Liver Unit, Hospital Universitario de Canarias.
Departamento de Medicina Interna, Psiquiatría y Dermatología, Instituto Universitario de Tecnologías Biomédicas CIBICAN, Universidad de La Laguna.
Eur J Gastroenterol Hepatol. 2020 Apr;32(4):528-534. doi: 10.1097/MEG.0000000000001534.
Many hepatitis C virus (HCV)-infected patients have a suboptimal diagnosis. Particularly, the characteristics and risk of fibrosis progression of HCV antibody-positive patients without RNA testing are unknown.
Patients with a positive HCV antibody performed during 2005-2007 were classified based on RNA request and result until January 2017. Fibrosis was estimated with serologic scores.
Of the 38 246 HCV tests performed, 791 (2.01%) patients tested positive. At the end of the follow-up (median 128.6 months, range 109.8-145.9), 49.43% (n = 391) of the subjects did not have RNA testing, 13.02% (n = 103) had undetectable RNA, and 37.55% (n = 297) had detectable RNA. After excluding patients without data for AST to platelet ratio index calculation (n = 334), patients without RNA testing (n = 122) compared with RNA undetectable (n = 92) were more frequently men (68.9 versus 46.7%), alcohol (52.6 versus 38.2%) and drug (53.0 versus 39.1%) users, lacking social support (50.4 versus 29.3%), and showed higher basal fibrosis. Patients without RNA testing had a significantly higher increase in the percentage of patients with ≥F2 (P = 0.035) and cirrhosis (P = 0.022). The relative risk for ≥F2 and cirrhosis in patients without RNA testing was 3.03 [95% confidence interval (CI): 1.54-5.98] and 4.31 (95% CI: 1.42-13.10), respectively. Non-RNA request was an independent predictor factor for progression to cirrhosis.
In our cohort, patients with positive HCV antibody without RNA testing were more likely to be people at risk of social exclusion with an increased risk of fibrosis progression, because non-RNA request was a predictor for cirrhosis. Therefore, we urge support measures and strategies to link to care these difficult-to-treat populations.
许多丙型肝炎病毒（HCV）感染者的诊断不理想。特别是，尚未进行 RNA 检测的 HCV 抗体阳性患者的纤维化进展特征和风险尚不清楚。
根据 RNA 请求和结果，将 2005-2007 年期间进行的 HCV 抗体阳性检测的患者进行分类，直至 2017 年 1 月。使用血清学评分估计纤维化程度。
在进行的 38246 次 HCV 检测中，有 791 例（2.01%）患者的检测结果呈阳性。在随访结束时（中位时间为 128.6 个月，范围为 109.8-145.9），49.43%（n=391）的受试者未进行 RNA 检测，13.02%（n=103）的 RNA 检测结果为不可测，37.55%（n=297）的 RNA 检测结果为可测。排除 AST 与血小板比值指数计算无数据的患者（n=334）和无 RNA 检测的患者（n=122）后，与 RNA 不可测的患者（n=92）相比，无 RNA 检测的患者更常为男性（68.9%比 46.7%）、酒精（52.6%比 38.2%）和药物（53.0%比 39.1%）使用者、缺乏社会支持（50.4%比 29.3%），且基础纤维化程度更高。无 RNA 检测的患者纤维化程度≥F2（P=0.035）和肝硬化（P=0.022）的患者比例显著增加。无 RNA 检测的患者纤维化程度≥F2 和肝硬化的相对风险分别为 3.03（95%置信区间[CI]：1.54-5.98）和 4.31（95%CI：1.42-13.10）。不要求 RNA 检测是肝硬化进展的独立预测因素。
在我们的队列中，未进行 RNA 检测的 HCV 抗体阳性患者更有可能是处于社会排斥风险中的人群，纤维化进展的风险增加，因为不要求 RNA 检测是肝硬化的预测因素。因此，我们敦促采取支持措施和策略，将这些难以治疗的人群纳入治疗。
