Castillo Inmaculada, Pardo Margarita, Bartolomé Javier, Ortiz-Movilla Nuria, Rodríguez-Iñigo Elena, de Lucas Susana, Salas Clara, Jiménez-Heffernan Jose A, Pérez-Mota Arturo, Graus Javier, López-Alcorocho Juan Manuel, Carreño Vicente
Fundación para el Estudio de las Hepatitis Virales, Clínica Puerta de Hierro, Madrid, Spain.
J Infect Dis. 2004 Jan 1;189(1):7-14. doi: 10.1086/380202. Epub 2003 Dec 31.
There are patients in whom the etiology of long-standing abnormal results of liver-function tests is unknown (ALF-EU) after exclusion of all known causes of liver diseases. We analyzed the presence of hepatitis C virus (HCV) RNA in liver-biopsy specimens from 100 patients who were negative for anti-HCV antibodies and for serum HCV RNA and who had ALF-EU.
HCV RNA status was tested by reverse-transcription polymerase chain reaction (RT-PCR) and by in situ hybridization, in liver and peripheral-blood mononuclear cells (PBMCs).
HCV RNA was detected in liver-biopsy specimens from 57 of 100 patients negative for anti-HCV antibodies and for serum HCV RNA (i.e., who had occult HCV infection). HCV RNA of negative polarity was found in the liver of 48 (84.2%) of these 57 patients with occult HCV infection. Nucleotide-sequence analysis confirmed the specificity of detection of HCV RNA and that patients were infected with the HCV 1b genotype. Of these 57 patients with intrahepatic HCV RNA, 40 (70%) had viral RNA in their PBMCs. With regard to liver histology, patients with occult HCV infection were more likely to have necroinflammatory activity (P=.017) and fibrosis (P=.022) than were patients without intrahepatic HCV RNA.
Patients with ALF-EU may have intrahepatic HCV RNA in the absence of anti-HCV antibodies and of serum HCV RNA.
在排除所有已知肝脏疾病病因后，仍有部分患者肝功能检查长期异常的病因不明（病因不明的肝功能异常，ALF-EU）。我们分析了100例抗丙型肝炎病毒（HCV）抗体和血清HCV RNA均为阴性且患有ALF-EU的患者肝活检标本中HCV RNA的存在情况。
采用逆转录聚合酶链反应（RT-PCR）和原位杂交技术检测肝脏及外周血单个核细胞（PBMC）中的HCV RNA状态。
在100例抗HCV抗体和血清HCV RNA均为阴性的患者（即隐匿性HCV感染患者）的肝活检标本中，检测到57例存在HCV RNA。在这57例隐匿性HCV感染患者中，48例（84.2%）肝脏中发现了负链HCV RNA。核苷酸序列分析证实了HCV RNA检测的特异性，且患者感染的是HCV 1b基因型。在这57例肝内存在HCV RNA的患者中，40例（70%）外周血单个核细胞中也存在病毒RNA。关于肝脏组织学，隐匿性HCV感染患者比肝内无HCV RNA的患者更易出现坏死性炎症活动（P = 0.017）和纤维化（P = 0.022）。
患有ALF-EU的患者在没有抗HCV抗体和血清HCV RNA的情况下，肝脏中可能存在HCV RNA。
