Discipline of Gastroenterology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Department of Medicine, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil.
Department of Medicine, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil.
Braz J Infect Dis. 2014 Sep-Oct;18(5):507-11. doi: 10.1016/j.bjid.2014.04.003. Epub 2014 Jun 4.
A population-based survey conducted in Brazilian capital cities found that only 16% of the population had ever been tested for hepatitis C. These data suggest that much of the Brazilian population with HCV infection remains undiagnosed. The distribution of age ranges at diagnosis and its association with the degree of hepatitis C are still unknown in Brazilian patients.
Patients with HCV infection, diagnosed by HCV RNA (Amplicor-HCV, Roche), were included in the study. Patients with HBV or HIV coinfection, autoimmune diseases, or alcohol intake>20 g/day were excluded. HCV genotyping was performed by sequence analysis, and viral load by quantitative RT-PCR (Amplicor, Roche). The METAVIR classification was used to assess structural liver injury. The Chi-square (χ(2)) test and student's t-test were used for between-group comparisons. Spearman's rank correlation coefficient were used for analysing the correlation between parameters.
A total of 525 charts were reviewed. Of the patients included, 49.5% were male, only 10% of the patients were aged less than 30 years; peak prevalence of HCV infection occurred in the 51-to-60 years age range. Genotype 1 accounted for 65.4% of the cases. Information on HCV subtype was obtained in 227 patients; 105 had subtype 1a and 122 had 1b. According to the degree of structural liver injury, 8.3% had F0, 23.4% F1, 19.8% F2, 11.9% F3, and 36.5% F4. Age at diagnosis of hepatitis correlated significantly with fibrosis (rs=0.307, p<0.001). The degree of fibrosis increased with advancing age. Only age at diagnosis and fasting blood glucose were independently associated with disease stage. Those patients with subtype 1a had higher prevalence of F2-F4 than those with subtype 1b.
In Brazil, diagnosis of hepatitis C is more commonly established in older patients (age 45-60 years) with more advanced disease. Reassessment of strategies for hepatitis C diagnosis in the country is required.
巴西首都进行的一项基于人群的调查发现，只有 16%的人曾接受过丙型肝炎检测。这些数据表明，巴西有很大一部分 HCV 感染者尚未被诊断出来。在巴西患者中，诊断时的年龄范围分布及其与丙型肝炎严重程度的关系尚不清楚。
本研究纳入了丙型肝炎病毒感染患者，其诊断依据为丙型肝炎病毒 RNA（Amplicor-HCV，罗氏）。排除 HBV 或 HIV 合并感染、自身免疫性疾病或每天饮酒量>20 g 的患者。采用序列分析方法进行 HCV 基因分型，采用定量 RT-PCR（Amplicor，罗氏）检测病毒载量。采用 METAVIR 分类评估肝组织损伤程度。采用卡方检验（χ(2)）和学生 t 检验进行组间比较。采用斯皮尔曼等级相关系数分析参数之间的相关性。
共回顾了 525 份病历。纳入的患者中，49.5%为男性，仅有 10%的患者年龄小于 30 岁；HCV 感染的发病高峰出现在 51-60 岁年龄组。基因型 1 占 65.4%。在 227 例患者中获得了 HCV 亚型信息；105 例为 1a 亚型，122 例为 1b 亚型。根据肝组织损伤程度，8.3%为 F0，23.4%为 F1，19.8%为 F2，11.9%为 F3，36.5%为 F4。丙型肝炎的诊断年龄与纤维化程度显著相关（rs=0.307，p<0.001）。纤维化程度随年龄增长而增加。只有诊断年龄和空腹血糖与疾病分期独立相关。1a 亚型患者的 F2-F4 发生率高于 1b 亚型患者。
在巴西，丙型肝炎的诊断更常见于年龄较大（45-60 岁）、疾病更严重的患者。需要重新评估该国丙型肝炎诊断策略。
