Fulminant hepatic failure in acute hepatitis C: increased risk in chronic carriers of hepatitis B virus

被引:59
作者
Chu, CM
Yeh, CT
Liaw, YF
机构
[1] Chang Gung Mem Hosp, Liver Res Unit, Taipei 10591, Taiwan
[2] Coll Med, Taipei, Taiwan
关键词
acute hepatitis C; fulminant hepatitis; hepatitis B virus; hepatitis C virus; hepatitis G virus;
D O I
10.1136/gut.45.4.613
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background/Aims-The role of hepatitis C virus (HCV) in fulminant hepatitis remains controversial. This study was conducted to investigate the risk of fulminant hepatitis C in relation to HCV genotypes and concurrent infection of other viruses. Patients-109 HCV RNA positive patients from 334 consecutive cases hospitalised to a medical centre in northern Taiwan for overt acute viral hepatitis were prospectively evaluated. Methods-HCV RNA was detected by a combined reverse transcription-polymerase chain reaction assay. HCV genotypes were analysed using a genotype specific probe based assay in the 5' untranslated region. Results-39 patients tested positive for hepatitis B surface antigen but negative for IgM antibody to hepatitis B core antigen, indicating concurrent chronic hepatitis B virus (HBV) infection. Twelve patients were hepatitis G virus (HGV) RNA positive. Genotyping of HCV disclosed 1b in 93, 1b mixed with 2a/2c or 1b mixed with 2b in 11, and not classified in five. Serum titres of HCV RNA were <10(5) copies/ml in 77, 10(5)-10(7) copies/ml in 25, and >10(7) copies/ml in seven. Eleven patients (10.1%) had fulminant hepatitis as a complication. Development of fulminant hepatitis did not correlate with age and gender of the patients, concurrent HGV infection, HCV genotypes, or serum titre of HCV RNA. However, the incidence (95% confidence interval) of fulminant hepatitis in patients with underlying chronic HBV infection was 23.1% (9.9 to 36.3%), which is significantly higher than in those without (2.9% (-1.0 to 6.8%)). In 39 patients with concurrent chronic HBV infection, the clinical and virological characteristics showed no significant difference between those with fulminant hepatitis and those without. Conclusions-Acute hepatitis C in patients with concurrent chronic HBV infection is associated with a substantial risk of fulminant hepatitis.
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页码:613 / 617
页数:5
相关论文
共 35 条
[1]   THE NATURAL-HISTORY OF COMMUNITY-ACQUIRED HEPATITIS-C IN THE UNITED-STATES [J].
ALTER, MJ ;
MARGOLIS, HS ;
KRAWCZYNSKI, K ;
JUDSON, FN ;
MARES, A ;
ALEXANDER, WJ ;
HU, PY ;
MILLER, JK ;
GERBER, MA ;
SAMPLINER, RE ;
MEEKS, EL ;
BEACH, MJ .
NEW ENGLAND JOURNAL OF MEDICINE, 1992, 327 (27) :1899-1905
[2]   FULMINANT AND SUBFULMINANT LIVER-FAILURE - DEFINITIONS AND CAUSES [J].
BERNUAU, J ;
RUEFF, B ;
BENHAMOU, JP .
SEMINARS IN LIVER DISEASE, 1986, 6 (02) :97-106
[3]   PERIPHERAL T-CELL SUBSETS IN ASYMPTOMATIC HEPATITIS B-VIRUS CARRIERS [J].
CHU, CM ;
LIAW, YF .
CELLULAR IMMUNOLOGY, 1986, 98 (02) :533-537
[4]   THE ETIOLOGY OF ACUTE HEPATITIS IN TAIWAN - ACUTE HEPATITIS SUPERIMPOSED ON HBSAG CARRIER STATE AS THE MAIN ETIOLOGY OF ACUTE HEPATITIS IN AREAS WITH HIGH HBSAG CARRIER RATE [J].
CHU, CM ;
SHEEN, IS ;
LIAW, YF .
INFECTION, 1988, 16 (04) :233-237
[5]  
CHU CM, 1987, LIVER, V7, P182
[6]   THE ROLE OF HEPATITIS-C VIRUS IN FULMINANT VIRAL-HEPATITIS IN AN AREA WITH ENDEMIC HEPATITIS-A AND HEPATITIS-B [J].
CHU, CM ;
SHEEN, IS ;
LIAW, YF .
GASTROENTEROLOGY, 1994, 107 (01) :189-195
[7]   THE INCIDENCE OF FULMINANT HEPATIC-FAILURE IN ACUTE VIRAL-HEPATITIS IN TAIWAN - INCREASED RISK IN PATIENTS WITH PREEXISTING HBSAG CARRIER STATE [J].
CHU, CM ;
LIAW, YF .
INFECTION, 1990, 18 (04) :200-203
[8]   NATURAL-HISTORY OF CHRONIC HEPATITIS-B VIRUS-INFECTION IN TAIWAN - STUDIES OF HEPATITIS-B VIRUS-DNA IN SERUM [J].
CHU, CM ;
KARAYIANNIS, P ;
FOWLER, MJF ;
MONJARDINO, J ;
LIAW, YF ;
THOMAS, HC .
HEPATOLOGY, 1985, 5 (03) :431-434
[9]  
Dawson GJ, 1996, J MED VIROL, V50, P97, DOI 10.1002/(SICI)1096-9071(199609)50:1&lt
[10]  
97::AID-JMV16&gt