Hepatitas C

Hepatitas C

Hepatitas C yra virusas, sukeliantis lėtinį kepenų uždegimą ir ilgalaikę žalą. Dažniausiai jis plinta per užkrėstas adatas. HCV yra gydomas naujais antivirusiniais vaistais, tačiau daugelis žmonių nežino, kad yra užsikrėtę. Jie gali nejausti simptomų, kol kepenų liga progresuoja iki kepenų nepakankamumo.

Kas yra hepatitas C?

Hepatitas C yra virusinė infekcija, paveikianti kepenis. Ji sukelia uždegimą ir patinimą, kuris laikui bėgant pažeidžia kepenų audinius. „Hepatitas“ reiškia kepenų uždegimą. Hepatitas gali atsirasti dėl daugelio priežasčių, o kai kurios iš jų yra virusinės. Lyginant su kitomis virusinio hepatito priežastimis, hepatitas C daug dažniau lieka organizme ilgą laiką.

Lėtinis uždegimas, trunkantis daugelį metų, stipriai pažeidžia kepenis. Tiesą sakant, hepatitas C yra viena iš pagrindinių kepenų nepakankamumo ir kepenų transplantacijos priežasčių Jungtinėse Valstijose. Dauguma žmonių negali jausti, kad jų kepenys uždegusios, kol neatsiranda rimta žala.

Kaip dažnas yra hepatitas C?

JAV hepatito C infekcijos atvejų skaičius per pastarąjį dešimtmetį beveik keturis kartus padidėjo. Pasak Ligų kontrolės ir prevencijos centrų (CDC), šiuo metu Jungtinėse Valstijose beveik 4 milijonai žmonių gali būti užsikrėtę hepatitu C. Daugelis to nežino. Pasauliniu mastu užsikrėtusiųjų skaičius siekia 60 milijonų.

Kokia yra pagrindinė hepatito C priežastis?

Hepatitą C sukelia virusas, kuris plinta per kontaktą su krauju. Infekcija perduodama, kai užsikrėtusio asmens kraujas patenka į sveiko žmogaus organizmą. JAV tai dažniausiai nutinka, kai žmonės dalijasi adatomis intraveniniams narkotikams švirkšti. Pasauliniu mastu infekcija dažnai perduodama medicinos įstaigose, naudojant nesterilizuotus instrumentus.

Kuo skiriasi hepatitas A, B ir C?

Hepatitas A ir hepatitas B yra kiti virusai, taip pat sukeliantys hepatitą. Jie skiriasi užsikrėtimo būdais, infekcijos tipais, kuriuos sukelia, bei gydymo ir prevencijos metodais. Pagrindiniai skirtumai:

Tipas Prevencija Perdavimas Infekcija Gydymas
Hepatitas A Turi vakciną Per išmatas Tik ūminė. Pasveikstama per kelias savaites. Gydymas gali būti nereikalingas. Vakcina padeda, jei nebuvo skiepyta.
Hepatitas B Turi vakciną Per kraują Lėtinė tik 5% suaugusiųjų, bet 30% vaikų iki 5 metų amžiaus. Antivirusiniai vaistai gali padėti kontroliuoti lėtinę infekciją, bet jos neišgydo.
Hepatitas C Nėra vakcinos Per kraują Lėtinė 80% žmonių. Antivirusiniai vaistai gali išgydyti 95–98% lėtinių infekcijų.

Kaip hepatito C infekcija veikia organizmą?

Hepatito C infekcija turi keletą stadijų.

Inkubacinis laikotarpis

Kai pirmą kartą užsikrečiama virusu, prasideda inkubacinis laikotarpis, kai virusas dauginasi organizme. Virusas dauginasi tol, kol pasiekia slenkstį, kai organizmas atpažįsta infekciją. Tuomet įsijungia imuninė sistema, ir pradeda pasireikšti simptomai.

Ūminė infekcija

Hepatito C inkubacinis laikotarpis gali trukti nuo dviejų savaičių iki šešių mėnesių. Ūminė infekcijos stadija prasideda, kai imuninė sistema įsijungia. Tai ir tas laikas, kai gali pradėti pasireikšti simptomai. Dauguma virusinių infekcijų ūminėje stadijoje sukelia ligos simptomus, tokius kaip karščiavimas ir uždegimas organizme. Su hepatitu uždegimas daugiausia vyksta kepenyse, ir jūs galite to nepastebėti.

Tik 20% žmonių, sergančių ūminiu hepatitu C, turi simptomų. Žmonės, kuriems pasireiškia simptomai, gali gydyti infekciją antivirusiniais vaistais. Tačiau dauguma žmonių nejaučia simptomų ir nesikreipia gydymo. Ūminė stadija trunka iki trijų mėnesių. Per šį laikotarpį iki 20% žmonių sėkmingai išvalo virusą iš savo organizmo.

Lėtinė infekcija

Dauguma žmonių (80%) nesugeba patys išvalyti viruso ir vystosi ilgalaikė lėtinė infekcija. Tai reiškia, kad jų kepenys nuolat uždegusios ir patinusios. Lėtinis hepatitas sukelia kepenų pažeidimą, vadinamą ciroze. Nuolatinis kepenų uždegimas galiausiai sukelia randėjimą.

Cirozė progresuoja lėtai per kelis dešimtmečius. Jei jūsų kepenys jau buvo pažeistos dėl kitų priežasčių, pavyzdžiui, piktnaudžiavimo alkoholiu, progresas gali būti greitesnis. Jei jūsų kepenys yra geresnės būklės, procesas gali būti lėtesnis. Galutinis rezultatas yra tas, kad randinis audinys neleidžia kepenims tinkamai funkcionuoti. Cirozės rizika nuo lėtinės hepatito C infekcijos yra apie 25% po 20 metų.

Simptomai ir priežastys

Kaip užsikrečiama hepatitu C?

Hepatito C virusas (HCV) plinta per kontaktą su krauju. Infekcija perduodama, kai užsikrėtusio asmens kraujas patenka į sveiko žmogaus kūną. JAV dažniausiai tai nutinka, kai žmonės dalijasi adatomis intraveniniams narkotikams švirkšti. Tačiau yra daugybė kitų atsitiktinių būdų, kaip galite susidurti su kito žmogaus krauju.

Pavyzdžiui:

  • Poveikis adatoms ar aštriems daiktams darbe, ypač sveikatos priežiūros srityje.
  • Tatuiruotės ar kūno auskarų vėrimas, naudojant nesterilizuotą įrangą.
  • Dalijimasis skustuvu ar dantų šepetėliu su kažkuo, kas galėjo kraujuoti jį naudodamas.
  • Rečiau per lytinius santykius, kuriuose atsiranda kraujo kontaktas.

Prieš 1992 m. hepatitas C dažnai buvo perduodamas per kraujo perpylimus ir organų transplantacijas. Dabar sveikatos priežiūros specialistai reguliariai tikrina, ar donoruose nėra viruso, prieš naudodami kraują ar organus. Nors ši priežastis nebėra pavojus, gydytojai rekomenduoja visiems, kurie prieš 1992 m. gavo kraujo perpylimą ar organų transplantaciją, pasitikrinti dėl HCV.

Kas dažniausiai paveiktas hepatito C infekcijos?

Labiau tikėtina, kad užsikrėsite hepatitu C, jei:

  • Vartojate intraveninius narkotikus.
  • Turite ŽIV.
  • Gavote kraujo perpylimą ar organų transplantaciją prieš 1992 m.
  • Gavote kraujo krešėjimo faktorių dėl hemofilijos prieš 1987 m.
  • Gimėte tarp 1945 ir 1965 m.
  • Gimėte motinai, sergančiai hepatitu C.

Kokie yra hepatito C simptomai?

Dauguma žmonių neturi jokių simptomų. Maža dalis gali turėti simptomų ūminės infekcijos metu. Simptomai gali būti neaiškūs, panašūs į gripo požymius, arba primenantys kepenų ligos simptomus, įskaitant pilvo skausmą ir geltą. Vėliau galite pastebėti simptomus, kai kepenų liga pasiekia pažengusią stadiją ir kepenys pradeda nebeveikti.

Kokie yra ankstyvieji hepatito C įspėjamieji ženklai?

Ūminiai hepatito C infekcijos simptomai gali priminti gripo simptomus, tokius kaip:

  • Karščiavimas.
  • Nuovargis.
  • Kūno skausmai.
  • Apetito praradimas.

Jie taip pat gali priminti ūminio kepenų nepakankamumo simptomus, tokius kaip:

  • Gelta (šviesios odos ir akių baltymų pageltimas).
  • Pilvo skausmas (ypač viršutiniame dešiniajame kvadrante).
  • Pykinimas ir vėmimas.
  • Tamsiai spalvotas šlapimas ir šviesios išmatos.

Kokie yra pažengusios kepenų ligos simptomai?

Jei nepastebite ankstyvųjų įspėjamųjų simptomų, galite turėti vėlesnius hepatito įspėjamuosius ženklus, kai pradėsite patirti cirozės poveikį po daugelio metų lėtinės infekcijos. Jūs galite patirti visus minėtus simptomus ir taip pat pastebėti:

  • Skysčio kaupimąsi rankose ir kojose (edema).
  • Skysčio kaupimąsi pilve (ascitas).
  • Niežulį.
  • Neaiškų svorio netekimą.
  • Lengvą mėlynių susidarymą ir kraujavimą.
  • Sunkumą mąstant ar prisimenant, sumišimą (hepatinė encefalopatija).

Diagnozė ir tyrimai

Kaip diagnozuojamas hepatitas C?

Patikra dėl hepatito C infekcijos prasideda nuo paprasto kraujo tyrimo. Gydytojas paims nedidelį kraujo mėginį iš venos ir išsiųs jį į laboratoriją. Jei užsikrėtėte virusu, jūsų kraujyje bus hepatito C antikūnų. Jei testas teigiamas, gydytojas atliks papildomus kraujo tyrimus.

Kokie kiti medicininiai tyrimai bus atliekami?

Jei testas teigiamas dėl lėtinės hepatito C infekcijos, gydytojas norės įvertinti jūsų kepenų būklę. Jie norės sužinoti, kiek kepenų audinio jau yra pakeista rando audiniu. Tyrimai gali apimti:

  • Kepenų funkcijos tyrimai. Tai serija kraujo tyrimų, kurie įvertina kepenų būklę.
  • Elastografija. Neinvazinis vaizdinis tyrimas, matuojantis kepenų audinio standumą ar fibrozę, naudojant ultragarsą arba MRT.
  • Kepenų biopsija. Kai kitų tyrimų rezultatai nėra galutiniai, gydytojas gali paimti audinio mėginį iš kepenų laboratoriniam tyrimui. Tai dažniausiai atliekama per pilvo sienelę įkišant tuščiavidurę adatą.

Gydymas ir valdymas

Ar hepatitas C praeina savaime?

Jis paprastai nepraeina be gydymo, bet kartais gali praeiti. Jei esate tarp nedaugelio žmonių, kurie sugeba savaime pašalinti virusą, tai įvyks ūminės infekcijos stadijos metu. Jei tai pavyksta, lėtinė infekcija neišsivystys.

Jei turite lėtinę infekciją, tai reiškia, kad virusas aplenkė jūsų imuninę sistemą, ir jums reikės pagalbos jį pašalinti. Laimei, nauji antivirusiniai vaistai leidžia tai padaryti. Šiuolaikiniai antivirusiniai vaistai gali išgydyti 95–98% lėtinių hepatito C infekcijų per 8–24 savaites.

Koks yra hepatito C gydymas?

Dabar yra daugybė vaistų, skirtų hepatitui C gydyti. Skirtingi vaistai rekomenduojami gydyti skirtingoms viruso atmainoms. Gydymo trukmė gali priklausyti nuo jūsų bendros būklės ir turimos viruso atmainos (genotipo). Kai kurios atmainos geriau reaguoja į gydymą nei kitos.

Patvirtinti vaistai hepatito C gydymui yra:

  • Sofosbuviras (Sovaldi®).
  • Ledipasviras/sofosbuviras (Harvoni®).
  • Simepreviras (Olysio®).
  • Paritapreviras/ombitasviras/ritonaviras/dasabuviras (Viekira Pak®).
  • Daklatasviras (Daklinza®).
  • Elbasviras/grazopreviras (Zepatier®).
  • Sofosbuviras/velpatasviras (Epclusa®).
  • Glecapreviras/pibrentasviras (Mavyret®).
  • Sofosbuviras/velpatasviras/voxilapreviras (Vosevi®).
  • Ombitasviras/paritapreviras/ritonaviras (Technivie®).
  • Ribavirinas (RibaPak®).
  • Peginterferonas alfa-2a/2b (Pegasys®/PEG-Intron®).

Ar man reikės papildomo gydymo?

Jei jau turite pažengusią kepenų ligą (cirozę), infekcijos išgydymas gali nepakakti. Jums gali reikėti kepenų transplantacijos. Net jei turite gauti naujas kepenis, išgydyti hepatitą C vis tiek svarbu siekiant apsaugoti naująsias kepenis.

Prevencija

Ar yra hepatito C vakcina?

Šiuo metu nėra veiksmingos vakcinos, skirtos hepatitui C išvengti. Tyrėjai ilgą laiką dirbo šiuo klausimu, tačiau hepatitas C pasirodė sunkiai išvengiamas dėl daugelio jo variacijų ir spartaus mutavimosi. Vienintelis veiksmingas būdas išvengti hepatito C infekcijos yra vengti kontakto su užkrėstu krauju, ypač nenaudoti bendrų adatų ar švirkštų.

Perspektyva ir prognozė

Kokia yra prognozė žmonėms, sergantiems lėtiniu hepatitu C?

Nauji vaistai leidžia padaryti prognozę daug šviesesnę. Net jei daugelį metų sergate lėtine infekcija, dabar galite ją išgydyti per kelias savaites. Vis dėlto kai kurie žmonės gali turėti didelę kepenų žalą prieš pradėdami gydymą.

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