Malina L, Zdárský E, Havlícková M, Stránský J
Dermatovenerologická klinika, LF UK, Praha.
Cas Lek Cesk. 1996 Jul 26;135(13):427-9.
In 1994 the authors published first results of anti-HCV antibodies in the group of 92 porphyria cutanea tarda patients, tested with ELISA second generation enzymatic method. Positivity, found in 21.7 per cent of them, was significantly higher when compared with the results of healthy blood-donors. Anti-HCV reactivity thus ascertained can be, however, non-specific in some cases and need not necessarily indicate existence of an active replication of hepatitis C-virus. The authors have therefore subsequently tried to verify the above results by the more sensitive polymerase chain reaction (PCR), enabling the proof of viral RNA and thus an assessment of the replication-activity of HCV. This study completes their previous findings for the evidence of viraemia in anti-HCV reactive PCT-patients.
21 of 92 PCT-patients were reactive when examined with the second generation ELISA method (Sanofi, Pasteur). HCV RNA was examined in 20 subjects from the above group (one patient died in the meantime) by means of PCR. Positive HCV RNA was found in 17 patients, i.e. in 85 percent of them. Percutaneous liver biopsy without visual control was performed in 17 anti-HCV reactive and HCV RNA positive patients and in 46 anti-HCV negative porphyrics. The biopsy-findings were significantly worse in the HCV RNA-positive group. Also the average activity of ALT and AST was significantly higher in the patients with positive HCV RNA when compared with anti HCV-negative subjects.
High frequency of HCV-infection (21.7 percent) was found in our group of 92 PCT-patients. Viraemia was present in the vast majority (85 per cent) of them, for they had also positive HCV RNA besides anti-HCV reactivity. These patients had also higher ALT- and AST-activity and more severe histological liver-changes. HCV-infection is the main virological cause of their liver lesion, beside ethylism. Hepatocellular carcinoma is rather exceptional in our porphyria patients in spite of their frequent HCV-infection.
1994年，作者发表了92例迟发性皮肤卟啉病患者抗丙型肝炎病毒（HCV）抗体的首批检测结果，采用的是第二代酶联免疫吸附测定（ELISA）法。其中21.7%的患者呈阳性，与健康献血者的检测结果相比，这一阳性率显著更高。然而，如此确定的抗HCV反应性在某些情况下可能是非特异性的，不一定表明丙型肝炎病毒存在活跃复制。因此，作者随后试图通过更灵敏的聚合酶链反应（PCR）来验证上述结果，该方法能够证实病毒RNA的存在，从而评估HCV的复制活性。本研究完善了他们之前关于抗HCV反应性迟发性皮肤卟啉病（PCT）患者病毒血症证据的研究结果。
采用第二代ELISA法（赛诺菲巴斯德公司产品）检测92例PCT患者，其中21例呈反应性。通过PCR对上述组中的20名受试者（期间有1名患者死亡）检测HCV RNA。17例患者HCV RNA呈阳性，即占85%。对17例抗HCV反应性且HCV RNA阳性的患者以及46例抗HCV阴性的卟啉病患者进行了无视觉控制的经皮肝活检。HCV RNA阳性组的活检结果明显更差。与抗HCV阴性受试者相比，HCV RNA阳性患者的谷丙转氨酶（ALT）和谷草转氨酶（AST）平均活性也显著更高。
在我们的92例PCT患者组中发现HCV感染的频率较高（21.7%）。其中绝大多数患者（85%）存在病毒血症，因为除了抗HCV反应性外，他们的HCV RNA也呈阳性。这些患者的ALT和AST活性也更高，肝脏组织学改变更严重。除酒精中毒外，HCV感染是其肝脏病变的主要病毒学原因。尽管卟啉病患者HCV感染频繁，但肝细胞癌在我们的患者中相当罕见。
