Kojima H, Hongo Y, Harada H, Inoue T, Miyaji K, Kashiwagi M, Momose T, Arisaka Y, Fukui H, Murai S, Tokita H, Kamitsukasa H, Yagura M, Katsu K
Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan.
J Gastroenterol Hepatol. 2001 Sep;16(9):1015-21. doi: 10.1046/j.1440-1746.2001.02569.x.
Interferon (IFN) therapy is effective in 20-40% of patients with chronic hepatitis C, but the relationship between histological changes and the response to interferon is still unclear. We investigated the long-term histological prognosis and the changes of serum fibrosis markers after interferon therapy relation to the response.
One hundred and eighteen patients with chronic hepatitis C who received interferon therapy were divided into four groups based on the detection of viremia and the serum alanine aminotransferase (ALT) level after treatment. A histological examination was performed by using the histological activity index and the criteria of the METAVIR score. Serum fibrosis markers were used to measure the levels of hyaluronic acid and type IV collagen 7s. Responders, whose serum ALT levels became normal after treatment, demonstrated histological improvement. Histological improvement was more rapid in sustained virological responders with hepatitis C virus (HCV) RNA seronegativity than in biochemical responders with HCV-RNA seropositivity. Only sustained virological responders exhibited histological cure. In partial responders, whose serum ALT levels decreased to less than twice the upper of normal, and non-responders whose serum ALT levels were not reduced, liver fibrosis was unchanged or showed progression. Serum fibrosis markers increased with progression of the histological stage and varied depending on the response to interferon.
Normalization of serum ALT levels after interferon therapy led to a histological improvement, and that with viral clearance achieved histological cure. Serum fibrosis markers were useful indicators for long-term according to the response of IFN therapy.
干扰素（IFN）治疗对20%-40%的慢性丙型肝炎患者有效，但组织学变化与干扰素反应之间的关系仍不清楚。我们研究了干扰素治疗后的长期组织学预后以及血清纤维化标志物与反应相关的变化。
118例接受干扰素治疗的慢性丙型肝炎患者根据治疗后病毒血症检测和血清丙氨酸氨基转移酶（ALT）水平分为四组。采用组织学活动指数和METAVIR评分标准进行组织学检查。血清纤维化标志物用于测量透明质酸和IV型胶原7s的水平。治疗后血清ALT水平恢复正常的应答者表现出组织学改善。丙型肝炎病毒（HCV）RNA血清学阴性的持续病毒学应答者的组织学改善比HCV-RNA血清学阳性的生化应答者更快。只有持续病毒学应答者表现出组织学治愈。在血清ALT水平降至正常上限两倍以下的部分应答者和血清ALT水平未降低的无应答者中，肝纤维化无变化或进展。血清纤维化标志物随着组织学阶段的进展而增加，并因对干扰素的反应而异。
干扰素治疗后血清ALT水平正常化导致组织学改善，病毒清除则实现组织学治愈。血清纤维化标志物是根据干扰素治疗反应进行长期评估的有用指标。
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