Aach R D, Stevens C E, Hollinger F B, Mosley J W, Peterson D A, Taylor P E, Johnson R G, Barbosa L H, Nemo G J
Mount Sinai Medical Center, Cleveland, OH 44106.
N Engl J Med. 1991 Nov 7;325(19):1325-9. doi: 10.1056/NEJM199111073251901.
The causes of post-transfusion non-A, non-B hepatitis are still not fully defined, nor is it clear how accurate the tests are that are used to screen blood donors for hepatitis C virus (HCV) and to diagnose post-transfusion hepatitis caused by infected blood.
We used two first-generation enzyme-linked immunoassays (EIAs) and one second-generation immunoassay to test for anti-HCV antibodies in serum samples collected between 1976 and 1979 in the Transfusion-Transmitted Viruses Study (from 1247 patients who underwent transfusion and 1235 matched control subjects who did not receive transfusions). We tested serum collected before and after infection from the patients in whom non-A, non-B hepatitis developed, serum from their blood donors, and serum from 41 of the control subjects who had hepatitis unrelated to transfusion.
Of the 115 patients in whom post-transfusion non-A, non-B hepatitis developed, the initial serum samples of 111 were anti-HCV-negative; after hepatitis developed in these 111 patients, the first-generation EIAs detected anti-HCV in 51 (46 percent), and the second-generation assay detected anti-HCV in an additional 16 (14 percent), for a total of 60 percent. Of 40 controls, 37 were anti-HCV-negative initially, and none seroconverted after hepatitis developed. If the 3 percent rate of non-A, non-B, non-C hepatitis among the controls (37 of 1235) was applied to the 1247 transfusion recipients, only 74 of the 111 cases of hepatitis were attributable to the transfusion. Thus, 91 percent (67 of 74) of the cases of post-transfusion hepatitis were caused by HCV. Of the 99 donors, 60 were HCV-positive (9 on second-generation tests only) and 39 were not.
Nearly all cases of non-A, non-B post-transfusion hepatitis are caused by HCV. Screening with a second-generation assay improves the rate of detection of HCV infection in patients with post-transfusion hepatitis and in blood donors. The use of this test showed a 3.6 percent risk of non-A, non-B, non-C hepatitis, which was not significantly different from the rate in the controls (3.0 percent).
输血后非甲非乙型肝炎的病因仍未完全明确，用于筛查献血者丙型肝炎病毒（HCV）以及诊断因受感染血液导致的输血后肝炎的检测方法的准确性也尚不清楚。
我们使用两种第一代酶联免疫吸附测定（EIA）和一种第二代免疫测定法，对1976年至1979年期间在输血传播病毒研究中收集的血清样本进行抗HCV抗体检测（样本来自1247例接受输血的患者以及1235例未接受输血的匹配对照对象）。我们检测了发生非甲非乙型肝炎患者感染前后的血清、他们的献血者血清以及41例患有与输血无关肝炎的对照对象的血清。
在115例发生输血后非甲非乙型肝炎的患者中，111例患者的初始血清样本抗HCV呈阴性；在这111例患者发生肝炎后，第一代EIA检测到51例（46%）抗HCV阳性，第二代检测又额外检测到16例（14%）抗HCV阳性，总计60%。40例对照对象中，37例最初抗HCV呈阴性，发生肝炎后无一人血清转化。如果将对照对象中非甲非乙非丙型肝炎3%的发生率（1235例中有37例）应用于1247例输血受者，那么111例肝炎病例中只有74例可归因于输血。因此，输血后肝炎病例的91%（74例中的67例）由HCV引起。99名献血者中，60例HCV呈阳性（仅第二代检测呈阳性的有9例），39例呈阴性。
几乎所有输血后非甲非乙型肝炎病例均由HCV引起。使用第二代检测法可提高输血后肝炎患者及献血者中HCV感染的检测率。使用该检测法显示非甲非乙非丙型肝炎的风险为3.6%，与对照对象中的发生率（3.0%）无显著差异。
