直接抗丙型肝炎药物的新进展

全球约2亿人（3％）感染丙型肝炎病毒（HCV），并且每年约有300万新增病例。HCV感染者中约70％将发展成慢性丙型肝炎（CHC）。若无有效治疗，其中约25％将在25年内发展成肝硬化，每年仅因肝硬化导致的病死率可达3％。由于标准治疗方案的疗效、不良反应等方面存在诸多问题，因此，新型抗HCV药物，尤其是直接抗病毒药物的研发成为研究的热点。     

丙型肝炎研究进展

由北京医科大学肝病研究所陶其敏教授撰写的“丙型肝炎研完进展”一文,内容包括:从非甲非乙到丙型肝炎、HCV基因结构和功能、HCV株型和中国北方HCV株序列分析、HCV感染的实验诊断、丙型肝炎临床、丙型肝炎流行病学和预防,以及丙型肝炎的治疗等7部分,本刊将分3期连载。编辑部     

动态联合检测抗HCV与HCV—RNA诊断丙型肝炎的意义

自从发现并应用融合蛋白C_(100—3)诊断丙型肝炎以来,多种特异性诊断方法相继应用,但目前临床常用的方法仍为抗HCV及PCR方法检测HCV—RNA,由于丙型肝炎病毒(HCV)在体内复制的阶段性及抗HCV产生较晚,部分患者体内抗HCV水平较低,使上述两种方法的敏感性和特异性受到影响,本文对两种方法进行动态观察,以期阐明各自的变化,指导临床应用。     

丙型肝炎病毒感染与脂肪肝的关系

本文研究６９例非酒精性脂肪肝患者中的ＨＣＶ感染状况，发现ＨＣＶ感染率为１１．６％，明显高于健康对照组的感染率１．４％（Ｐ＝０．００４２）。伴有ＨＣＶ感染的脂肪肝患者多数存在ＡＬＴ升高（７／８）和病毒复制（５／８），而共主要血清生化指标均瑟单纯脂肪肝比较并无显著怀差异，结果初步提示ＨＣＶ感染与脂肪肝有关，并可能是非精性脂肪肝的成因之一。     

丙型肝炎研究进展(续)

<正> HCV 感染的实验诊断目前用于 HCV 感染的实验诊断方法主要有两种,检测抗-HCV 和 HCV RNA。抗-HCV 检测1989年5月,美国 Chiron 公司用分子克隆法分离到一个能表达 NANB 肝炎病毒特异性蛋白的 cDNA 克隆5-1-1。又将3个与5-1-1有共同 ORF 的重叠克隆联结起来建立了另一个克隆     

丙型肝炎病毒感染与乙型肝炎

本文报告８５例ＨＣＶ感染者，并与同期经随机抽样而得的８５例抗一ＨＣＶ阴性的乙汗患者相比较。抗一ＨＣＶ阳性组输血史及输血制品史分别为３５．３％与１６．５％，而抗－ＨＣＶ阴生组分别为７．１％与０，两纽相比Ｐ＜０．０１，抗－ＨＣＶ阳性组注射史高于抗一ＨＣＶ阴性组（Ｐ＜０．０５），提示丙肝病毒医源性感染较ＨＢＶ多见，丙型肝炎有高龄发病趋向且其病程较乙于为长。ＨＣＶ感染者８２．４％存在ＨＢＶ重叠感染，ＨＣＶ７可抑制ＨＢＶ复制，ＨＣＶ与ＨＢＶ重叠感染预后较乙肝差。     

丙型肝炎标志物的检测研究进展及其临床意义

本文报告丙型肝炎病毒的特性，以及其特异性标志物－特异性抗体的检测，包括抗－ＨＣＶ、重组免疫印迹法和核心蛋白抗体的检测，以及用ＰＣＲ检测其核酸，对有关检测方法进行评价，介绍有关检查结果的临床意义与应用。     

HCV-IgG、HCV-cAg与HCV-RNA对丙型肝炎诊断的评价

目的评价丙型肝炎病毒核心抗原(HCV-cAg)、丙型肝炎病毒抗体(HCV-IgG)及丙型肝炎病毒RNA(HCV-RNA)3种检测方法在丙型肝炎实验室诊断中的意义。方法收集84例丙型肝炎疑似患者和87例健康对照者血清,采用ELISA法检测HCV-cAg和HCV-IgG,实时荧光定量聚合酶链式反应法(RT-PCR)检测HCV-RNA。结果 84例丙型肝炎疑似患者中HCVIgG阳性率为84.5%,HCV-cAg阳性率为13.1%,HCV-RNA阳性率为52.4%;71例HCV-IgG阳性患者中HCV-RNA阴性35例,假阳性率为49.3%,11例HCV-cAg阳性患者中HCV-RNA阴性5例,假阳性率为45.5%;44例HCV-RNA阳性的丙型肝炎确诊患者中HCV-IgG假阴性率为18.2%,HCV-cAg假阴性率为86.4%;HCV-cAg和HCV-IgG联合检测的假阴性率为13.6%,真阳性率为100.0%。结论 HCV-cAg和HCV-IgG在丙型肝炎的实验室诊断中均存在一定的假阴性和假阳性,将二者联合检测或在必要时与HCV-RNA三者联合检测可降低漏诊率。     

丙型肝炎病毒感染的流行病学研究进展

丙型肝炎病毒(hepatitis C virus, HCV)感染呈全球性流行,不同年龄、性别及种族对HCV均易感[1-3]。WHO提出了在2030年前消除病毒性肝炎的战略,HCV多呈隐匿性感染,多数人感染后并不知情,完成该战略需要诊断出90%的HCV感染者,且诊断出的感染者80%以上接受治疗[4]。1丙型肝炎病毒感染全球流行现状既往资料显示,全球有1.3亿~1.5亿HCV感染者[5]。近期,一项应用马尔可夫模型回顾了2000年1月至2016年3月期间的HCV流行病学相关文献的研究显示[6],2015年全球约有7100万HCV感染者。     

Current treatment for hepatitis C virus/human immunodeficiency virus coinfection in adults

Hepatitis C virus (HCV)/human immunodeficiency virus (HIV) coinfection is a major problem among HIV-infected patients, resulting in increased morbidity and mortality rates due to the acceleration of liver fibrosis progression by HIV, leading to liver cirrhosis and hepatocellular carcinoma. Although the efficacy of direct-acting antiviral therapy in patients with HIV/HCV coinfection and HCV monoinfection are similar in terms of sustained virologic response rate, there are some additional complications that arise in the treatment of patients with HIV/HCV coinfection, including drug-drug interactions and HCV reinfection due to the high risk behavior of these patients. This review will summarize the current management of HIV/HCV coinfection.     

Telaprevir and boceprevir in african americans with genotype 1 chronic hepatitis C: implications for patients and providers

ABSTRACT: Telaprevir and boceprevir have received US Food and Drug Administration approval for use as triple therapy with pegylated interferon and ribavirin in genotype 1 chronic hepatitis C virus (HCV) infection. Clinical trials of these agents included few African Americans, despite the overwhelming need for improved therapies in this racial group. Although African Americans are predicted to have improved response rates with this new treatment paradigm, clinical trials illustrate lower rates of sustained virologic response for this racial group versus whites. African Americans with genotype 1 HCV infection appear to require longer durations of therapy than do whites to achieve a sustained virologic response. Further investigation is required to adequately counsel African Americans with genotype 1 chronic HCV infection on the efficacy of telaprevir and boceprevir in their racial group. Increased participation of this racial group in HCV clinical trials is needed to improve therapies in this difficult-to-treat population.     

Current status and emerging challenges in the treatment of hepatitis C virus genotypes 4 to 6

Hepatitis C virus(HCV) genotypes 4, 5 and 6 are mainly present in Africa, the Middle East and Asia and they have been less extensively studied with respect to epidemiology, natural disease history and therapeutic endpoints. Response rates to a 48-wk combined peginterferon/ribavirin treatment range to 40%-69% for HCV 4, 55%-60% for HCV 5 and 60%-90% for HCV 6. Response-guided schedules are recommended to optimize the outcomes of peginterferon/ribavirin treatment in HCV 4 and, in form of preliminarydata, for HCV 6, but no data are yet available to support such an individualization of therapy for HCV 5. Recently, the direct-acting antivirals(DAAs) with pan-genotypic activities simeprevir, sofosbuvir and daclatasvir have been recommended in triple regimens with peginterferon/ribavirin for the treatment of HCV genotypes 4 to 6 infections. In the future, DAA-based interferon-free therapies are awaited to drastically improve treatment outcomes in HCV. However, efforts to improve treatment outcomes with peginterferon/ribavirin should continue, as the HCV 4-6 infected population is mainly based in resource-limited settings with restricted access to the costly DAAs.     

丙型肝炎病毒相关性肾炎的研究进展

丙型肝炎病毒（hepatitisCvirus,HCV）引起肝细胞受损,从而导致肝炎、肝硬化,甚至进展为肝癌,而且可能导致肝外组织损伤,引起多种器官病变,其导致的肾小球疾病称为丙型肝炎病毒相关性肾炎（hepatitisCvirusassociatedglomerulonephritis,HCV—GN）,对于其发病机制、临床表现、治疗方案及预后,研究相对不够完善,就其发病机制上说,考虑为混合性冷球蛋白介导和非混合性冷球蛋白介导肾脏损伤两种。最常见的临床表现包括蛋白尿、镜下血尿伴或不伴有肾功能受损。为排除是HCV-GN还是丙型肝炎合并原发性肾脏疾病,其鉴别主要肾脏病理检查及抗病毒治疗后肾脏疾病预后情况。故其治疗方案制订上相对复杂,目前尚无最佳治疗方案,其导致的肾脏疾病有不同的转归,对其预后说法不一,因此,探讨丙型肝炎病毒与。肾小球肾炎关系,总结其发病机制、临床表现、治疗方案,为将来研究提供理论基础。     

Current status of hepatitis C virus infection in Korea

Chronic liver disease, including liver cirrhosis and hepatocellular carcinoma (HCC), has been a major cause of mortality in Korea. The prevalence rates of hepatitis C virus (HCV) and hepatitis B virus (HBV) infections in the general population of Korea are approximately 1 and 5%, respectively. The most common genotypes of HCV in Korea are 1b and 2a. The sustained virological response rates after antiviral therapies, including combined interferon-alpha and ribavirin, have been reported to be 38-59%. The annual incidence of HCC among HCV-related liver cirrhosis has been estimated at 5%, and approximately 12% of HCC is attributable to HCV and 68% to HBV in Korea. The mean age of patients with HCV-related HCC at the time of diagnosis was consistently 10 years older than that of patients with HBV-related HCC. Moreover, HCV-related HCC was accompanied by more advanced liver cirrhosis than HBV-related HCC. Coinfection with HBV seemed to increase the risk of developing HCC in chronic HCV infection. After the successful program of hepatitis B vaccination, HCV infection is now emerging as an important etiology of chronic liver disease in Korea, which warrants more detailed and large-scale studies.     

丙型肝炎治疗及疗效判断指标进展

自1992年美国食品药品监督管理局批准普通干扰素用于治疗丙型肝炎以来,丙型肝炎的抗病毒治疗取得了很大进展.为进一步提高疗效,国内外学者积极探讨基于各种基线因素和早期治疗应答的疗效预测和个体化治疗方案,并加紧研发新型抗HCV药物.