Sagnelli E, Argentini C, Genovese D, Pisaturo M, Coppola N, Taffon S, Sagnelli C, Rapicetta M
Department of Public Medicine, Section of Infectious Diseases, Second University of Naples, c/o Ospedale Gesù e Maria, Via D. Cotugno 1, Naples, Italy.
Infection. 2009 Aug;37(4):344-8. doi: 10.1007/s15010-008-8197-6. Epub 2009 Jul 27.
To evaluate the virological and clinical events occurring during a 3-year follow-up in three patients who, after symptomatic acute hepatitis C (AHC), experienced subsequent episodes of HC virus (V)-related acute liver cell necrosis.
The three patients were investigated for viral variability in the core, E1/E2, and NS5b regions during different phases of infection, and a computer-assisted analysis of the variation of known predicted epitopes in the consensus sequence was performed.
The first patient showed numerous genetic variations, which may be related to the maintenance of a chronic HCV infection state and to episodes of liver disease exacerbation. The second patient showed minimal viral variations associated with apparent resolution of the infection, but the same virus isolate, based on phylogenetic analysis, produced a second acute episode after the occult phase. The third patient, after the resolution of AHC, manifested a second episode of HCV infection by a different HCV sub-genotype.
Episodes of HCV-related acute liver cell necrosis after AHC may be associated to different virological patterns, such as the establishment of a chronic HCV infection, a reactivation of an occult virus, or a reinfection by a different HCV genotype.
评估3例有症状的急性丙型肝炎（AHC）患者在3年随访期间发生的病毒学和临床事件，这些患者随后经历了丙型肝炎病毒（HCV）相关的急性肝细胞坏死发作。
对这3例患者在感染的不同阶段进行核心区、E1/E2区和NS5b区的病毒变异性研究，并对共有序列中已知预测表位的变异进行计算机辅助分析。
首例患者表现出众多基因变异，这可能与慢性HCV感染状态的维持以及肝病加重发作有关。第二例患者表现出与感染明显缓解相关的最小病毒变异，但基于系统发育分析，同一病毒分离株在隐匿期后引发了第二次急性发作。第三例患者在AHC缓解后，由不同的HCV亚基因型引发了第二次HCV感染发作。
AHC后HCV相关的急性肝细胞坏死发作可能与不同病毒学模式有关，如慢性HCV感染的建立、隐匿病毒的再激活或不同HCV基因型的再次感染。
