Lamoril J, Andant C, Bogard C, Puy H, Gouya L, Pawlotsky J M, Da Silva V, Soulé J C, Deybach J C, Nordmann Y
Centre Français des Porphyries, Hôpital Louis Mourier, Colombes.
Hepatology. 1998 Mar;27(3):848-52. doi: 10.1002/hep.510270329.
From 1995 to 1997, we prospectively evaluated the prevalence of hepatitis C virus (HCV) RNA in 124 patients with porphyria cutanea tarda (PCT) from Northern France (83 sporadic and 41 familial PCT). Serum samples were analyzed for ferritin, transaminases, HCV antibodies, and HCV RNA. In addition, genotyping of HCV and searches for HCV infection risk factors (blood transfusion, iv drug abuse, and surgical intervention) were performed. Twenty-six of 124 patients (21%; 95% CI: 13.9-28) were positive for serum HCV antibodies. All of them were also positive for HCV RNA. The prevalence of HCV infection was higher in the sporadic PCT group (26.5%, 22 out of 83) than in the familial PCT group (9.7%, 4 out of 41). Risk factors for hepatitis C infection were found to be significantly increased in the HCV-positive group when compared with the HCV-negative PCT group. In all HCV-positive patients with a risk factor, the suspected date of exposure to the virus always preceded the clinical onset of PCT. The HCV genotype pattern in PCT patients was similar to that observed in nonporphyric HCV patients in western European countries. Serum ferritin level was increased in both HCV-positive and HCV-negative porphyric patients. Transaminase levels were significantly higher in HCV-infected PCT patients. Sixty-seven out of 124 patients were retrospectively studied for hepatitis G virus (HGV) infection. Six of these 67 patients (8.9%; 95% CI: 2.1-15.8) were positive for HGV RNA. None of the six HGV-infected patients were positive for HCV RNA. The HGV-infected patients did not differ statistically from those without HGV infection with regard to age, ferritin, transaminase levels, and PCT treatment. These results support the view that sporadic cases of HGV infection may occur frequently. This study of a large cohort of HCV and PCT patients further documents an increasing gradient in HCV prevalence from northern to southern Europe, and shows that HCV infection acts as a triggering factor of PCT. Finally, the HGV prevalence found in the PCT patients was comparable with that found in French blood donors, suggesting that HGV is not a PCT triggering factor.
1995年至1997年，我们对来自法国北部的124例迟发性皮肤卟啉病（PCT）患者（83例散发性和41例家族性PCT）的丙型肝炎病毒（HCV）RNA流行情况进行了前瞻性评估。对血清样本进行铁蛋白、转氨酶、HCV抗体和HCV RNA分析。此外，还进行了HCV基因分型及HCV感染危险因素（输血、静脉药物滥用和手术干预）的调查。124例患者中有26例（21%；95%可信区间：13.9 - 28）血清HCV抗体呈阳性。所有这些患者的HCV RNA也呈阳性。散发性PCT组的HCV感染率（26.5%，83例中有22例）高于家族性PCT组（9.7%，41例中有4例）。与HCV阴性的PCT组相比，HCV阳性组的丙型肝炎感染危险因素显著增加。在所有有危险因素的HCV阳性患者中，疑似病毒暴露日期总是先于PCT的临床发病。PCT患者的HCV基因型模式与西欧非卟啉病HCV患者中观察到的相似。HCV阳性和HCV阴性的卟啉病患者血清铁蛋白水平均升高。HCV感染的PCT患者转氨酶水平显著更高。对124例患者中的67例进行了庚型肝炎病毒（HGV）感染的回顾性研究。这67例患者中有6例（8.9%；95%可信区间：2.1 - 15.8）HGV RNA呈阳性。6例HGV感染患者中无一例HCV RNA呈阳性。HGV感染患者在年龄、铁蛋白、转氨酶水平和PCT治疗方面与未感染HGV的患者无统计学差异。这些结果支持散发性HGV感染可能频繁发生的观点。这项对大量HCV和PCT患者队列的研究进一步证明了从北欧到南欧HCV流行率呈上升梯度，并表明HCV感染是PCT的触发因素。最后，在PCT患者中发现的HGV流行率与在法国献血者中发现的相当，表明HGV不是PCT的触发因素。
