李艳艳 任慧芳 朱龙川 徐龙

[摘要] 目的 了解丙型肝炎的流行病學及临床特点。 方法 对2010年7月至2018年12月在本院诊断为丙型肝炎的1018例患者采用回顾性调查的方式，记录性别、年龄、传播途径、临床表现、ALT、HCVRNA、基因分型等。将患者分为慢性丙型肝炎（无肝硬化）组846例和丙型肝炎肝硬化（肝硬化）组172例，比较两组年龄及HCVRNA。结果 1018例患者中，男518例，女500例。年龄<30岁者120例，年龄≥30岁者898例。经输血或有偿献血传播628例，占61.7%，ALT<3 ULN者716例，占70.3%。HCVRNA≥1×103 copies/mL 932例，占91.5%。基因型1b 850例，占83.5%，2a 60例，占5.9%。临床症状多为乏力、纳差、肝区不适等，进展为肝硬化失代偿期症状有所加重。无肝硬化组平均年龄（45.4±13.5）岁，肝硬化组平均年龄（56.8±11.1）岁，组间比较差异有统计学意义（P<0.05）;无肝硬化组HCVRNA（2.76×107±1.33×107）copies/mL，肝硬化组（3.50×107±1.27×107） copies/mL，组间比较差异无统计学意义（P>0.05）。 结论 丙型肝炎感染者无性别差异，抗-HCV阳性率随年龄增长而逐渐上升。感染途径以经血液为主，常见的病毒基因型为1b和2a。丙型肝炎症状轻，ALT轻度异常，在临床上遇到症状轻、ALT反复异常者，即使无输血史也应行丙型肝炎相关检测。进展至肝硬化多见于年龄较大者，与HCVRNA载量高低无关，因此对于HCVRNA阳性的丙型肝炎患者，应尽早抗病毒治疗。

[关键词] 病毒性肝炎;丙型;流行病学;临床特点

[中图分类号] R512.6+3          [文献标识码] B          [文章编号] 1673-9701（2021）35-0154-04

Analysis of epidemiology and clinical characteristics of 1018 cases of hepatitis C

LI Yanyan1   REN Huifang2   ZHU Longchuan3   XU Long1

1.The Second Department of Liver Diseases，Nanchang Ninth Hospital，Nanchang   330000，China;2.The Second Department of Infectious Diseases，Nanchang Ninth Hospital，Nanchang   330000，China;3.The First Department of Liver Diseases，Nanchang Ninth Hospital，Nanchang   330000，China

[Abstract] Objective To understand the epidemiology and clinical characteristics of hepatitis C. Methods A retrospective survey of 1018 patients diagnosed with hepatitis C in our hospital from July 2010 to December 2018 was used to record gender，age，route of transmission，clinical manifestations，ALT，HCVRNA，genotyping，etc.The patients were divided into the chronic hepatitis C（no cirrhosis）group（846 cases）and the hepatitis C cirrhosis（cirrhosis）group（172 cases）.The age and HCVRNA of the two groups were compared. Results 518 cases were male and 500 cases were female among in 1018 patients，and 120 cases were <30 years old，898 cases were≥30 years old. A total of 628 cases spread through blood transfusion or paid blood donation，accounting for 61.7%.The ALT of 716 cases was less than 3 ULN，accounting for 70.3%.There were 932 cases with HCVRNA greater than or equal to 1×103 copies/mL，accounting for 91.5%.There were 850 cases with genotype 1b，accounting for 83.5%，and 60 cases with 2a，accounting for 5.9%.The clinical symptoms were mostly fatigue，anorexia，liver discomfort，etc.，and the symptoms of liver cirrhosis were aggravated in the decompensated stage.The age of the non-cirrhosis group was（45.4±13.5）years old，and the age of the cirrhosis group was（56.8±11.1）years old，there was a significant difference between the two groups（P<0.05）.The HCVRNA in the cirrhosis group was（2.76×107±1.33×107）copies/mL.And the HCVRNA in the liver cirrhosis group was（3.50×107±1.27×107）copies/mL，there was no significant difference between the two groups（P>0.05）.Conclusion There is no gender difference in hepatitis C infection，and the anti-HCV positive rate gradually increases with age.The main route of infection is through blood.The common virus genotypes are 1b and 2a. Hepatitis C symptoms are mild and ALT is mildly abnormal.Patients who have mild symptoms and repeated ALT abnormalities in the clinic should be tested for hepatitis C even without a history of blood transfusion.Progression to liver cirrhosis is more common in older people，and has nothing to do with the level of HCV RNA load.Therefore，for HCVRNA-positive hepatitis C patients，antiviral treatment should be given as soon as possible.

[Key words] Viral hepatitis;Type C;Epidemiology;Clinical characteristics

HCV感染严重威胁人类健康，全球超过1.7亿人为慢性HCV感染者，我国约有1000万。在发生慢性感染的患者中，有15%～30%在随后30年可进展至肝硬化。随着直接抗病毒药物（Direct-acting antiviral agengs，DAAs）的问世，使得丙型肝炎的抗病毒治疗实现了病毒清除[1]。但丙型肝炎患者癥状隐匿，HCV感染的及时诊断率与抗病毒治疗率较低，不同地区流行病学也不尽相同，增加了HCV感染的危害。……