Wiese Manfred, Grüngreiff Kurt, Güthoff Wolfgang, Lafrenz Michael, Oesen Ute, Porst Heiner
University Affiliated Hospital St. Georg, Leipzig, Germany.
J Hepatol. 2005 Oct;43(4):590-8. doi: 10.1016/j.jhep.2005.04.007.
BACKGROUND/AIMS: The natural course of the hepatitis C virus genotype 1b (HCV-1b) infection is still unclear but important for therapeutic decisions. There are few unbiased long-term follow-up studies with known dates of infection.
Between August 1978 and March 1979, 14 HCV-1b contaminated batches of anti-D immunoglobulin had been administered to 2867 women for prophylaxis of rhesus isoimmunization throughout East Germany. We reexamined 1980 women, representing 70% of the total cohort of 15 centers.
After application of the contaminated anti-D, 93% of the recipients developed an acute hepatitis C. After 25 years, 86% of the 1833 affected women still tested positive for hepatitis C virus antibodies and 46% for HCV RNA. Only nine (0.5%) had overt liver cirrhosis, 30 women (1.5%) developed pre-cirrhotic stages and one HCC was diagnosed. Ten (0.5%) died of HCV related complications, half of these related to additional comorbidity. In the last 5 years, a continuous, but low increase of fibrotic scores was observed.
Young women without comorbidity may clear HCV (1b) infection in more than half of the cases, or develop mild chronic hepatitis C. We confirmed the low risk of progression to cirrhosis in this cohort within 25 years.
背景/目的：丙型肝炎病毒1b型（HCV-1b）感染的自然病程仍不明确，但对于治疗决策至关重要。目前鲜有关于已知感染日期的无偏倚长期随访研究。
1978年8月至1979年3月期间，东德各地共有2867名女性接受了14批受HCV-1b污染的抗D免疫球蛋白，用于预防恒河猴血型免疫。我们重新检查了1980名女性，占15个中心总队列的70%。
使用受污染的抗D免疫球蛋白后，93%的接受者发生了急性丙型肝炎。25年后，1833名受影响女性中，86%的丙型肝炎病毒抗体检测仍呈阳性，46%的HCV RNA检测呈阳性。只有9人（0.5%）出现明显肝硬化，30名女性（1.5%）发展为肝硬化前期，确诊1例肝细胞癌。10人（0.5%）死于丙型肝炎相关并发症，其中一半与其他合并症有关。在过去5年中，观察到纤维化评分持续但缓慢上升。
无合并症的年轻女性在半数以上的病例中可能清除HCV（1b）感染，或发展为轻度慢性丙型肝炎。我们证实了该队列在25年内进展为肝硬化的风险较低。
