Tong M J, el-Farra N S
Liver Center, Huntington Memorial Hospital, Pasadena, CA 91105, USA.
West J Med. 1996 May;164(5):399-404.
We determined the course of hepatitis C infection in 125 patients with a history of injection drug use. The mean age at presentation was 43.5 years, and the mean age of initiating injection drug use was 23.1 years. Fatigue and hepatomegaly were present in as many as 60% of patients. All had antibodies to the hepatitis C recombinant protein C25, and 99% were positive for hepatitis C virus RNA. After the initial workup, 33 (26%) patients had chronic hepatitis, 46 (37%) had chronic active hepatitis, 45 (36%) had cirrhosis, and 1 (0.8%) presented hepatocellular carcinoma. During follow-up, hepatocellular carcinoma developed in 2 other patients. In 74 patients with a 1-year history of injection drug use, the mean number of years to the development of chronic hepatitis, chronic active hepatitis, cirrhosis, and hepatocellular carcinoma were 15.6, 17.6, 19.4, and 26.3 years, respectively. In this subgroup of patients, heavy alcohol abuse did not appear to influence the progression of liver disease. The 2-year case-fatality rate was 2%. Our findings indicate that hepatitis C is a progressive disease, but only a few died during the average 20.4 years after the initiation of injection drug use. Antiviral treatment to eradicate the virus and halt the progression of disease is indicated in this group of patients.
我们确定了125名有注射吸毒史患者的丙型肝炎感染病程。就诊时的平均年龄为43.5岁，开始注射吸毒的平均年龄为23.1岁。多达60%的患者有疲劳和肝肿大症状。所有患者均有丙型肝炎重组蛋白C25抗体，99%的患者丙型肝炎病毒RNA呈阳性。初步检查后，33例（26%）患者患有慢性肝炎，46例（37%）患有慢性活动性肝炎，45例（36%）患有肝硬化，1例（0.8%）患有肝细胞癌。在随访期间，另外2例患者发生了肝细胞癌。在74例有1年注射吸毒史的患者中，发展为慢性肝炎、慢性活动性肝炎、肝硬化和肝细胞癌的平均年数分别为15.6年、17.6年、19.4年和26.3年。在这组患者中，重度酒精滥用似乎并未影响肝病的进展。2年病死率为2%。我们的研究结果表明，丙型肝炎是一种进行性疾病，但在开始注射吸毒后的平均20.4年中只有少数人死亡。这组患者需要进行抗病毒治疗以清除病毒并阻止疾病进展。
