Puoti Claudio
Dept. of Gastroenterology and Internal Medicine, Genzano Hospital, Genzano, Via Achille Grandi 43, 00045 Rome, Italy.
Rom J Gastroenterol. 2004 Dec;13(4):329-32.
Approximately 30% of patients with chronic HCV infection show persistently normal alaninaminotransferase (ALT) levels. The majority of HCV carriers are females, and up to 40-50% of carriers harbor non-1 genotype, at least in western Europe. No association has been found between HCV type/viral load and the severity of liver damage. The prevalence of HCV carriers with normal liver seems to be very low (less than 20%). Liver disease is usually minimal/mild and fibrosis is generally absent or minimal, although the association of normal ALT with cirrhosis or with hepatocellular carcinoma has been reported. In all studies, liver histology was, on average, significantly less severe in subjects with persistently normal ALT than with abnormal ALT. Although the majority of data seem to show that HCV carriers with normal ALT have mild and stable disease, with a favourable prognosis, several studies reported a significant progression of fibrosis in approximately 20-30% of the patients with ALT normality, and the development of hepatocellular carcinoma in some cases has been described, despite persistent ALT normality. Sudden worsening of disease with ALT increase and histological deterioration has been described after up to 15 years of follow-up.
约30%的慢性丙型肝炎病毒（HCV）感染者的丙氨酸氨基转移酶（ALT）水平持续正常。大多数HCV携带者为女性，至少在西欧，高达40 - 50%的携带者携带非1基因型。尚未发现HCV类型/病毒载量与肝损伤严重程度之间存在关联。肝脏正常的HCV携带者的患病率似乎非常低（低于20%）。肝病通常轻微，一般不存在纤维化或纤维化程度轻微，尽管有报告称ALT正常与肝硬化或肝细胞癌有关联。在所有研究中，ALT持续正常的受试者的肝脏组织学平均而言比ALT异常的受试者明显较轻。虽然大多数数据似乎表明ALT正常的HCV携带者病情轻微且稳定，预后良好，但多项研究报告称，约20 - 30%的ALT正常患者的纤维化有显著进展，并且在某些病例中描述了肝细胞癌的发生，尽管ALT持续正常。在长达15年的随访后，有报告称疾病会随着ALT升高和组织学恶化而突然加重。
