Zeuzem S, Teuber G, Lee J H, Rüster B, Roth W K
Medical Department II, University Hospital, Frankfurt, Germany.
J Hepatol. 1996;24(2 Suppl):3-10.
Due to the availability of testing for antibodies to the hepatitis C virus (anti-HCV) and with the use of the polymerase chain reaction (RT-PCR) to detect HCV-RNA, more sensitive and specific measures can be applied to assess routes of HCV transmission. The aim of the present study was to investigate possible risk factors for transmission of HCV.
160 consecutive patients with chronic hepatitis C (mean age 47.1 +/- 14.1 yr) attending a hepatology out-patient clinic were interviewed to identify transmission risk factors. Genotyping of HCV isolates was performed by direct sequencing of RT-PCR products in the 5'-noncoding and the NS-5 region.
The risk factors of HCV infection were as follows: transfusion of blood or blood products 34.4%, intravenous drug abuse 20.6%, heterosexual contact 3.8%, occupational risk 1.9% and tattoo 0.6%. In 62/160 (38.7%) the route of transmission remained unknown. In one HCV-infected couple we analyzed the nucleotide sequences of the NS-5 region of the respective HCV isolates and found almost complete sequence homology (> 97%). The majority of patients with post-transfusional or unknown mode of transmission were infected with genotype HCV-1a and -1b, while in 6/10 patients with previous i.v. drug abuse, genotype HCV-3a was present. We found no evidence that the mode of disease acquisition influences the course of liver disease.
The majority of patients with chronic hepatitis C have a classical parenteral transmission risk factor. In our study, no source of HCV acquisition was identified in 38.7% of patients. It may well be that the major factors in these "sporadic" HCV infections are variations on the known risk factors. However, since the proportion of these cases is rather high, further attention should be on alternative and as yet unclear transmission routes.
由于丙型肝炎病毒抗体检测（抗 - HCV）的普及以及聚合酶链反应（RT - PCR）用于检测HCV - RNA，现在可以采用更敏感和特异的方法来评估HCV的传播途径。本研究的目的是调查HCV传播的可能危险因素。
对一家肝病门诊连续就诊的160例慢性丙型肝炎患者（平均年龄47.1±14.1岁）进行访谈，以确定传播危险因素。通过对RT - PCR产物在5' - 非编码区和NS - 5区进行直接测序来对HCV分离株进行基因分型。
HCV感染的危险因素如下：输血或血液制品34.4%，静脉药物滥用20.6%，异性接触3.8%，职业风险1.9%，纹身0.6%。在62/160（38.7%）的患者中，传播途径仍不清楚。在一对HCV感染的夫妇中，我们分析了各自HCV分离株NS - 5区的核苷酸序列，发现几乎完全的序列同源性（> 97%）。大多数输血后或传播方式不明的患者感染的是HCV - 1a和 - 1b基因型，而在10例曾有静脉药物滥用的患者中有6例感染的是HCV - 3a基因型。我们没有发现疾病获得方式影响肝病病程的证据。
大多数慢性丙型肝炎患者有典型的经肠外途径传播的危险因素。在我们的研究中，38.7%的患者未发现HCV感染源。很可能这些“散发性”HCV感染的主要因素是已知危险因素的变异。然而，由于这些病例的比例相当高，应进一步关注其他尚不清楚的传播途径。
