Shindo M, Hamada K, Oda Y, Okuno T
Division of Liver Diseases, Department of Internal Medicine, Akashi Municipal Hospital, Akashi, Japan.
Hepatology. 2001 May;33(5):1299-302. doi: 10.1053/jhep.2001.24100.
A proportion of chronic hepatitis C patients who were treated with interferon have a sustained normalization of transaminase levels after interferon therapy without hepatitis C virus (HCV)-RNA clearance. We determined their clinical characteristics and long-term outcome in relation to progression to liver cirrhosis (LC) and the development of hepatocellular carcinoma (HCC). A total of 250 patients with chronic hepatitis C who were treated with interferon were studied for 8 to 11 years' posttherapy. Sixty-seven patients (27%) were complete responders with clearance of HCV RNA. Twenty-six (10%) were biochemical responders who had sustained normal alanine transaminase (ALT) levels without viral clearance. The remaining patients were short-term responders (n = 70) and nonresponders (n = 87). Biochemical responders were older, had higher levels of pretreatment HCV RNA in serum than complete responders, and had less advanced liver histology than nonresponders. Histologic grading scores decreased significantly at the end of therapy, while the staging scores did not change significantly. The annual incidence of cirrhosis was 0% in biochemical and complete responders, which was significantly lower than nonresponders and the controls (P = .0001). The annual incidence of HCC was 0.37% in complete responders and 0.50% in biochemical responders, which was significantly lower than nonresponders (P = .0001 for both). Our findings suggest that biochemical responders had high pretreatment viral levels with less advanced liver histology, and their long-term outcome appeared to be good irrespective of the persistence of the virus.
一部分接受干扰素治疗的慢性丙型肝炎患者在干扰素治疗后转氨酶水平持续正常，但丙型肝炎病毒（HCV）-RNA未清除。我们确定了他们与肝硬化（LC）进展和肝细胞癌（HCC）发生相关的临床特征及长期预后。对总共250例接受干扰素治疗的慢性丙型肝炎患者进行了治疗后8至11年的研究。67例患者（27%）为HCV RNA清除的完全应答者。26例（10%）为生化应答者，其丙氨酸转氨酶（ALT）水平持续正常但病毒未清除。其余患者为短期应答者（n = 70）和无应答者（n = 87）。生化应答者年龄较大，血清中治疗前HCV RNA水平高于完全应答者，且肝组织学进展程度低于无应答者。治疗结束时组织学分级评分显著下降，而分期评分无显著变化。生化应答者和完全应答者的肝硬化年发病率为0%，显著低于无应答者和对照组（P = .0001）。完全应答者的HCC年发病率为0.37%，生化应答者为0.50%，均显著低于无应答者（两者P = .0001）。我们的研究结果表明，生化应答者治疗前病毒水平高，肝组织学进展程度低，且无论病毒是否持续存在，其长期预后似乎良好。
