Bizollon T, Guichard S, Ahmed S N, Chevallier P, Ducerf C, Sepetjan M, Baulieux J, Trepo C
Hepatology Unit Hôtel-Dieu, and INSERM U 271 Lyon, France.
J Hepatol. 1998 Dec;29(6):893-900. doi: 10.1016/s0168-8278(98)80116-5.
BACKGROUND/AIMS: Hepatitis G virus (HGV), a new RNA virus that is parenterally transmitted, has frequently been found in patients with chronic hepatitis C (HCV) infection but its role in chronic liver disease is unknown. The purpose of this study was to determine the prevalence of HGV infection in transplantation patients infected with hepatitis C and to assess the impact of HGV co-infection on the course of HCV infection after liver transplantation.
Eighty-nine liver transplantation recipients with persistent hepatitis C viremia detected by polymerase chain reaction (PCR) were evaluated. Serum samples were tested before and after liver transplantation for HGV RNA by two different PCR methods: LC assay (Abbott Laboratories) and an RT-PCR procedure which we developed using the silica gel technique for extraction of the HGV RNA. E2 antibodies were detected before orthotopic liver transplantation by an EIA-test. HCV RNA was quantified by branched DNA assay, and HCV genotype was determined. A mean of nine liver biopsy specimens were examined for each patient and the severity of the lesions was compared in HCV-positive patients with or without HGV co-infection.
The concordance between the two HGV RNA detection methods was excellent and the reproducibility of our RT-PCR procedure was confirmed. The prevalence of pretransplantation and posttransplantation HGV infection was 11% and 19%, respectively. Pretransplantation HGV infection was positively correlated with posttransplantation HGV infection (p<0.001). Before transplantation the E2 antibodies seroprevalence was 34%. Seven patients became HGV RNA positive after transplantation, but all of them were negative for E2 antibodies. Among the patients who remained RNA negative after liver transplantation, 40% were positive for E2 antibodies (p=0.04). Pretransplantation clinical features (except AST mean value) were not different in patients with HCV and HGV co-infection and those with HCV only. After a mean follow-up of 34 months (range: 6 to 70), 67/89 (75%) patients developed histological features of recurrent hepatitis but the frequency of the occurrence of graft hepatitis was not different between HGV/HCV co-infected patients and those with HCV alone (p=0.89). The mean interval from orthotopic liver transplantation to recurrence was 12.2 months (range: 3-63), which was not different for HVG/HVC-co-infected patients and HCV-infected patients. The histological severity of posttransplantation liver disease, and the graft and patient survival were not different for patients with and without HGV co-infection.
Our results suggest the general persistence of HGV infection after liver transplantation, but HGV co-infection did not appear to influence the posttransplantation course of HCV infection. Before transplantation the prevalence of E2 antibodies was 34%, and our data clearly indicate that E2 antibodies were protective against HGV infection.
背景/目的：庚型肝炎病毒（HGV）是一种经肠道外传播的新型RNA病毒，在慢性丙型肝炎（HCV）感染患者中经常被发现，但其在慢性肝病中的作用尚不清楚。本研究的目的是确定丙型肝炎感染的移植患者中HGV感染的患病率，并评估HGV合并感染对肝移植后HCV感染病程的影响。
对89例通过聚合酶链反应（PCR）检测到持续丙型肝炎病毒血症的肝移植受者进行评估。在肝移植前后，通过两种不同的PCR方法检测血清样本中的HGV RNA：LC检测法（雅培实验室）和我们使用硅胶技术提取HGV RNA开发的逆转录-聚合酶链反应程序。在原位肝移植前通过酶免疫测定检测E2抗体。通过分支DNA测定法对HCV RNA进行定量，并确定HCV基因型。每位患者平均检查9份肝活检标本，并比较有或无HGV合并感染的HCV阳性患者的病变严重程度。
两种HGV RNA检测方法之间的一致性极佳，我们的逆转录-聚合酶链反应程序的可重复性得到了证实。移植前和移植后HGV感染的患病率分别为11%和19%。移植前HGV感染与移植后HGV感染呈正相关（p<0.001）。移植前E2抗体血清阳性率为34%。7例患者移植后HGV RNA呈阳性，但所有患者E2抗体均为阴性。在肝移植后RNA仍为阴性的患者中，40%的患者E2抗体呈阳性（p=0.04）。HCV和HGV合并感染患者与仅HCV感染患者的移植前临床特征（除平均AST值外）无差异。平均随访34个月（范围：6至70个月）后，89例患者中有67例（75%）出现复发性肝炎的组织学特征，但HGV/HCV合并感染患者与仅HCV感染患者的移植肝肝炎发生率无差异（p=0.89）。从原位肝移植到复发的平均间隔时间为12.2个月（范围：3至63个月），HGV/HVC合并感染患者与HCV感染患者无差异。有或无HGV合并感染患者的移植后肝病组织学严重程度、移植肝和患者生存率无差异。
我们的结果表明肝移植后HGV感染普遍持续存在，但HGV合并感染似乎并未影响HCV感染的移植后病程。移植前E2抗体的患病率为34%，我们的数据清楚地表明E2抗体对HGV感染具有保护作用。
