研究背景及目的：丙型肝炎病毒（HCV）感染与心肌损伤之间的直接致病关联还尚未阐明。我们使用了铊-201心肌灌注显影来研究慢性丙型肝炎患者心肌状况与HCV感染之间的联系。方法：我们对217名无明显心脏疾病的慢性HCV感染连续患者进行了心电图（ECG）、超声心动图、相关血清学及铊-201心肌灌注显影检测。心肌损伤通过严重度评分（SS）来评估，该积分使用总铊-201灌注缺损积分来计算。记录200名慢性丙型肝炎患者干扰素（IFN）治疗前后的SS值。结果：9%的慢性丙型肝炎患者有ECG表现的异常。87%的慢性丙型肝炎患者有异常的SS值。与治疗前SS值升高相关的独立因素包括：组织学炎症活动度评分、血清HCV RNA滴度及吲哚菁绿消除率。经IFN治疗后，获得持续病毒学应答患者的SS值有所升高。在复发患者中，虽然SS值可在HCV RNA消失初始升高，但在HCV RNA 重新出现时会大幅降低。无病毒学应答患者的SS值不因接受了干扰素治疗而有所改变。结论：87%的慢性丙型肝炎患者有心肌灌注缺损，且能通过IFN治疗在清除病毒后得到改善。




BACKGROUND & AIMS: The existence of a direct pathogenic link between hepatitis C virus (HCV) infection and myocardial injury has not been confirmed. We investigated the association between myocardial conditions and HCV in patients with HCV-related chronic hepatitis using thallium-201 myocardial scintigraphy. METHODS: In 217 consecutive cases of chronic HCV infection without overt heart disease, we performed electrocardiography (ECG), echocardiography, serum tests on myocardial injury and thallium-201 myocardial scintigraphy. Myocardial injury was confirmed by severity score (SS), which was calculated as the sum of thallium-201 perfusion defect scores. SS was followed prior to and after interferon (IFN) therapy in 200 patients with chronic hepatitis C. RESULTS: An abnormal ECG was found in 9% of the patients with chronic hepatitis C. Abnormal SS was found in 87% of chronic hepatitis C patients. Independent factors related to higher pretreatment SS were histology activity index score, serum HCV RNA titer and indocyanine green disappearance rate. After IFN therapy, SS was improved in patients with sustained virologic response. Among relapsers, the SS improved at the initial disappearance of HCV RNA, but SS worsened with reappearance of HCV RNA. The SS in non-viral responders did not change with IFN therapy. CONCLUSIONS: Myocardial perfusion defects were found in 87% of the patients with chronic hepatitis C and improved with viral eradication from IFN therapy

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