Cox Daniel A, Ginde Salil, Tweddell James S, Earing Michael G
Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
World J Pediatr Congenit Heart Surg. 2014 Oct;5(4):503-6. doi: 10.1177/2150135114547587.
Symptoms associated with hepatitis C infection often do not develop until an advanced stage of liver disease. Prior to 1992, reliable testing for hepatitis C was unavailable, resulting in potential patient exposure during cardiopulmonary bypass. As the hepatitis C prevalence in our center was unknown, a screening protocol for patients who underwent surgery prior to 1992 was developed.
Patients evaluated in the Wisconsin Adult Congenital Heart Disease program who underwent surgery prior to 1992 were screened for hepatitis C as part of their initial clinical evaluation. The hepatitis C-positive patients were assessed for risk factors, level of hepatic involvement, whether they received treatment, and whether viral clearance was obtained.
A total of 147 patients (53% male) underwent testing. Seven (4.8%) patients had evidence of chronic hepatitis C infection, which is higher than the Wisconsin reported prevalence of 0.3%. Six of the seven patients had elevated liver enzymes at time of diagnosis. No relationship was found between hepatitis C infection and number of surgeries, year of surgery, or age at surgery. Four patients had hepatitis C genotype 1, but none achieved viral clearance despite three having received treatment. Three had genotype 2, were treated, and had viral clearance. No hepatitis C-positive patient developed cirrhosis or required liver transplant.
Hepatitis C infection in patients with congenital heart disease who underwent surgical palliation prior to 1992 is common, with prevalence higher than the general population. Our data emphasize the continued importance of screening the high-risk adult congenital heart disease patients.
丙型肝炎感染相关症状通常直到肝病晚期才会出现。1992年之前，尚无可靠的丙型肝炎检测方法，这导致在体外循环期间患者有潜在暴露风险。由于我们中心的丙型肝炎患病率未知，因此制定了针对1992年之前接受手术患者的筛查方案。
在威斯康星州成人先天性心脏病项目中接受评估且于1992年之前接受手术的患者，在其初始临床评估时进行丙型肝炎筛查。对丙型肝炎阳性患者评估危险因素、肝脏受累程度、是否接受治疗以及是否获得病毒清除。
共有147例患者（53%为男性）接受检测。7例（4.8%）患者有慢性丙型肝炎感染证据，高于威斯康星州报告的0.3%患病率。7例患者中有6例在诊断时肝酶升高。未发现丙型肝炎感染与手术次数、手术年份或手术年龄之间存在关联。4例患者为丙型肝炎基因1型，但尽管3例接受了治疗，均未实现病毒清除。3例为基因2型，接受了治疗并实现了病毒清除。没有丙型肝炎阳性患者发展为肝硬化或需要肝移植。
1992年之前接受手术姑息治疗的先天性心脏病患者中丙型肝炎感染很常见，患病率高于一般人群。我们的数据强调了对高危成人先天性心脏病患者进行筛查的持续重要性。
