症例は65歳，女性．57歳時より更年期障害に対してホルモン療法を施行されていたが，59歳時に腹痛精査の腹部超音波検査で3 cm大の肝腫瘤を指摘された．画像検査では肝細胞癌を否定できず，経皮的肝生検を施行，肝細胞腺腫と診断された．ホルモン療法を中止して，外来にて半年毎の経過観察となっていたが，発見時より6年後の腹部超音波検査では同腫瘤は4 cm大に増大していた．造影CT検査および造影MRI検査所見からは，肝細胞腺腫の悪性転化が疑われたため，腹腔鏡補助下肝S7亜区域切除術を施行した．病理組織検査では，FNH類似病変との診断であった．
We conducted a retrospective, single-center, observational study to estimate the positive detection rate for HCV antibodies in the people who underwent an HCV antibody test as part of their physical checkup (comprehensive health checkup). The people who underwent the HCV antibody test as part of their comprehensive health checkup at our hospital between April 1, 2014 and March 31, 2017 were included as subjects. Of the 61578 people who underwent a comprehensive health checkup, 3938 people underwent an HCV antibody test (excluding those who underwent the test again), of which 42 people were positive for HCV antibodies, resulting in a positive rate of 1.07%. The positive rate gradually increased with age up to a peak value of 2.54% (12 of 472 subjects) in the age group of 60-64 year olds, and decreased past that age group.
In terms of future issues, it is considered necessary to confirm whether HCV-RNA is detected in the subjects who were positive for HCV antibodies. As almost the same people undergo regular health checkups every year, a new approach from regular health checkups such as going to a local community to provide health checkups is considered necessary in order to more widely detect still undiagnosed patients infected with HCV.
48 patients with chronic HCV genotype 3a, 3b, 3k, 4 infection were evaluated HCV serological group (serotype). In 25 patients with 3a, serotype 1, serotype 2, and undetected were 28.0%, 4.0%, and 68.0%, respectively. In 21 patients with 3b, serotype 1, serotype 2, and undetected were 38.1%, 4.8%, and 57.1%, respectively. One patient with 3k was serotype 2, and one patient with 4 was serotype 1. In HCV patients except for genotype 1 and 2, there are patients of undetected, or inconsistency between genotype and serotype.
In non-cirrhotic patients without prior NS5A inhibitors regimen, treatment duration of glecaprevir plus pibrentasvir for genotype 1 or 2 (8weeks) is different from that for genotype 3-6 (12weeks). Hence, we emphasized the importance of genotyping in patients except for genotype 1 or 2, at the time of selection of NS5A inhibitors regimen.