急性丙型肝炎 Acute hepatitis C refers to the first 6 months after infection with HCV.急性丙型肝炎是指前6个月后感染丙肝病毒。 Between 60% to 70% of people infected develop no symptoms during the acute phase.介于60 ％至70 ％的人感染没有症状发展急性期。 In the minority of patients who experience acute phase symptoms, they are generally mild and nonspecific, and rarely lead to a specific diagnosis of hepatitis C. Symptoms of acute hepatitis C infection include decreased appetite, fatigue, abdominal pain , jaundice , itching , and flu-like symptoms .少数患者谁急性期症状的经验，他们一般是轻微和非特异性，而很少导致具体诊断丙型肝炎急性丙型肝炎感染包括降低食欲，疲劳， 腹痛 ， 黄疸 ， 瘙痒 ，并感样症状 。

The hepatitis C virus is usually detectable in the blood within one to three weeks after infection by PCR , and antibodies to the virus are generally detectable within 3 to 15 weeks.丙型肝炎病毒通常是探测血液中的一至三个星期后，感染的聚合酶链反应 ，和抗体的病毒通常是探测在3至15周。 Up to 50% of persons infected with HCV clear the virus from their bodies during the acute phase as shown by normalization in liver enzymes ( alanine transaminase (ALT) & aspartate transaminase (AST)), as well as plasma HCV-RNA clearance (this is known as spontaneous viral clearance ).高达50 ％的人感染了丙型肝炎病毒的病毒清除他们的尸体在急性期所示正常化肝酶（ 丙氨酸转氨酶 （按ALT ）及天门冬氨酸转氨酶转移酶（ AST ） ） ，以及血浆丙型肝炎病毒核糖核酸清除（此被称为自发病毒清除 ） 。 The remaining 60-85% of patients infected with HCV develop chronic hepatitis C, ie, infection lasting more than 6 months. [ 2 ] [ 3 ] [ 4 ]其余60-85 ％的患者感染了丙型肝炎病毒发展慢性丙型肝炎，即感染持续超过6个月。 [ 2 ] [ 3 ] [ 4 ]

Previous practice was to not treat acute infections to see if the person would spontaneously clear; recent studies have shown that treatment during the acute phase of genotype 1 infections has a greater than 90% success rate with half the treatment time required for chronic infections. [ 5 ]以往的做法是没有治疗急性感染，看的人会自发地明确;最近的研究表明，治疗急性期基因型 1感染有大于90 ％成功率的一半所需的时间治疗慢性感染。 [ 5 ]

[ edit ] Chronic [ 编辑 ] 慢性

Chronic hepatitis C is defined as infection with the hepatitis C virus persisting for more than six months.慢性丙型肝炎的定义是：感染丙型肝炎病毒持续6个月以上。 Clinically, it is often asymptomatic (without symptoms) and it is mostly discovered accidentally.临床上，常常是无症状（无症状） ，它主要是意外发现的。

The natural course of chronic hepatitis C varies considerably from one person to another.在自然慢性丙型肝炎有很大的差别从一个人到另一个。 Although almost all people infected with HCV have evidence of inflammation on liver biopsy the rate of progression of liver scarring (fibrosis) shows significant variability among individuals.虽然几乎所有的人感染了丙型肝炎病毒有证据的炎症肝活检率进展肝脏结疤（纤维化）显示个人之间的显着变异。 Accurate estimates of the risk over time are difficult to establish because of the limited time that tests for this virus have been available.准确估计的风险随着时间的推移是难以确定，因为时间有限，测试该病毒已被使用。

Recent data suggest that among untreated patients, roughly one-third progress to liver cirrhosis in less than 20 years.近期的数据显示，未经处理的患者中，大约有三分之一的进展肝硬化在不到20年。 Another third progress to cirrhosis within 30 years.另外三分之一的进展性肝硬化的30岁。 The remainder of patients appear to progress so slowly that they are unlikely to develop cirrhosis within their lifetimes.其余的患者似乎进展缓慢，他们就不可能发展肝硬化在有生之年。 In contrast the NIH consensus guidelines state that the risk of progression to cirrhosis over a 20-year period is 3-20 percent. [ 6 ]相反，美国国家卫生研究院指出，协商一致的指导方针的危险发展成肝硬化在20年期间是3月20日百分之。 [ 6 ]

Factors that have been reported to influence the rate of HCV disease progression include age (increasing age associated with more rapid progression), gender (males have more rapid disease progression than females), alcohol consumption (associated with an increased rate of disease progression), HIV coinfection (associated with a markedly increased rate of disease progression), and fatty liver (the presence of fat in liver cells has been associated with an increased rate of disease progression).因素影响，据报道，丙型肝炎病毒的速度疾病进展包括年龄（增加年龄与更迅速的进展） ，性别（男性更迅速的疾病进展比女性） ，酒精消费（会增加疾病进展率） ，艾滋病毒感染（结合率显着增加疾病进展）和脂肪肝（脂肪存在于肝细胞都伴随着一个上升的疾病进展） 。

Symptoms specifically suggestive of liver disease are typically absent until substantial scarring of the liver has occurred.症状特别提示肝脏疾病通常没有到实质性的肝脏结疤发生。 However, hepatitis C is a systemic disease and patients may experience a wide spectrum of clinical manifestations ranging from an absence of symptoms to a more symptomatic illness prior to the development of advanced liver disease.然而，丙型肝炎是一种全身性疾病，患者可能会遇到各种各样的临床表现，从没有症状的疾病更症状之前，发展先进的肝脏疾病。 Generalized signs and symptoms associated with chronic hepatitis C include fatigue, flu-like symptoms, joint pains, itching, sleep disturbances, appetite changes, nausea, and depression.广义的迹象和症状与慢性丙型肝炎包括疲劳，类似流感的症状，关节痛，痒，睡眠障碍，食欲改变，恶心和抑郁症。

Once chronic hepatitis C has progressed to cirrhosis , signs and symptoms may appear that are generally caused by either decreased liver function or increased pressure in the liver circulation, a condition known as portal hypertension.一旦慢性丙型肝炎已进展到肝硬化 ，症状和体征可能出现的一般要么造成肝功能或减少压力增加肝脏血液循环，一种被称为门静脉高压症。 Possible signs and symptoms of liver cirrhosis include ascites (accumulation of fluid in the abdomen), bruising and bleeding tendency, varices (enlarged veins, especially in the stomach and esophagus), jaundice , and a syndrome of cognitive impairment known as hepatic encephalopathy .可能的症状和体征包括肝硬化腹水 （积累流体腹部） ，擦伤和出血倾向， 静脉曲张 （静脉扩大，尤其是在胃和食管） ， 黄疸 ，以及认知功能障碍综合征称为肝性脑病 。 Hepatic encephalopathy is due to the accumulation of ammonia and other substances normally cleared by a healthy liver.肝性脑病是由于积累的氨和其他物质通常清除了一个健康的肝脏。

Liver enzyme tests show variable elevation of ALT and AST .肝酶试验表明变量海拔肝和转氨酶 。 Periodically they might show normal results.他们可以查看定期正常结果。 Usually prothrombin and albumin results are normal, but may become abnormal, once cirrhosis has developed.通常凝血酶和白蛋白的结果是正常的，但也可能成为不正常的，一旦制定了肝硬化。 The level of elevation of liver tests do not correlate well with the amount of liver injury on biopsy.水平升高的肝测试不符合相关的数额肝损伤的活检。 Viral genotype and viral load also do not correlate with the amount of liver injury.病毒基因型与病毒载量也没有相关的金额肝损伤。 Liver biopsy is the best test to determine the amount of scarring and inflammation.肝活检是最好的测试，以确定的数额瘢痕和炎症。 Radiographic studies such as ultrasound or CT scan do not always show liver injury until it is fairly advanced.影像学的研究，如超声或CT扫描并不总是表现出肝损伤，直到它是相当先进的。

Chronic hepatitis C, more than other forms of hepatitis, can be associated with extrahepatic manifestations associated with the presence of HCV such as porphyria cutanea tarda , cryoglobulinemia (a form of small-vessel vasculitis ) [ 7 ] and glomerulonephritis (inflammation of the kidney), specifically membranoproliferative glomerulonephritis (MPGN). [ 8 ] Hepatitis C is also rarely associated with sicca syndrome (an autoimmune disorder), thrombocytopenia , lichen planus , diabetes mellitus and with B-cell lymphoproliferative disorders . [ 9 ]慢性丙型肝炎，超过其他形式的肝炎，可以与肝外表现与丙型肝炎病毒的存在，如迟发性皮肤卟啉症 ， 冷球蛋白血症 （一种形式的小血管炎 ） [ 7 ]和肾炎 （炎症肾） ，特别是膜增生性肾炎 （系膜增生型肾炎） 。 [ 8 ] C型肝炎也很少与干燥综合症（一种自身免疫性疾病） ， 血小板减少症 ， 扁平苔藓 ， 糖尿病和B细胞淋巴增殖性疾病 。