Abraham Rachel, Ramakrishna Banumathi, Balekuduru Avinash, Daniel Hubert Darius J, Abraham Priya, Eapen C Eapen, Kurian George
Department of Pathology, Christian Medical College, Vellore, India.
Indian J Gastroenterol. 2009 Mar-Apr;28(2):53-8. doi: 10.1007/s12664-009-0018-z. Epub 2009 Aug 21.
Hepatitis C virus (HCV) genotype influences the severity of disease and response to therapy. This retrospective study examined the clinical and histological features and the genotype distribution in biopsied patients with HCV related chronic liver disease.
Of 105 biopsies from patients with HCV infection, 96 from patients with chronic liver disease were reviewed. The Ishak scoring system was used for histological analysis.
Genotype 3 was most common accounting for 77.1%, and genotype 1 for 9.4% of cases. There was no significant association of transaminase levels, viral load or necro-inflammatory activity score with genotype. A severe degree of fibrosis was seen in 77.8% cases of genotype 1 and in 63.5% of genotype 3 (p=0.76). Variable degrees of steatosis were noted in 68.8% of cases. However, severe steatosis was noted only in genotype 3 (7 cases). Serum transaminase levels did not correlate with either histological activity (p=0.43) or degree of fibrosis (p=0.72). Severe fibrosis / cirrhosis was seen in 74.24% of patients above 40 years of age as compared to 33.3% of patients below 40 years (p=0.001). The frequency of Mallory hyaline was significantly different between genotypes 1 and 3 infection (P<0.001).
This study confirms the preponderance of genotype 3 in Indian patients with HCV related chronic liver disease. Severe steatosis was seen only in genotype 3 and Mallory hyaline was very common in genotype 1. The small numbers of patients in non genotype 3 could be a reason for the apparent lack of histological differences between different HCV genotypes. Severe fibrosis seen in older age groups confirms that HCV infection is progressive and major acceleration of the disease process occurs after 40 years of age.
丙型肝炎病毒（HCV）基因型会影响疾病的严重程度以及对治疗的反应。这项回顾性研究调查了经活检的HCV相关慢性肝病患者的临床和组织学特征以及基因型分布情况。
在105例HCV感染患者的活检样本中，对96例慢性肝病患者的样本进行了回顾分析。采用Ishak评分系统进行组织学分析。
基因型3最为常见，占77.1%，基因型1占9.4%。转氨酶水平、病毒载量或坏死性炎症活动评分与基因型之间无显著关联。基因型1的病例中77.8%出现严重纤维化，基因型3的病例中63.5%出现严重纤维化（p = 0.76）。68.8%的病例出现不同程度的脂肪变性。然而，仅在基因型3中发现严重脂肪变性（7例）。血清转氨酶水平与组织学活性（p = 0.43）或纤维化程度（p = 0.72）均无相关性。40岁以上患者中74.24%出现严重纤维化/肝硬化，而40岁以下患者中这一比例为33.3%（p = 0.001）。基因型1和3感染之间马洛里透明小体的频率存在显著差异（P<0.001）。
本研究证实基因型3在印度HCV相关慢性肝病患者中占优势。仅在基因型3中发现严重脂肪变性，而马洛里透明小体在基因型1中非常常见。非基因型3的患者数量较少可能是不同HCV基因型之间组织学差异不明显的原因。老年组出现的严重纤维化证实HCV感染是渐进性的，且疾病进程在40岁后会显著加速。
