Rosman A S, Paronetto F, Galvin K, Williams R J, Lieber C S
Alcohol Research and Treatment Center, Bronx Veterans Affairs Medical Center, NY.
Arch Intern Med. 1993 Apr 26;153(8):965-9.
To evaluate the relationship between hepatitis C viral infection and alcoholic liver disease.
Case-comparison study.
Bronx (NY) Veterans Affairs Medical Center.
Forty-seven consecutive alcoholic patients undergoing diagnostic liver biopsy.
Serum was obtained at the time of liver biopsy and assayed for antibodies to hepatitis C virus using enzyme-linked immunosorbent assay, recombinant immunoblot assay, and hepatitis C virus neutralization methods.
Antibody to hepatitis C virus, as confirmed by the recombinant immunoblot assay, was strongly associated with the presence of portal and/or lobular inflammation (91% seropositivity) but was only present in 16% of patients without this histologic finding (P < .001). In patients without portal or lobular hepatitis, recombinant immunoblot assay seropositivity was seen in 27% of patients with cirrhosis and 20% of patients with alcoholic hepatitis and was absent in patients with steatosis and/or perivenular fibrosis. In the subgroup of alcoholic patients who were without known risk factors for hepatitis C virus infection (ie, no history of intravenous drug use or blood transfusions), antibody to hepatitis C virus was present in 78% of subjects with portal and/or lobular hepatitis but was absent in those with other types of alcoholic liver disease. Finally, anti-hepatitis C virus-seropositive patients had a significantly greater mean necroinflammatory score as compared with anti-hepatitis C virus-seronegative alcoholic patients (2.1 vs 1.2; P < .001). In contrast, there was no significant difference in the mean fibrosis score between the two groups.
The presence of portal and/or lobular inflammation is strongly associated with antibodies to hepatitis C virus in alcoholic patients, even in the absence of known risk factors. This association indicates that hepatitis C virus is responsible, at least in part, for the portal and/or lobular hepatitis associated with alcoholic liver disease.
评估丙型肝炎病毒感染与酒精性肝病之间的关系。
病例对照研究。
纽约布朗克斯退伍军人事务医疗中心。
47例连续接受诊断性肝活检的酒精性肝病患者。
在肝活检时采集血清，采用酶联免疫吸附试验、重组免疫印迹试验和丙型肝炎病毒中和法检测丙型肝炎病毒抗体。
经重组免疫印迹试验确认，丙型肝炎病毒抗体与门脉和/或小叶炎症的存在密切相关（血清阳性率为91%），但在无此组织学表现的患者中仅16%存在（P<0.001）。在无门脉或小叶性肝炎的患者中，肝硬化患者重组免疫印迹试验血清阳性率为27%，酒精性肝炎患者为20%，脂肪变性和/或静脉周围纤维化患者则无阳性。在无丙型肝炎病毒感染已知危险因素（即无静脉吸毒或输血史）的酒精性肝病患者亚组中，门脉和/或小叶性肝炎患者78%存在丙型肝炎病毒抗体，其他类型酒精性肝病患者则无。最后，丙型肝炎病毒抗体血清阳性的患者与丙型肝炎病毒抗体血清阴性的酒精性肝病患者相比，平均坏死性炎症评分显著更高（2.1对1.2；P<0.001）。相比之下，两组间平均纤维化评分无显著差异。
即使在无已知危险因素的情况下，酒精性肝病患者门脉和/或小叶炎症的存在也与丙型肝炎病毒抗体密切相关。这种关联表明，丙型肝炎病毒至少部分地导致了与酒精性肝病相关的门脉和/或小叶性肝炎。
