Soni P N, Tait D R, Gopaul W, Sathar M A, Simjee A E
Gastrointestinal Unit, University of Natal, Durban.
S Afr Med J. 1996 Jan;86(1):80-3.
The aim of this cross-sectional seroprevalence study was to determine the prevalence of antibodies to hepatitis C virus (HCV) (anti-HCV) in patients with cirrhosis, hepatocellular carcinoma (HCC) and chronic active hepatitis (CAH) attending a referral hospital in a hepatitis B virus (HBV)-endemic area in South Africa. One hundred and ten patients with suspected cirrhosis, 44 with suspected HCC and 6 with chronic hepatitis were initially included. The diagnoses were confirmed in 77 patients with cirrhosis (histologically or macroscopically at peritoneoscopy), 33 patients with HCC (histologically or elevated alpha-fetoprotein levels plus focal lesion on hepatic imaging) and 6 patients with CAH (histologically) without antinuclear antibodies. All patients were tested for anti-HCV with the Abbott second-generation enzyme immunoassay combined with a supplemental neutralisation assay, and hepatitis B surface antigen (HBsAg). Anti-HCV seroprevalence for cirrhosis, HCC and CAH were 18/77 (23%), 8/33 (24%) and 2/6 (33%) respectively. HBsAg was detected in serum in 16 (21%), 15 (46%) and 1 (17%) patient respectively. Only 1 patient (with cirrhosis) was positive for both anti-HCV and HBsAg. Of those who were anti-HCV-positive, 4/18 (22.2%) cirrhotics, none with HCC and 1/2 (50%) with CAH, had previously received blood transfusions, resulting in a cumulative frequency of 5/28 (18%). Our results indicate that HCV is an important aetiological agent in the pathogenesis of chronic liver disease in our patients. In the majority of patients (82%), the infection was not transfusion-related. Thus, screening of blood donors for anti-HCV would not prevent the majority of cases of chronic liver disease secondary to HCV. It appears as if HCV and HBV have different modes of transmission in southern Africa.
这项横断面血清流行率研究的目的是确定在南非乙型肝炎病毒（HBV）流行地区一家转诊医院就诊的肝硬化、肝细胞癌（HCC）和慢性活动性肝炎（CAH）患者中丙型肝炎病毒（HCV）抗体（抗-HCV）的流行率。最初纳入了110例疑似肝硬化患者、44例疑似HCC患者和6例慢性肝炎患者。77例肝硬化患者（通过组织学检查或腹腔镜检查宏观确诊）、33例HCC患者（通过组织学检查或甲胎蛋白水平升高加肝脏影像学检查发现局灶性病变确诊）和6例CAH患者（通过组织学检查确诊且无抗核抗体）的诊断得到确认。所有患者均采用雅培第二代酶免疫测定法结合补充中和试验检测抗-HCV，并检测乙型肝炎表面抗原（HBsAg）。肝硬化、HCC和CAH患者的抗-HCV血清流行率分别为18/77（23%）、8/33（24%）和2/6（33%）。血清中分别有16例（21%）、15例（46%）和1例（17%）患者检测到HBsAg。仅1例患者（肝硬化患者）抗-HCV和HBsAg均呈阳性。在抗-HCV阳性的患者中，4/18（22.2%）的肝硬化患者、无HCC患者以及1/2（50%）的CAH患者既往接受过输血，累计发生率为5/28（18%）。我们的结果表明，HCV是我们研究患者慢性肝病发病机制中的一种重要病原体。在大多数患者（82%）中，感染与输血无关。因此，对献血者进行抗-HCV筛查无法预防大多数由HCV引起的慢性肝病病例。在非洲南部，HCV和HBV似乎具有不同的传播方式。
