Mallette Carol, Flynn Maura A, Promrat Kittichai
Division of Gastroenterology, Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Am J Gastroenterol. 2008 Jan;103(1):131-7. doi: 10.1111/j.1572-0241.2007.01522.x. Epub 2007 Sep 25.
Screening for hepatitis C virus (HCV) infection in individuals at increased risk is currently recommended by most, but not all, health authorities. This study identifies outcomes of individuals diagnosed through a screening program targeting high-risk patients.
Veterans presenting for care in VA facilities are assessed for HCV risk factors by a questionnaire. Those with a risk factor are offered anti-HCV testing. Between October 1998 and May 2004, 25,701 patients were assessed and 8,471 patients had a risk factor for HCV. Patients diagnosed through the screening program were assessed per study protocol.
The prevalence of a positive HCV antibody in veterans who identified a risk factor was 7.3% (95% CI 6.6-8.0%). Among those diagnosed through the screening program (N = 260), 47% had chronic hepatitis C. Among patients with chronic HCV, 18% had evidence of advanced liver disease (stage III/IV on biopsy or clinical cirrhosis) while 34% had persistently normal alanine aminotransferase (ALT). Two-thirds of individuals who underwent liver biopsy had minimal or no fibrosis. About half (47%) of the screen-detected patients with chronic HCV were treatment candidates. Forty-four percent were not immediate candidates secondary to medical or psychiatric comorbidities or active substance abuse. Twenty-two patients (8%) had died after a median follow-up of 911 days. Two were liver-related deaths.
Screening for hepatitis C in persons at high risk can lead to early identification of individuals at risk for progressive liver disease who may benefit from antiviral therapy and counseling to reduce HCV-related liver injury.
目前大多数（但并非所有）卫生当局都建议对高危个体进行丙型肝炎病毒（HCV）感染筛查。本研究确定了通过针对高危患者的筛查项目诊断出的个体的结局。
通过问卷调查评估在退伍军人事务部（VA）设施接受治疗的退伍军人的HCV危险因素。对有危险因素的人进行抗HCV检测。在1998年10月至2004年5月期间，对25701名患者进行了评估，其中8471名患者有HCV危险因素。根据研究方案对通过筛查项目诊断出的患者进行评估。
确定有危险因素的退伍军人中HCV抗体阳性率为7.3%（95%CI 6.6 - 8.0%）。在通过筛查项目诊断出的患者中（N = 260），47%患有慢性丙型肝炎。在慢性HCV患者中，18%有晚期肝病证据（活检或临床肝硬化为III/IV期），而34%的丙氨酸氨基转移酶（ALT）持续正常。接受肝活检的患者中有三分之二纤维化程度轻微或无纤维化。筛查发现的慢性HCV患者中约一半（47%）适合治疗。44%由于合并内科或精神疾病或正在滥用药物而不适合立即治疗。22名患者（8%）在中位随访911天后死亡。其中2例为与肝脏相关的死亡。
对高危人群进行丙型肝炎筛查可早期识别有进展性肝病风险的个体，这些个体可能受益于抗病毒治疗和咨询，以减少HCV相关的肝损伤。
