，并观察抗-HCV和HCV-RNA是否与组织学结果相关。16例患者有慢性肝炎的组织学证据，这并非血清ALT或抗-HCV特异性模式所能预测。所有16例丙型肝炎病毒血症患者（通过聚合酶链反应检测到HCV-RNA），包括9例ALT正常者，活检显示为慢性肝炎（p<0.001），而7例HCV-RNA阴性患者肝脏组织学正常。这些发现表明，血清HCV-RNA是抗-HCV阳性受试者肝脏疾病的敏感且特异的标志物，独立于ALT值，并对HCV“真正”健康携带者的存在这一观点提出了挑战。
