163例丙型肝炎八年前瞻性研究  

AN EIGHT-YEAR PROSPECTIVE STUDY ON 163 CASES OF HEPATITIS C

作　　者：孟宗达 孙永德 孙德贵 刘彩云 陈学儒[1] 王素玉[1] 陈中[1] 牛建章 赵玉良 陈淑芬 田茶 陈素良 徐东刚 康铁军 史蕴华 

机构地区：[1]河北省卫生防疫站,河北省固安县卫生防疫站,河北省廊坊市卫生防疫站,河北职工医学院

出　　处：《中华内科杂志》1995年第8期548-552,共5页Chinese Journal of Internal Medicine

摘　　要：为探讨我国丙型肝炎的特点，对１６３例丙型肝炎患者进行了８年随访。急性丙型肝炎急性期后的主要异常表现为血清丙氨酸转氮酶（ＡＬＴ）升高，病后１年内、１、２、５和８年的ＡＬＴ异常率分别为１００％、７３％、５７％、３７％和２８％；ＡＬＴ异常分持续性和波动性两类，后者约占１／３～１／２。用第二代丙型肝炎病毒抗体（抗－ＨＣＶ）ＥＬＩＳＡ试剂检测，病后２个月内、２～６个月、７～１２个月及１、２、５和８年的抗－ＨＣＶ阳性率分别为５６％、９３％、９４％、９６％、９７％、９３％和８３％；病后１年起少数患者抗－ＨＣＶ阴转，仅见于ＡＬＴ复常者，病后１、２、５和８年，ＡＬＴ复常者的抗－ＨＣＶ阴转率分别为１０％、８％、１６％和２２％。病后８年时用套式聚合酶链反应（ＰＣＲ）法检测抗－ＨＣＶ阳性血，丙型肝炎病毒（ＨＣＶ）ＲＮＡ阳性率为８４％，其中ＡＬＴ异常和正常者无明显差异。用型特异引物ＰＣＲ法测定４５份抗－ＨＣＶ阳性血清，４２份为Ⅱ型，３份待定。８年时未检出甲胎蛋白异常者，肝功能（血清胆红素和白蛋白）９６％～９７％为ＨｏｂｂｓⅠ级，表明还没有明显的失代偿性肝硬化和肝细胞癌者。o explore the characteristics of hepatitis C in China,one hundred and sixty three cases of hepatitis C were followed for 8 years,The rates of abnormal alanine aminotransferase(ALT) were 100%,73%,57%,37%and 28% in less than one,1,2,5 and 8 years after the onset respectively. Abnormality of ALT might be persistent or fluctuating,and the latter type accounted for about 1/3 to 1/2 of the cases. The positive rates of anti-hepatitis C virus(HCV)were 56%, 93%, 94%, 96%, 97%,93%and 83%in less than two,2～6,7～12 months and 1,2,5 and 8 years after the onset respectively. Negative conver-sion of anti-HCV was found only in a few patients whose ALT had returned to normal level and the rates of negative conversion for them were 10%,8%, 16%,and 22% in 1,2, 5 and 8 years after the onset. Positive rate of HCV-RNA,detected with nested PCR 8 years after the onset was 84%for patients who still showed positive anti-HCV and there was no significant difference between patients with abnormal(80%)and normal ALT (85%)levels, Genotype Ⅱ accounted for 93%of the cases. No patient developed heptocellular carcinoma or decompensated cirrhosis after a follow-up of eight years.

关 键 词：丙型肝炎 丙氨酸转氨酶 血清 胆红素 白蛋白 

分 类 号：R512.630.4[医药卫生—内科学] R446.112[医药卫生—临床医学]