Hassan Mohamed, Hasan Syed, Giday Samuel, Alamgir Laila, Banks Alpha, Frederick Winston, Smoot Duane, Castro Oswaldo
Division of Gastroenterology, Howard University Hospital, Washington, DC, USA.
J Natl Med Assoc. 2003 Oct;95(10):939-42.
To determine the prevalence of hepatitis C virus antibodies (anti-HCV) in patients with sickle cell disease.
Between 1983 and 2001, 150 patients from the Howard University Hospital Center for Sickle Cell Disease were screened for HCV antibody (52% women, 48% men, mean age 34 years). Frozen serum samples from 56 adult sickle cell patients who had participated in previous surveys (1983-92) of HIV and HTLV-1 serology and who were tested in 1992 for anti-HCV antibody--when commercial ELISA test (Ortho) became available--were included in this paper. Of the 150 patients in the study, 132 had sickle cell anemia genotype (SS), 15 had sickle cell hemoglobin-C disease (SC) and three had sickle beta thalassemia. Clinical charts were reviewed for history of blood transfusion, IV drug abuse, homosexuality, tattooing, iron overload, and alcohol abuse.
Antibodies to HCV were detected in 53 patients (35.3%). Of the 55 patients who had frozen serum samples tested in 1992, 32 (58%) were reactive for anti-HCV, while only 21 of the 95 patients (22%) tested after 1992 were positive for HCV antibodies (P<0.001). Thirty-nine of 77 patients (51%) who received more than 10 units of packed red blood cells were positive for HCV antibody, and only 14 of 61 patients (23%) who received less than 10 units of packed red blood cells transfusion were positive for HCV antibodies (P<0.001). None of the 12 patients who never received transfusion were positive for HCV antibody. In the 53 anti-HCV positive patients, the mean alanine amino-transferase (ALT) value was 98- and 81 U/L, respectively, for males and females. These values were normal for the HCV-antibody negative patients. The aspartate amino-transferase (AST) and the total bilirubin were also higher in the anti-HCV positive patients compared to patients in the anti-HCV negative group. Forty-four patients (57.1%) who were transfused more than 10 units developed iron overload defined by a serum ferritin level higher than 1,000 ng/ml. A total of 20 of the patients with iron overload underwent liver biopsies. Seven of these 20 patients (35%) were HCV positive. These patients often had more severe liver disease and higher degree of iron deposition.
The prevalence of HCV antibody and iron overload is directly related to the number of blood transfusions in patients with sickle cell disease. The prevalence of HCV infection has decreased significantly, since blood donor screening for HCV became available. Chronic HCV infection and iron overload place sickle cell patients at risk for significant liver disease.
确定镰状细胞病患者丙型肝炎病毒抗体（抗-HCV）的流行情况。
1983年至2001年间，对霍华德大学医院镰状细胞病中心的150例患者进行了HCV抗体筛查（女性52%，男性48%，平均年龄34岁）。本文纳入了56例成年镰状细胞病患者的冷冻血清样本，这些患者曾参与1983 - 1992年期间的HIV和HTLV-1血清学调查，并于1992年进行了抗-HCV抗体检测——当时商用ELISA检测（Ortho）已可用。在该研究的150例患者中，132例为镰状细胞贫血基因型（SS），15例为镰状细胞血红蛋白-C病（SC），3例为镰状β地中海贫血。查阅临床病历以了解输血史、静脉药物滥用史、同性恋史、纹身史、铁过载及酒精滥用情况。
53例患者（35.3%）检测出抗-HCV抗体。在1992年检测冷冻血清样本的55例患者中，32例（58%）抗-HCV呈反应性，而1992年后检测的95例患者中只有21例（22%）HCV抗体呈阳性（P<0.001）。接受超过10单位浓缩红细胞输注的77例患者中有39例（51%）HCV抗体呈阳性，而接受少于10单位浓缩红细胞输注的61例患者中只有14例（23%）HCV抗体呈阳性（P<0.001）。12例从未接受输血的患者中无一例HCV抗体呈阳性。在53例抗-HCV阳性患者中，男性和女性的平均丙氨酸转氨酶（ALT）值分别为9-eight和81 U/L。这些值在HCV抗体阴性患者中为正常。与抗-HCV阴性组患者相比，抗-HCV阳性患者的天冬氨酸转氨酶（AST）和总胆红素也更高。44例（57.1%）接受超过10单位输血的患者出现铁过载，定义为血清铁蛋白水平高于1000 ng/ml。共有20例铁过载患者接受了肝活检。这20例患者中有7例（35%）HCV呈阳性。这些患者通常有更严重的肝脏疾病和更高程度的铁沉积。
镰状细胞病患者中HCV抗体和铁过载的流行率与输血次数直接相关。自对献血者进行HCV筛查以来，HCV感染的流行率已显著下降。慢性HCV感染和铁过载使镰状细胞病患者面临严重肝脏疾病的风险。
