Zeuzem S, Roth W K, Herrmann G
Medizinische Klinik II, Johann Wolfgang Goethe-Universität Frankfurt a.M..
Z Gastroenterol. 1995 Feb;33(2):117-32.
Soon after the isolation of the hepatitis C virus (HCV) genome in 1988 it became evident that HCV is the most important cause of non-A, non-B-hepatitis. In recent years the structure of this (+)-stranded RNA-virus, the different genotypes of HCV and the replication in hepatic and extrahepatic sites have been investigated. HCV has a remarkable degree of genetic heterogeneity, mutates rapidly, leading to the simultaneous coexistence of different genoms in the same individual (quasispecies) and most likely to the generation of neutralization escape mutants. The cytotoxicity of the hepatitis C virus appears to be mainly immune-mediated. This review article summarizes basic, diagnostic and clinical aspects of acute and chronic HCV-infection, association with other diseases and complications such as liver cirrhosis and hepatocellular carcinoma. Interferon-alpha has been shown useful in normalizing serum aminotransferases and decreasing liver inflammatory lesions in about half of the patients with chronic hepatitis C. However, relapses after the cessation of interferon-alpha are frequent, leading to a sustained response in less than 30% of treated patients. Several clinical and biochemical parameters for response to interferon-alpha have been proposed. In patients with orthotopic liver transplantation due to progressive chronic hepatitis C and decompensated liver cirrhosis, reinfection of the donor organ frequently occurs. However, in transplanted patients under immunosuppression the course of hepatitis C reinfection is usually mild. Due to screening programs of blood and blood products the incidence of posttransfusion-acquired hepatitis C has declined. However, further efforts in understanding the transmission of community-acquired hepatitis C are necessary. The development of a hepatitis C vaccine will be difficult due to the high degree of viral genetic heterogeneity.
1988年丙型肝炎病毒（HCV）基因组分离后不久，就很明显HCV是非甲非乙型肝炎的最重要病因。近年来，对这种正链RNA病毒的结构、HCV的不同基因型以及在肝脏和肝外部位的复制进行了研究。HCV具有显著程度的遗传异质性，突变迅速，导致不同基因组在同一个体中同时共存（准种），并且很可能产生中和逃逸突变体。丙型肝炎病毒的细胞毒性似乎主要是免疫介导的。这篇综述文章总结了急性和慢性HCV感染的基础、诊断和临床方面，以及与其他疾病和并发症如肝硬化和肝细胞癌的关联。已表明α干扰素对约一半的慢性丙型肝炎患者使血清转氨酶正常化和减少肝脏炎症病变有用。然而，停止使用α干扰素后复发频繁，导致不到30%的接受治疗患者出现持续应答。已经提出了几种针对α干扰素应答的临床和生化参数。在因进行性慢性丙型肝炎和失代偿性肝硬化而接受原位肝移植的患者中，供体器官的再感染经常发生。然而，在免疫抑制下的移植患者中，丙型肝炎再感染的病程通常较轻。由于对血液和血液制品的筛查计划，输血后获得性丙型肝炎的发病率已经下降。然而，有必要进一步努力了解社区获得性丙型肝炎的传播情况。由于病毒遗传异质性程度高，丙型肝炎疫苗的研发将很困难。
