Bernardi M, Glauser A, Kupferschmidt H, Havelka J, Zaugg P, Joller-Jemelka H I, Schwery S, Schmid M, Bühler H
Medizinische Klinik, Stadtspital Waid, Zürich.
Schweiz Med Wochenschr Suppl. 1996;79:30S-35S.
We determine the correlation between viremia in serum specimens, transaminase activity (ALT and AST) and histological grading in 37 patients with chronic hepatitis C. In addition we compared two PCR methods for hepatitis C virus (HCV)-RNA in serum specimens. For the histological grading we used a modified Knodell score. For detection and quantification we measured the viremia (HCV-RNA titer) with a standardized "nested primer" PCR (end-point dilution method) and the commercially available Amplicor HCV Monitor. The mean HCV-RNA and AST level was significantly higher in patients with a histologically active inflammation. In the individual patient we could not conclude from the titer of HCV-RNA on the histologic grading because of the wide range of the results. We did not find a significant difference in ALT in patients having varying histological gradings. HCV-RNA titer and transaminases (ALT and AST) did not correlate significantly. The HCV-RNA titer was significantly marked in older patients (above 40 years) and patients having sporadic hepatitis than in younger patients and patients with chronic hepatitis after drug abuse. The "nested primer" PCR (end-point dilution method) was more sensitive for detection of HCV-RNA in serum specimens than Amplicor HCV Monitor. The lack of HCV-RNA with Amplicor HCV Monitor in 12 of 37 patients (32%) did not rule out viremia. We conclude that in patients with a chronic hepatitis C marked viremia points to a histologically active inflammation. In the individual patient we could not conclude from the titer of HCV-RNA on the histological grading. Because of the lower sensitivity of Amplicor HCV Monitor it is necessary to confirm negative results with a "nested primer" PCR.
我们测定了37例慢性丙型肝炎患者血清标本中的病毒血症、转氨酶活性（ALT和AST）与组织学分级之间的相关性。此外，我们比较了两种用于检测血清标本中丙型肝炎病毒（HCV）-RNA的PCR方法。对于组织学分级，我们采用改良的Knodell评分。为了进行检测和定量，我们使用标准化的“巢式引物”PCR（终点稀释法）和市售的Amplicor HCV Monitor测定病毒血症（HCV-RNA滴度）。组织学上有活动性炎症的患者，其平均HCV-RNA和AST水平显著更高。在个体患者中，由于结果范围广泛，我们无法根据HCV-RNA滴度推断组织学分级。我们未发现不同组织学分级的患者在ALT方面有显著差异。HCV-RNA滴度与转氨酶（ALT和AST）之间无显著相关性。与年轻患者及药物滥用后慢性肝炎患者相比，老年患者（40岁以上）和散发性肝炎患者的HCV-RNA滴度显著更高。“巢式引物”PCR（终点稀释法）在检测血清标本中的HCV-RNA方面比Amplicor HCV Monitor更敏感。37例患者中有12例（32%）使用Amplicor HCV Monitor检测不到HCV-RNA，但这并不排除病毒血症的存在。我们得出结论，在慢性丙型肝炎患者中，明显的病毒血症表明存在组织学上的活动性炎症。在个体患者中，我们无法根据HCV-RNA滴度推断组织学分级。由于Amplicor HCV Monitor的敏感性较低，有必要用“巢式引物”PCR来确认阴性结果。
