Locasciulli A, Bacigalupo A, Vanlint M T, Tagger A, Uderzo C, Portmann B, Shulman H M, Alberti A
Division of Pediatric Hematology, University of Milan, Italy.
Transplantation. 1991 Aug;52(2):315-8. doi: 10.1097/00007890-199108000-00025.
Antibody to the recently identified hepatitis C virus was investigated in sera of 128 patients treated with allogeneic bone marrow transplantation, to determine the prevalence of HCV infection and its role in post-transplant liver complications. The overall prevalence of anti-HCV positivity was 28.6% (38/128 patients). The presence of pretransplant anti-HCV positivity (in 10/35 tested patients) did not seem to predict a more severe liver disease. In fact 8/10 anti-HCV+ and 15/25 anti-HCV- patients had elevated transaminases at BMT, and posttransplant liver failure (due to VOD or subacute hepatitis), and post-BMT rises in transaminases occurred regardless of anti-HCV serology (P = 0.6 and 0.2, respectively). In patients tested for anti-HCV after BMT (n = 128), only two (one anti-HCV+ and one anti-HCV-) experienced VOD; the number of patients in whom liver failure contributed to death was comparable in anti-HCV-positive and anti-HCV- negative patients (P = 0.4). Among 17 patients with documented posttransplant seroconversion (from anti-HCV- to anti-HCV+) the appearance of anti-HCV was concomitant with hepatitis exacerbation in 9 (53%). Histologic changes demonstrated a more severe liver damage in anti-HCV+ patients: a chronic hepatitis was diagnosed in 9/11 anti-HCV+ versus 1/7 anti-HCV- cases. Based on these observations, we conclude that hepatitis C virus has a role in liver disease in such patients, although its evaluation by the anti-HCV test is still of limited accuracy, due to low sensitivity and incomplete specificity.
对128例接受同种异体骨髓移植治疗的患者血清进行了针对最近发现的丙型肝炎病毒抗体的检测，以确定丙型肝炎病毒（HCV）感染的患病率及其在移植后肝脏并发症中的作用。抗HCV阳性的总体患病率为28.6%（38/128例患者）。移植前抗HCV阳性（10/35例检测患者）似乎并不能预测更严重的肝脏疾病。事实上，8/10抗HCV阳性和15/25抗HCV阴性患者在骨髓移植时转氨酶升高，移植后肝功能衰竭（由于肝静脉闭塞病或亚急性肝炎），且移植后转氨酶升高与抗HCV血清学无关（P值分别为0.6和0.2）。在骨髓移植后检测抗HCV的患者中（n = 128），只有两例（一例抗HCV阳性和一例抗HCV阴性）发生了肝静脉闭塞病；抗HCV阳性和抗HCV阴性患者中因肝功能衰竭导致死亡的患者数量相当（P = 0.4）。在17例记录有移植后血清学转换（从抗HCV阴性转为抗HCV阳性）的患者中，9例（53%）抗HCV出现时伴有肝炎加重。组织学变化显示抗HCV阳性患者的肝损伤更严重：9/11抗HCV阳性患者被诊断为慢性肝炎，而抗HCV阴性患者中只有1/7例。基于这些观察结果，我们得出结论，丙型肝炎病毒在这类患者的肝脏疾病中起作用，尽管通过抗HCV检测对其评估的准确性仍然有限，这是由于敏感性低和特异性不完全所致。
