血清HCV RNA阴性慢性丙型肝炎的诊断及抗病毒治疗  

Diagnosis and treatment of serum HCV RNA-negative patients with chronic hepatitis C

作　　者：陈仕珠[1] 韩永战[1] 陈瑞琴[1] 张增平[1] 

机构地区：[1]中国人民解放军第451医院感染科,陕西省西安市710054

出　　处：《世界华人消化杂志》2010年第28期3031-3034,共4页World Chinese Journal of Digestology

摘　　要：目的:探讨血清HCV RNA阴性慢性丙型病毒性肝炎(CHC)的诊断,抗病毒治疗及效果.方法:2004-02以来连续收治的血清HCV RNA阴性CHC患者11例.免疫组织化学检查HCV RNA5例均阳性.无其他肝病依据.予干扰素α300万U,肌注,1/2d;利巴韦林900mg/d,分次口服,疗程1年后随访.结果:10例患者治疗1年,1例患者治疗9mo后自行停药.所有患者血清ALT和AST均于4wk内降至正常.11例患者均有不同程度的干扰素不良反应,均未影响治疗.治疗结束后随访17-35mo患者血清ALT和AST未再升高(含治疗9mo者),HCV RNA及抗-HCV无变化.结论:血清HCV RNA阴性HCV感染者体内仍可能存在低水平HCV RNA.有创伤史,抗-HCV阳性或以前曾有过阳性,ALT、AST持续或反复升高当考虑HCV RNA阴性CHC诊断.排除其他肝病及/或肝组织等,检测到HCV时,当诊断HCV RNA阴性CHC并积极进行抗病毒治疗,其对干扰素α和利巴韦林反应良好.AIM：To investigate the diagnosis and the treatment of serum HCV RNA-negative patients with chronic hepatitis C （CHC）.METHODS：Eleven consecutive serum HCV RNA-negative CHC patients treated since February 2004 were collected.HCV RNA could be detected in the liver of five patients.There was no evidence of other causes of viral hepatitis.The patients were treated with interferon （IFN） alpha-2b 300 MU,intramuscularly,1/2 d,in combination with ribavirin 900 mg/d for 12 mo and then followed up regularly.RESULTS：Of the 11 patients,10 completed the 12-mo treatment,and 1 discontinued the treatment at 9 mo.The levels of serum ALT and AST in all the patients declined to normal range within 4 wk.No exceptional adverse events occurred.The levels of serum ALT and AST were maintained within the normal range during 17-35 mo of follow-up.HCV-RNA and anti-HCV status remained unchanged during the followup.CONCLUSION：A diagnosis of serum HCV RNA-negative CHC should be considered when a patient has a history of injury and a current or past history of positive serum anti-HCV with incessantly or repeatedly elevated ALT and AST for more than 6 mo after excluding other liver diseases.Anti-HCV treatment with IFN and ribavirin should be promptly given to serum HCV RNA-negative CHC patients.

关 键 词：丙型肝炎 HCV RNA阴性 病毒性肝炎 抗-HCV治疗 

分 类 号：R512.63[医药卫生—内科学]