目的 研究26例丙肝病人的演变过程。方法 采用前瞻性的研究方法,以26例已跟踪10年以上的丙肝病人作为研究对象,对所采集到的输血前及输血后血清,进行ALT和抗HCV检测及HCV RNA检测。结果 对该26例输血后丙肝病人跟踪时间平均128个月,输血后抗HCV最早于第15天被检测到,最晚出现于第80天,平均窗口期为42d,至第11年时其抗HCV阳性率仍维持在约70％。大多数病人在输血后的30d内其ALT即出现异常,随后其ALT的变化大致可分为3种类型:短期异常后转为正常并维持至今;ALT维持较长时间异常;ALT呈波浪式反复异常。笔者所跟踪的26例输血后丙肝病人中,24例病人的ALT或只有一个异常峰,但维持时间较长(平均16个月),或呈现波浪式多次的高异常,其抗HCV在第11年时仍绝大多数维持阳性,说明丙肝病毒在人体内引起的免疫反应较弱而持久。2例病人在ALT异常5个月后转为正常,随后其抗HCV及HCV RNA亦转为阴性,至今已超过10年未发现肝炎症状,HCV感染人体以后能引起较快、较强的免疫反应,该被感染者又能通过免疫系统将病毒清除掉。结论 大多数丙型肝炎病人转为慢性化,少数丙型肝炎病人则存在自愈。 Objective To study the evolution of 26 cases of hepatitis C patients. Methods A prospective study was conducted in 26 cases of hepatitis C patients who have been followed up for more than 10 years. ALT, anti-HCV and HCV RNA were detected before and after blood transfusion. The results of the 26 patients with hepatitis C after transfusion tracking time averaging 128 months after transfusion of anti-HCV was detected as early as the first 15 days, the latest appeared on the 80th day, the average window period of 42d, to the 11th year of its anti- HCV positive rate remained at about 70%. Most patients within 30d after transfusion, the abnormality of ALT, followed by changes in ALT can be divided into three types: short-term abnormalities turned normal and maintained until now; ALT remained abnormal for a long time; ALT was wave repeated abnormal. Twenty-six patients with post-transfusion hepatitis C were followed by ALT or only one abnormal peak, but the maintenance time was longer (16 months on average) or there were many abnormal waves. The vast majority remained positive at 11 years, indicating that the immune response caused by the hepatitis C virus in humans is weak and long lasting. Two patients returned to normal after 5 months of abnormal ALT, and subsequently their anti-HCV and HCV RNA also turned negative. No hepatitis symptoms have been found for more than 10 years. After being infected by HCV, the human body can cause a faster and stronger immune response , The infected person can remove the virus through the immune system. Conclusion Most patients with chronic hepatitis C become chronic, and few patients with hepatitis C have self-healing.