National Centre for Dual Diagnosis, Innlandet Hospital Trust, 2381 Brumunddal, Norway; Norwegian Centre for Addiction Research, University of Oslo, Norway.
Department of Forensic Pathology and Clinical Forensic Medicine, Norwegian Institute of Public Health, PO Box 4404 Nydalen, N-0403 Oslo, Norway; Faculty of Medicine, University of Oslo, Norway.
J Hepatol. 2014 Feb;60(2):260-6. doi: 10.1016/j.jhep.2013.09.022. Epub 2013 Oct 2.
BACKGROUND & AIMS: There is a paucity of unbiased data on the natural history of hepatitis C virus (HCV) infection in injecting drug users (IDUs). The purpose of this study was to assess the risk of developing advanced fibrosis associated with chronic hepatitis C (CHC) infection among injecting drug users (IDUs) who underwent an autopsy.
A longitudinal cohort design was applied, in which the stage of liver fibrosis in anti-HCV positive IDUs with or without chronic HCV infection was assessed in liver tissue from autopsies performed up to 35 years after HCV exposure. The cohort originated from 864 IDUs consecutively admitted for drug abuse treatment 1970-1984. Stored sera, mostly drawn at the time of admission for drug treatment, were available in 635 subjects. 220 out of 523 anti-HCV positive subjects had died before 2009. Liver tissue from autopsies was available from 102/220 subjects, of which 61 were HCV RNA positive. Liver sections were classified according to METAVIR scores for fibrosis. Two pathologists, both blinded for serologic results, scored sections of liver tissue.
Among HCV RNA positive subjects 16.4% (10/61) had septal fibrosis (F3) or cirrhosis (F4) compared to 2.4% (1/41) among anti HCV positive/HCV RNA negative subjects (p=0.026). Of 18 HCV RNA positive subjects autopsied <15 years after HCV exposure none had F3 or F4. Among subjects autopsied >25 years after exposure 35% (6/17) had F3-F4.
Among IDUs chronically infected by HCV, 1/3 developed septal fibrosis or cirrhosis 25 years or more after exposure.
目前，关于注射吸毒者（IDUs）中丙型肝炎病毒（HCV）感染自然史的无偏数据很少。本研究的目的是评估接受尸检的 IDUs 中慢性丙型肝炎（CHC）感染相关的进展性肝纤维化风险。
应用纵向队列设计，在 HCV 暴露后长达 35 年内，通过尸检评估抗 HCV 阳性 IDUs 中有无慢性 HCV 感染的肝纤维化分期。该队列源自 1970 年至 1984 年连续接受药物滥用治疗的 864 名 IDUs。635 名受试者中储存了血清，大部分是在接受药物治疗时采集的。220 名抗 HCV 阳性患者中有 220 名在 2009 年前死亡。102/220 名尸检中有 HCV RNA 阳性的患者中，有肝组织可供尸检。102 名患者中有 61 名 HCV RNA 阳性。肝组织切片根据 METAVIR 纤维化评分进行分类。两名病理学家均对肝组织切片进行评分，且均对血清学结果不知情。
在 HCV RNA 阳性患者中，16.4%（10/61）有间隔纤维化（F3）或肝硬化（F4），而抗 HCV 阳性/HCV RNA 阴性患者中仅为 2.4%（1/41）（p=0.026）。在 HCV 暴露后 15 年内尸检的 18 名 HCV RNA 阳性患者中，无一例出现 F3 或 F4。在 HCV 暴露后 25 年以上尸检的患者中，35%（6/17）出现 F3-F4。
在 HCV 慢性感染的 IDUs 中，1/3 在 HCV 暴露 25 年或更长时间后发生间隔纤维化或肝硬化。
