Ríos M, Diago M, Rivera P, Tuset C, Cors R, García V, Carbonel P, Gonzalez C
Hepatology Section, Service of Digestive Diseases, University General Hospital, Valencia, Spain.
J Viral Hepat. 2006 Mar;13(3):177-81. doi: 10.1111/j.1365-2893.2005.00673.x.
We studied the epidemiological, laboratory and histological characteristics of a group of patients with positive antibodies against hepatitis C virus (HCV) as determined by third-generation enzyme-linked immunosorbent assay (ELISA), and with indeterminate HCV antibody positivity as established by third-generation recombinant immunoblot assay (RIBA-3). The results obtained were compared with those recorded in a group of RIBA-3-positive patients. Both groups correspond to blood donors in whom the prevalence of hepatitis C is low. There were no statistically significant intergroup differences in mean age, or in the presence of infection risk factors. RNA positivity was much more frequent in the RIBA-positive group (71%vs 10%; P < 0.05), as was transaminase elevation during the 3 years of follow-up (54%vs 13%; P < 0.05). In 46% of the RIBA-indeterminate patients the liver biopsy proved normal, or only liver steatosis or minimal changes were detected, while 33% had persistent chronic hepatitis, and 21% showed active chronic hepatitis. A mean Knodell index score of 2.28 was recorded; 50% of the subjects showed no fibrosis, 46% grade 1 fibrosis (fibrous portal expansion), 4% grade 2 fibrosis (bridging fibrosis), and none grade 3 fibrosis (liver cirrhosis). In the RIBA-positive group, a greater percentage of patients had active chronic hepatitis, a greater Knodell index, and increased-grade fibrosis. It can be concluded that the RIBA-3-indeterminate group is epidemiologically similar to the RIBA-3-positive series, although with a lesser prevalence of laboratory test alterations, a lower viral replication index, and more likely to have benign disease - particularly in subjects without viral replication.
我们研究了一组经第三代酶联免疫吸附测定（ELISA）检测丙型肝炎病毒（HCV）抗体呈阳性、且经第三代重组免疫印迹法（RIBA-3）判定HCV抗体阳性结果不确定的患者的流行病学、实验室及组织学特征。将所得结果与一组RIBA-3阳性患者的记录结果进行比较。两组均为丙型肝炎患病率较低的献血者。两组在平均年龄或感染风险因素的存在方面无统计学显著差异。RIBA阳性组的RNA阳性率（71%对10%；P<0.05）以及随访3年期间转氨酶升高的发生率（54%对13%；P<0.05）均更高。在46%的RIBA结果不确定的患者中，肝活检显示正常，或仅检测到肝脂肪变性或轻微改变，而33%有持续性慢性肝炎，21%表现为活动性慢性肝炎。记录的平均Knodell指数评分为2.28；50%的受试者无纤维化，46%为1级纤维化（纤维门静脉扩张），4%为2级纤维化（桥接纤维化），无3级纤维化（肝硬化）患者。在RIBA阳性组中，有更高比例的患者患有活动性慢性肝炎、更高的Knodell指数以及纤维化分级增加。可以得出结论，RIBA-3结果不确定组在流行病学上与RIBA-3阳性组相似，尽管实验室检查改变的患病率较低、病毒复制指数较低，且更可能患有良性疾病——尤其是在无病毒复制的受试者中。
