Mathurin P, Moussalli J, Cadranel J F, Thibault V, Charlotte F, Dumouchel P, Cazier A, Huraux J M, Devergie B, Vidaud M, Opolon P, Poynard T
Service d'HépatoGastroentérologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
Hepatology. 1998 Mar;27(3):868-72. doi: 10.1002/hep.510270333.
In hepatitis C virus (HCV) patients with persistently normal alanine transaminase (ALT), the progression rate of fibrosis is unknown. The aims of this study were: 1) to compare HCV patients with normal ALT (group I) with HCV patients with elevated ALT (group II) matched on independent factors associated with fibrosis; and 2) to assess the progression rate of fibrosis. One hundred two HCV patients were included in each group. Histological lesions were staged using the METAVIR score. We defined fibrosis progression per year as the ratio of the fibrosis stage in METAVIR units to the duration of infection. In group I, ALT values were normal, and lower than in group II (25 vs. 127 IU/L; P < .0001). HCV RNA was present less frequently in group I (66% vs. 97%; P < .0001). There were no significant differences for viremia and genotypes. Histological activities were lower in group I (0.6 vs. 1.38; P < .0001). The stage of fibrosis was lower in group I (0.95 vs. 1.8; P < .001). The median progression rate of fibrosis was lower in group I (0.05 vs. 0.13; P < .001). In group I, after exclusion of negative HCV-RNA patients, the median progression rate of positives remained lower (0.05 vs. 0.13; P < .001). In group I, all cirrhotic patients (n = 3) were heavy drinkers. HCV patients with normal ALT showed weaker histological activity and lower fibrosis scores, and the progression rate of fibrosis was twice as slow as in HCV patients with elevated ALT. In these patients, severe fibrosis was associated with high alcohol consumption.
在丙型肝炎病毒（HCV）感染患者中，丙氨酸转氨酶（ALT）持续正常时，纤维化的进展速率尚不清楚。本研究的目的是：1）比较ALT正常的HCV患者（I组）与ALT升高的HCV患者（II组），两组在与纤维化相关的独立因素上相匹配；2）评估纤维化的进展速率。每组纳入102例HCV患者。使用METAVIR评分对组织学病变进行分期。我们将每年的纤维化进展定义为METAVIR单位的纤维化分期与感染持续时间的比值。I组中，ALT值正常，且低于II组（25 vs. 127 IU/L；P <.0001）。I组中HCV RNA的出现频率较低（66% vs. 97%；P <.0001）。病毒血症和基因型方面无显著差异。I组的组织学活性较低（0.6 vs. 1.38；P <.0001）。I组的纤维化分期较低（0.95 vs. 1.8；P <.001）。I组纤维化的中位进展速率较低（0.05 vs. 0.13；P <.001）。在I组中，排除HCV-RNA阴性患者后，阳性患者的中位进展速率仍然较低（0.05 vs. 0.13；P <.001）。在I组中，所有肝硬化患者（n = 3）均为重度饮酒者。ALT正常的HCV患者表现出较弱的组织学活性和较低的纤维化评分，纤维化进展速率比ALT升高的HCV患者慢两倍。在这些患者中，严重纤维化与高酒精摄入量相关。
