Thomas David L, Seeff Leonard B
Johns Hopkins School of Medicine, 1503 E. Jefferson Street, Baltimore, MD 21231, USA.
Clin Liver Dis. 2005 Aug;9(3):383-98, vi. doi: 10.1016/j.cld.2005.05.003.
Fifteen years after the discovery of the hepatitis C virus, a substantial amount of information has been learned about the natural history of infection. Testing for viral nucleic acid made it possible to accurately diagnose chronic infection and provided a more precise estimate of the overall frequency of viral persistence. Although cirrhosis and hepatocellular carcinoma can arise in persons with chronic hepatitis C, these outcomes do not always occur. The cirrhosis risk is greater in those who are infected at older ages, those who drink >50 g of alcohol each day, and persons coinfected with HIV. However, much of the person-to-person variability in progression of chronic hepatitis C remains unexplained. The ability to detect persons at highest risk of progression remains incomplete and represents an important future challenge in the understanding of the natural history of hepatitis C.
丙型肝炎病毒被发现15年后，人们已经了解到大量关于感染自然史的信息。病毒核酸检测使准确诊断慢性感染成为可能，并能更精确地估计病毒持续存在的总体频率。虽然慢性丙型肝炎患者可能会出现肝硬化和肝细胞癌，但这些结果并非总会发生。年龄较大、每天饮酒超过50克以及合并感染艾滋病毒的人患肝硬化的风险更高。然而，慢性丙型肝炎进展过程中人与人之间的许多差异仍无法解释。识别进展风险最高人群的能力仍不完整，这是未来理解丙型肝炎自然史的一项重要挑战。
