CAJ | 학술논문

目的从临床和病理学方面探讨庚型肝炎病毒(GBV-C/HGV)的致病性。方法收集24例单纯血清GBV-C/-HGV RNA阳性人体的穿刺活检肝组织及血清标本，其中8例作间隔2年以上的二次肝穿，进行血清和肝组织GBV-C/HGV RNA、血清抗E2抗体及ALT水平、肝组织NS3和NS5抗原检测，并作肝组织光、电镜观察。结果 24例血清GBV-C/HGV RNA阳性者首次肝穿前3 d内平均ALT水平为60.17 IU/ml(42～87 IU/m1)，抗E2抗体阳性率4.17％，首次肝组织GBV-C/HGV RNA阳性率为75.00％，NS3和(或)NS5抗原阳性率为54.17％。GBV-C/HGV RNA及NS3和NS5抗原主要于肝细胞胞质内检出，阳性细胞呈散在分布，少数浸润的单个核细胞内有病毒RNA检出。肝细胞呈极轻度急、慢性炎症病变者占79.17％。与2年前比较，2年后24例观测对象血清GBV-C/HGV RNA自然转阴率66.67％(P<0.001)，血清ALT复常率75.00％(P<0.001)，E2抗体阳性率为41.67％(P<0.001)，8例二次穿刺肝组织除2例有灶状肝细胞水样变性外，余均复常。结论庚型肝炎病毒可引起极轻度自限性肝炎，提示其致肝损伤作用微弱且具自限性；血清E2抗体是GBV-C/HGV感染恢复性标志，是否存在其他恢复性血清标志物尚待研究。
목적종림상화병이학방면탐토경형간염병독(GBV-C/HGV)적치병성。방법수집24례단순혈청GBV-C/-HGV RNA양성인체적천자활검간조직급혈청표본，기중8례작간격2년이상적이차간천，진행혈청화간조직GBV-C/HGV RNA、혈청항E2항체급ALT수평、간조직NS3화NS5항원검측，병작간조직광、전경관찰。결과 24례혈청GBV-C/HGV RNA양성자수차간천전3 d내평균ALT수평위60.17 IU/ml(42～87 IU/m1)，항E2항체양성솔4.17％，수차간조직GBV-C/HGV RNA양성솔위75.00％，NS3화(혹)NS5항원양성솔위54.17％。GBV-C/HGV RNA급NS3화NS5항원주요우간세포포질내검출，양성세포정산재분포，소수침윤적단개핵세포내유병독RNA검출。간세포정겁경도급、만성염증병변자점79.17％。여2년전비교，2년후24례관측대상혈청GBV-C/HGV RNA자연전음솔66.67％(P<0.001)，혈청ALT복상솔75.00％(P<0.001)，E2항체양성솔위41.67％(P<0.001)，8례이차천자간조직제2례유조상간세포수양변성외，여균복상。결론경형간염병독가인기겁경도자한성간염，제시기치간손상작용미약차구자한성；혈청E2항체시GBV-C/HGV감염회복성표지，시부존재기타회복성혈청표지물상대연구。
Objective To elucidate the pathogenicity of GBV-C/HGV in causing viral hepatitis. Methods The sera and bioptic liver tissues,which involved 8 cases of the second liver puncture with an in terval of 2 years, from 24 cases of single GBV-C/HGV RNA positive patients were observed for more than 2 years. GBV-C/HGV RNA in the sera and liver tissues was detected by using RT-PCR and in situ hy bridization,respectively. Under light and electron microscope, the pathology of the liver tissues was observed. Results At the beginning of the observation, the mean serum alanine transaminase(ALT) level was 60.17 IU/ml( range , 42.00 ～ 87.00 IU/ml),and the positive rates of anti-E2 antibody and GBV-C/HGV RNA in the sera and NS3 and/or NS5 in the liver tissues were 4.17% ,75.00% and 54.17% ,respectively. In all the examined specimens,79.17 % of them showed mild acute or chronic hepatitis, mainly presenting with degeneration of hepatocytes, mild portal inflammation. GBV-C/HGV RNA and its NS3 and/or NS5 antigens were mainly detected in hepatocytes and a few mononuclear cells. In contrast, after more than 2 years, the natural change rate ( negative rate of GBV-C/HGV) of 24 cases was 66.67 % ( P＜0.001 ). 75.00 % had normal ALT level ( P < 0.001 ) and 41.67 % of anti-E2 antibody in the patients was positive (P＜0.001 ). Through histological observation, besides 2 cases of liver tissues showing very mild hydropic degeneration, there were no abnormal findings in 8 cases of the second liver biopsy. Conclusion GBV-C/ HGV could induce mild and self-limited hepatitis, which showed that GBV-C/HGV may be a light and selflimited pathogenic agent to human liver. E2 antibody appearance may indicate a recovery and provide a protection from GBV-C/HGV infection. Whether there is any other recovery marker in serum requires further study.