Béchade D, Oui B, Mayet F, Trouette H, Schouler L, Jouglen J, Raymond J M, Couzigou P
Département d'Hépatologie et de Gastroentérologie, Hôpital du Haut-Léveque, Pessac.
Gastroenterol Clin Biol. 1996;20(8-9):696-9.
Autoimmune-related and hepatitis C virus-related chronic hepatitis are sometimes difficult to differentiate. We report two cases of chronic hepatitis with high levels of serum anti-smooth muscle antibodies, positive hepatitis C virus serology, and negative serum RNA, which were first treated with corticotherapy. Both patients responded with marked increases in aminotransferase levels, and positive RNA. The first case may have been type 1 autoimmune hepatitis with hepatitis C virus infection, and the second chronic hepatitis C with positive serum auto-antibodies. The increase in viral antigen expression on the surface of the hepatocytes following corticosteroid treatment may have favoured a direct cytopathogenic effect of hepatitis C virus.
自身免疫相关的慢性肝炎和丙型肝炎病毒相关的慢性肝炎有时难以鉴别。我们报告了两例血清抗平滑肌抗体水平高、丙型肝炎病毒血清学阳性且血清RNA阴性的慢性肝炎病例，这两例最初接受了皮质激素治疗。两名患者的转氨酶水平均显著升高且RNA呈阳性。第一例可能是1型自身免疫性肝炎合并丙型肝炎病毒感染，第二例是血清自身抗体阳性的慢性丙型肝炎。皮质类固醇治疗后肝细胞表面病毒抗原表达的增加可能有利于丙型肝炎病毒的直接细胞致病作用。
