Morales T G, Sampliner R E, Bhattacharyya A, Alter M J
University of Arizona Health Sciences Center, Tucson 85724, USA.
J Clin Gastroenterol. 1995 Dec;21(4):301-5. doi: 10.1097/00004836-199512000-00011.
The significance of a positive hepatitis C virus (HCV) screening test in asymptomatic blood donors with normal or near normal aminotransferases was studied along with the usefulness of HCV RNA polymerase chain reaction (PCR) testing for predicting chronic hepatitis in these individuals. One hundred and thirty-nine volunteer blood donors who were found positive by second generation ELISA for antibodies to HCV agreed to participate in the study. Thirty-one of them were supplemental test positive, had ALT values less than twice normal, and were followed over a minimum of 12 months. Thirteen consented to percutaneous liver biopsy and also had HCV RNA determination by PCR. Ten of the 13 subjects were positive for HCV RNA by PCR. Of the nine who were positive for HCV RNA and had adequate tissue for evaluation, seven had evidence of chronic hepatitis, three with limiting plate necrosis. Lobular inflammation was similar in severity to that found in the portal region. In addition, two had periportal fibrosis, and one had bridging fibrosis. Of the three subjects who were negative for HCV RNA, only one had portal inflammation which was limited to the portal region. None of these three had lobular changes, or periportal or bridging fibrosis. Of the three normal biopsies, two were from subjects who were negative for HCV RNA. The sensitivity and specificity of HCV RNA testing for chronic hepatitis was 87.5% and 50%, respectively, yielding an overall accuracy of 75%. We conclude that asymptomatic blood donors with antibodies to HCV, normal or mildly elevated liver tests, and HCV RNA may have abnormal liver histology indicating the potential for progressive liver disease. HCV RNA testing by PCR may be clinically useful as a noninvasive means to discriminate between those with and without chronic liver disease.
对丙型肝炎病毒（HCV）筛查试验呈阳性的无症状献血者（其转氨酶正常或接近正常）的意义以及HCV RNA聚合酶链反应（PCR）检测在预测这些个体慢性肝炎方面的实用性进行了研究。139名通过第二代酶联免疫吸附测定法检测出抗HCV抗体呈阳性的志愿献血者同意参与该研究。其中31人补充检测呈阳性，丙氨酸转氨酶（ALT）值低于正常上限的两倍，并接受了至少12个月的随访。13人同意接受经皮肝活检，并通过PCR测定HCV RNA。13名受试者中有10名通过PCR检测出HCV RNA呈阳性。在9名HCV RNA呈阳性且有足够组织用于评估的受试者中，7名有慢性肝炎的证据，其中3名有界板坏死。小叶炎症的严重程度与门脉区相似。此外，2名有门脉周围纤维化，1名有桥接纤维化。在3名HCV RNA呈阴性的受试者中，只有1名有局限于门脉区的门脉炎症。这3名受试者均无小叶改变、门脉周围或桥接纤维化。在3例正常活检中，2例来自HCV RNA呈阴性的受试者。HCV RNA检测慢性肝炎的敏感性和特异性分别为87.5%和50%，总体准确率为75%。我们得出结论，抗HCV抗体呈阳性、肝功能检查正常或轻度升高且HCV RNA呈阳性的无症状献血者可能有肝脏组织学异常，提示有进行性肝病的可能性。通过PCR检测HCV RNA作为一种非侵入性手段，在区分有无慢性肝病方面可能具有临床实用性。
